Sacred Trust (24 page)

Lukas sucked in his breath.

Mrs. Pinkley nodded. “If somebody investigates the report, it could be touchy for this hospital. Most people take Bailey Little seriously, and he has a lot of support in high places, even into state and federal offices.”

Lukas suddenly felt defeated and very tired. “Maybe you should fire me. Or maybe I should quit.”

Estelle gave an impatient sigh. “I didn't ask you up here to fire you. I called for you because I am going to need your help to fight this thing. Why wasn't an AMA form signed before Dwayne left?”

“He got mad and stormed out before we had a chance to get one, but I filled one out afterward and signed it and left it for the nurse to sign and file. Beverly and I were both witnesses that he refused the shot of Toradol I offered, and the shots of morphine with Narcan. He nearly knocked Beverly down on his way out.”

“We will need Beverly to sign a statement to that effect, but as of now there is no AMA form with the file.”

Lukas shook his head. “Then I don't know what
happened to it. I don't think Beverly would forget something like…” But Beverly had been acting strangely the past few days.

“We'll talk to Beverly about it. If we get the right answers from her, I believe we can beat this. I'm more worried about public opinion at this point. I have to answer to the taxpayers of Knolls community.” She leaned forward again and indicated the stack of files. “Dr. Bower, these complaints all come from the patients of one physician. They're mostly about tests and medications that they considered to be too expensive or unnecessary. Nitpicking. Would you care to venture a guess as to who their physician is?”

“Dr. George.”

“You have a great deal of insight,” she said drily. “Unfortunately, Dr. George still wields power here at the hospital and, therefore, in this town. Do me a favor for the time being and try really, really hard to placate him.” She frowned. “Believe it or not, he's not usually this hard to get along with. I don't know what's bothering him right now.”

“He may still be upset about the disaster drill and the Ruby Taylor case.”

Mrs. Pinkley nodded. “The needlestick report couldn't have been popular with him, either, even though it was the right thing for you to do. He never did follow protocol on that.”

“I think he needs to. The other day he was obviously suffering from a bad headache, and his hand seemed to be bothering him. He grew very defensive when I asked him about it.”

“I bet he did.” She sighed. “All these things have been ill-timed events, but not enough to trigger the backlash we're getting. These people are out of line. I just want you
to be forewarned.” She stepped around her desk and offered him a hand.

He stood and took it gently. “Thank you, Mrs. Pinkley.” She had a firm grip, showing no signs of the arthritis he knew she had. “I'll try to show more restraint in the future.”

“I appreciate it. This could be a learning experience for both of us.” She released his hand and stepped back behind her desk.

“Tell me something, Dr. Bower,” she said before he reached the door.

He stopped and turned back around.

“How did it feel to chase a drug seeker out of our emergency department?”

He grinned at her. “It felt great.”

Her smile was genuine as he turned around and walked out the door.

M
ercy had just finished a twenty-one-suture closure in the E.R. when Lauren came into the exam room. “Dr. Mercy, you're not going to believe this one. There's a hysterical woman on the line who says her brother is having a heart attack, but he weighs too much for an ambulance.”

Mercy knew before she asked. “What's the name?”

“Their name's Knight.”

Mercy snapped off her gloves. “Is she still on the line?”

“Yes. She insisted she had to talk to you.”

“Okay, I'm coming.” She turned to the young man on the exam table. “Mark, I'll be back as soon as I can.”

She ran to the telephone and picked up the receiver. Before she could even put it to her ear, she heard sobbing. “Darlene? This is Dr. Mercy. What's wrong?”

There was a deep, trembling breath; then Darlene's words came out in a rush. “It's Clarence, Dr. Mercy. He's really sick and I can't get him to wake up, and I don't know what's happened. He just knocked over a glass, and—”

“Darlene, slow down. Take a deep breath. Are you saying Clarence is not conscious now?”

“I…I don't know. He wasn't just before I came to call you. He's breathing, but he won't open his eyes or say anything.”

“Okay. I want you to put the receiver down and go in and rub your knuckles really hard against the bony center of his chest. See if there's a reaction, and then come back and tell me.”

“But can't we just call Dr. Bower to come out? I tried to get his home phone number to call him, but it's not listed, but I know he'd come—”

“Darlene, we're wasting precious time!” Mercy spoke sharply. “We can get Clarence here, but I need your help. Go check him.”

She heard a clatter as the receiver hit the counter, then turned to the secretary. “Carol, call an ALS ambulance, ask for a double team, and also request first responders. Get them on the line for me and have them hold. Tell them their patient weighs at least five hundred pounds.”

Carol's eyes widened. “Five hundred—”

“Probably a lot more. Just do it. And check to see if Dr. Bower is still in the hospital. Page him.”

Darlene came back on the line. “Dr. Mercy?”

“I'm here.”

“He's groaning. His chest hurts really bad.” Her voice shook with sobs again. “He's dying.”

“Stop it! I need you calm, Darlene. I'm going to send an ambulance with enough people to lift Clarence. Just keep him still until they get there, and don't leave him. He needs you there with him. Are you okay?”

There was a pause. “I'm bleeding quite a bit.”

“Bleeding?”

“I cut my foot on the glass he broke when he had the attack.”

“Okay. Get a thick washcloth and fold it into a big square. Place it directly over the cut, then tie a towel around it was tightly as you can. That'll hold you until help gets there.”

“I'll be okay. I'm worried about Clarence.”

“You can't do him any good if you pass out from blood loss. I want you to come in with the ambulance. We'll take a look at you when you get here. Okay?”

Darlene took a deep breath. “Okay. I can do it.”

“Good. I'll see you soon. Hang in there, Darlene.”

She disconnected and punched the second line. “Hello, this is Dr. Mercy.”

“This is Connie, the paramedic. Where's the patient?”

Mercy gave her the address. “I want you to double team and call the first responders.”

“Right. Carol told us.”

“Get a heavy-duty Stryker cot. The patient's name is Clarence Knight. His sister will meet you, and she has a glass cut on her foot. Hurry. He could be having an MI.” She hung up and rushed back to finish her present patient and prepare for Clarence's arrival. Darlene would need stitches. It would sure be nice if Lukas were here.

She was writing Mark a script for pain when she glanced up to find Lukas walking in and looking around the E.R. as if expecting at least more than one patient after being paged.

“Lukas, thank goodness! I may need your help. It's Clarence.”

“What happened? Is he okay? He called?”

“Darlene called. Sounds like he's in trouble, could be
his heart. They're bringing him in, and Darlene, too. I know you wanted to get some sleep, but—”

“Not now.” He sighed. “We were afraid this would happen. What's wrong with Darlene?” he asked, setting his bag down.

“She cut her foot. I don't know how bad it is.”

“Okay, you're in charge, you call the shots,” Lukas said. “If you want, I'll check the cardiac room and make sure everything is ready.”

“Yes, please.”

Mercy had just finished releasing her only patient when the ambulance radio spoke to her from the central desk. “Knolls Community Hospital, this is Knolls 830 requesting medical control.” It was Connie's voice.

Mercy punched the button. “This is medical control. Go ahead.”

“Medical control, we have reached the Knight residence. The patient is alert and oriented, complaining of severe chest pain rated at a nine. Requesting permission to give sublingual nitroglycerin per protocol.”

“Is IV established at this time?”

“Negative. Attempts have been unsuccessful at this point.”

“Do you have a current set of vitals on this patient?”

“Heart rate 120, respiration 22 and labored, oxygen saturation 93 percent on nonrebreather mask.”

“What is his BP?”

Connie's voice sounded sheepish. “Unable to determine blood pressure at this time. We were able to auscultate a radial pulse.”

Mercy shook her head. “Permission for sublingual nitroglycerin denied until IV access is obtained. I suggest you attempt an external jugular route. Keep us
advised of any change in the patient's condition. What is your ETA?”

“About fifteen minutes. Full patient report will be given prior to arrival.” There was a pause. “Request change to private channel.”

Mercy switched the button.

“Doc, are you there?” Connie asked.

“I'm here.”

“Dr. Mercy, we're doing the best we can, but this guy's big. I've never had anything like it before.”

“I know. Do your best. Medical control clear.” Mercy turned to find Lauren and Carol hovering behind her. “Hope these rescuers have been trained properly on safe weight-lifting techniques, or we could have more than two patients coming in with that ambulance.”

“I've got everything set up in the cardiac room, Dr. Mercy,” Lauren said. “Dr. Bower is checking it out just in case we might need extra of anything. Is this man really over five hundred pounds?”

“That's a very rough guess. We'll definitely have our hands full because our patient has a lot of other health problems. Oh, and, Lauren, make sure we have a suture tray ready. We'll get two patients.”

Lauren went to recheck supplies, and Mercy got up to pace, waiting for a radio report. Would the teams even be able to convince Clarence to come in? He might decide this was the big one, take advantage of it and stay at home, waiting, once more, to die. After all, it was Darlene who had called.

Lukas came back a few moments later and watched Mercy wring her hands as she stared out at the street. “You look like a worried mother. They're a professional crew. I think they'll do a good job.”

“Are we all set up for him?”

“The cardiac room is stocked, and we have a good, sturdy exam bed. Lauren also has the laceration room ready for Darlene.”

“Thanks, Lukas.” She glanced at him and stopped wringing her hands. “Did you have a good meeting with Mrs. Pinkley?”

He winced. “Do you have to bring that up?”

“I need something to keep my mind off Clarence. Was it that bad?”

“Patient complaints.”

She waited.

He glanced around, then lowered his voice. “Ever hear of Dwayne Little?”

“Sure, he's Bailey Little's son.”

“Have you ever had him as a patient?”

“A couple of times in the past year in the emergency room.”

“I offended him by offering to set him up in a drug rehab program.”

Mercy groaned. “You didn't.”

“I refused to give him the drugs he wanted, and I called the area emergency departments to check on him. His father wants me fired.”

“And?”

“And Jarvis George obviously wants me fired, as well.”

“What does Estelle say?”

“She says no way.”

Mercy nodded with satisfaction. “Estelle usually gets what she wants.”

He shrugged. “I don't know. They're talking big guns, maybe even COBRA. This may be out of Mrs. Pinkley's hands.”

“Wait. Just wait. She seldom loses a fight, and she was a trial lawyer and a prosecuting attorney for thirty years before she decided to become a hospital administrator.”

“I hear Bailey Little seldom loses a fight, either. He apparently has strong political connections.”

“True, and he fights dirty.”

“Oh, great, I needed to hear that.”

“You just need to be prepared to defend yourself, Lukas. Bailey is powerful, but he's not God.”

Connie's voice came back over the radio. “This is Knolls 830 calling Knolls medical control. Over.”

Mercy went back to her chair and flipped the switch. “This is medical control.”

“We are currently inbound to your facility with two patients. Patient one is a class-two medical, a forty-two-year-old male complaining of chest pain. Be advised that we have established a jugular IV on patient one. Sublingual nitroglycerin times two has been given, pain has been reduced from a nine to a four. Patient's current vitals are BP 92 over 68, respirations 18 and mildly labored, heart rate 112. Patient is on a cardiac monitor, revealing sinus tachycardia. No ST segment elevation is noted at this time. We have an ETA of two minutes. Are you requesting any further orders on patient one?”

“Negative. Proceed with report on patient two.”

“Second patient is a class-three trauma, a forty-year-old female who has sustained a deep laceration to the right foot, vitals are stable at this time and bleeding is controlled.”

“Knolls 830, are you requesting lifting help upon your arrival?”

“Negative. There will be ten of us.”

“Medical control out.” Mercy turned to Lukas. “Let's
hope Clarence isn't totally pain free when he arrives, or he may make them turn around and take him right back home.”

“I don't think so. Not this time.”

“Oh, yeah?” Mercy crossed her arms. “What makes you the expert on Clarence all of a sudden? You're the one who couldn't convince him to come in last week.”

“Fear is a great convincer.”

Mercy shook her head slowly, frowning. “I think he needs a motivator. Darlene.”

“She's always been a motivating factor. I think it just took him some time to realize he's been going about it the wrong way.”

“So you've made him see the error of his ways,” Mercy said drily.

“Nope. I already told you. When fear and pain talk, people listen.”

 

When the ambulance arrived, Lukas followed Mercy out to meet it.

“Dr. Bower,” Clarence called from his seemingly precarious perch on the Stryker cot.

Lukas leaned through the ambulance door. “How's the pain?”

Clarence nodded. “Still hurts, but not like it did. Take care of Darlene.”

“A nurse is already helping her inside.” Lukas shot him a mischievous grin. “Dr. Mercy's on duty, and she's going to take good care of you.”

Clarence looked at Mercy and groaned.

Mercy glared at him. “I see you haven't lost your chauvinistic charm.”

She and Lukas backed out of the way while eight men and two women surrounded Clarence and heaved his
huge bulk out of the ambulance. There was a tense moment when the stretcher nearly tipped, but they righted it and turned to push Clarence toward the entrance.

Mercy descended on her patient. “How's the pain now?” she asked.

“Better than it was,” Clarence muttered.

“Rate it for me on a scale of one to ten,” she said.

“I don't know.” Clarence glanced down at the cot that carried him. Thick folds of flesh hung over each side. “Maybe a three, but it'll get worse if I fall off this sawhorse.”

“Then you'd better hold still and do what the doctor tells you,” Mercy said as the team wheeled him toward the cardiac room.