Shoot Not to Kill
Shoot Not to Kill
by Daniel L. Stephenson
Copyright © 2007 by Daniel L. Stephenson
All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the
expressed written permission from the author except in the case of brief quotation embodied in the critical articles and reviews.
This is a work of fiction. All the characters, names and incidents, organizations and dialogue in the novel are either the product of the author’s imagination or are used fictitiously. I have met some characters in my education through medicine, but they are not depicted in this fictional novel.
ISBN-13: 978-0-595-407323-3 (pbk)
ISBN-13: 978-0-595-84700-6 (ebk)
ISBN-10: 0-595-40323-9 (pbk)
ISBN-10: 0-595-84700-5 (ebk)
Dedicated to Kim and Kate, the Tater Tots.
[LE1][LE2][LE3]
Contents
Chapter One Emergency Department
Chapter Two Bishell Offered a Position as a Staff Physician
Chapter Three Bishell on the Run
Chapter Four Bishell Follows Colin and Michelle
Chapter Five Calling in Detective Doreveck
Chapter Six Hospital Chairman Ms. Yost
Chapter Seven Dr. Bishell Away from Patients
Chapter Eight Scene of the Crime
Chapter Nine One Year Earlier
Chapter TenThe Morgue
Chapter Eleven First Date
Chapter Twelve Hank Helps
Chapter Thirteen Diamond Miner
Chapter Fourteen Ticket out of Analysis
Chapter Fifteen Anesthesiology Medications
Chapter Sixteen Geech Jumps Too
Chapter Seventeen Police Academy
Chapter Eighteen Cop School
Chapter Nineteen First Day of Training
Chapter Twenty Michelle Cadet Commander
Chapter Twenty-One Pacific Rim Riots
Chapter Twenty-Two Diamond Miner Gets a New Chair
Chapter Twenty-Three Five Months after Graduation
Chapter Twenty-Four Drugs Locked up
Chapter Twenty-Five Nine Years Later
Chapter Twenty-Six Loop Hole, Reciprocity
Chapter Twenty-Seven Pictures Seldom Lie
Chapter Twenty-Eight Pitching the Door
Chapter Twenty-Nine Tracking Bishell
Chapter Thirty FBI Assignment
Chapter Thirty-One St. Louis
Chapter Thirty-Two Geech and Michelle Assignments
Chapter Thirty-Three Clinker’s Trick
Chapter Thirty-Four Social Security Numbers
Chapter Thirty-Five Matsu Valley Hospital
Chapter Thirty-Six Kotzebue, Alaska
Chapter Thirty-Seven Kotzebue Hospital
Chapter Thirty-Eight Geech is Blown
Chapter Thirty-Nine Arctic Storage Revisited
Chapter Forty Michelle in Alaska
Chapter Forty-One Two Years Later
Chapter Forty-Two Spokane, Washington
Chapter Forty-Three Colin’s Turn
Chapter Forty-Four Bishell Cracks
Acknowledgments
I would like to acknowledge the gracious patience and dedication of the iUniverse editors as they worked with a Neanderthal using a word processor in the making of
Malicious Intent.
I would also like to express appreciate for Robyn Gabel’s unflagging enthusiasm for this project.
Chapter 1
Emergency Department
The emergency department heard another siren, and the radio cracked, “Metro Hospital, this is Community 23 five minutes out with a gunshot wound to chest. Vitals are transmitted, two IVs, he’s been tubed, and we’re losing a lot of air out a hole I’ve covered with dressings. Any instructions?”
The shift nurse turned to a young thoracic surgeon resident who shook his head no, and she said, “No, Community, continue to transport.”
The young resident said, “Call Dr. Bishell, he’s the chief resident; I need him on this.”
The nurse turned to the phone as the resident headed for the trauma suite. Overhead they heard, “Trauma Team Fox alert in five minutes,” repeated three times. That would be the emergency department nurse’s crew while the trauma patient is in her domain.
The doors to the trauma suite began to swing open as surgery technicians and nurses arrived along with laboratory and radiology technicians. All wore different types of hospital utility uniforms. All are young, except for the shift leader in the emergency department. She is older, in her forties, by far the oldest. She called to the resident, “Dr. Simms, Dr. Bishell will be here in five, he was in the area.”
“Thanks, Ellie,” Dr. Simms replied as the doors to the ambulance bay automatically swung in. The patient was strapped to the transport gurney, a tube protruding from the mouth. A large bandage that had been applied to his chest was already soaking through. The ambulance team halted while Dr. Simms listened to the chest for a few seconds. “OK, get him on the main gurney. Lab, standard trauma. Rads, just the chest first. Is anesthesia here yet?” he asked.
“I’m here,” called a tired-looking, young female physician. “I’m third call and was just headed home, so you’re damned lucky to catch me.” By her side was another woman, standing behind and to the side with her arms crossed, tubes and hoses in her hands, staring at the patient, immobile.
“Glad you’re here. Sounds like this will be a challenge,” Dr. Simms called. “Who’s your friend? It looks like it is the first time she’s seen a gunshot wound. Hey, gorgeous, what do you think this is, television?”
The anesthesiologist replied, “She’s a student; she’s with me. I’ll keep her out of the way.” She gently nudged the younger woman back away from the gurney. The anesthesiologist suctioned the patient’s mouth and then pulled the original tube from the patient’s throat. She then expertly guided a thin black brochoscope down the victim’s throat and she then slid a new tube over the scope with a quick fluid move of her hand. Satisfied she had the correct placement, she inflated the cuff and pulled out her bronchoscope. She then took a bag from the technician standing beside her and started breathing for the victim. All this was done in less than thirty seconds.
“OK, folks, anesthesia has his airway secure. Let’s get him on our gurney. Keep the backboard on. Monitor and oxygen first, then lab, you get your stuff. We’ll need another large IV, Ellie, and get us two units of O negative blood going before we get the cross-matched stuff up,” called Dr. Simms. Then he listened to the sounds of the lungs and said, “Tube’s good, keep the bag going. Please get a chest X-ray to confirm placement.”
The gurney was pumped up and a monitor propped between the patient’s legs. A gay-colored shirt was cut loosely off the patient’s chest. The shirt, black with red chili peppers, suggesting happier times, in Mexico perhaps, was now blood soaked, although a large bandage had been applied to the patient’s chest. One medic held an intravenous infusion high above the gurney while a nurse tried to get it hooked to an overhead support.
“Screw the X-ray; we’re moving up now, people. Lab, meet us upstairs with the blood when you get it,” called a new voice coming into the suite.
Heads turned to see Dr. Bishell walking in briskly. “Roger, I’ve got it from here. Ellie, make that dressing an occlusive dressing over that leaking hole. Get the bigger IV in now; we’re rolling for surgery.”
“Dr. Bishell, I need a chest X-ray to see the tube placement before we go up,” the anesthesiologist said as she listened to the chest.
; “No, you don’t,” Dr. Bishell said. “Can’t you see this gunshot is through the sternum and across the mediastinum to the right posterior? I can see it from here, no exit, bullet’s in there, air’s coming out all over the place from the right while he’s being kept alive on the left. Now move it; we’ll get pictures later.”
Dr. Bishell moved rapidly to the far side of the gurney and stood next to the second anesthesiologist. He pulled the dressing back and noted the large clot that immediately began to ooze. He replaced the bandage, turned to the second anesthesiologist, and said, “Here, make yourself useful and put pressure on this dressing.”
The second anesthesiologist reached out with her hand, and Dr. Bishell slapped it away.
“Don’t you know enough to glove up?” he asked as he turned to the other anesthesiologist. “Where the hell did she come from? This is the third month of their internship, and she should have some sense. Christ.”
“I’ll work with her, Dr. Bishell. Shelly, go glove up and do what you can,” she said.
Dr. Bishell looked at the anesthesiologist and said, “I don’t need some damned flunking resident to be the gas passer here. I want you to stay on the case.”
“I am Dr. Pengill, primary trauma anesthesiology, and I am not going anywhere,” the first anesthesiologist said as she placed her stethoscope into her ears to listen yet again to the chest.
“Good, now call surgery. Tell them we’re on the way,” Dr. Bishell called out.
The crew moved the victim from the suite as Dr. Bishell started removing his shirt, following along behind to the surgery suites adjacent to the emergency department.
Ellie stood back, pulling her gloves off. “How does he know all that? Guess that’s why they call him ‘Doc,’” she said as she started pushing clothing, bandages, and litter into a bloody pile.
The elevator was waiting. A technician in orange scrubs from the trauma team was holding the elevator door as the gurney swung around the corner from the emergency room. The patient now had a tube in almost every orifice and several intravenous lines, and there was a monitor beeping between his feet. The anesthesiologist walked beside the patient with her small bag of gear and a clipboard, rhythmically squeezing the bag attached to the endotracheal tube. The chart from the emergency room stood out from under the patient’s left shoulder. Two nurses pushed the gurney, and Dr. Bishell and Dr. Simms followed along.
“Good for you, Roger. This will be a good case. We’ve been pulling call for a week now and finally have a good one. I’ll see that you get credit for it,” Dr. Bishell said as they squeezed into the waiting elevator.
“Thanks, Dr. Bishell, my copy of the op report will certainly get recorded,” Dr. Simms said as he cautiously took a glance at the nurses, somewhat embarrassed.
“OK, but make sure. Here we are, folks,” Dr. Bishell said, pushing the door open.
Surgery was already busy with other cases, but this case did have a room open and ready—the Gun Club, prepared for gunshot wounds at all times. Three technicians were in sterile gowns and were busy placing sterile instrument tables around the surgery table.
Dr. Bishell leaned into the surgery suite and held a mask to his face and yelled in, “Would someone call Radiology and get a chest X-ray on this guy while I’m scrubbing?”
Dr. Bishell and Dr. Simms went to change and soon emerged in green scrubs, surgical hats, and face shields. They began scrubbing. The clock on the scrub sink began the countdown from five minutes, but Dr. Bishell was done in half that time. He pushed his way backward through the doors to the Gun Club, and while dripping the last of the water from the scrub sink across the floor of the operative suite, he walked to the gown technicians who began the ritual of gowning. The surgery outfit made them look more like people that worked in a carwash because they wore face shields, waterproof boots, and gowns topped off by gloves. Finally, there was a neck shield that met the hood. It would be virtually impossible for the blood and irrigation fluids to reach them when they were fully gowned.
One technician handed Dr. Bishell an unfolded towel, which he then used to dry his arms. He then cast the used towel in the general direction of the farthest corner, ignoring the dirty linen bag in the adjacent corner. He turned and allowed another technician to place his arms into the surgical sterile coverings while another technician, who was not sterile, affixed the hood to the collar. The hood then finally attached to the surgical gown. When this was done, an air hose was placed on the back of the hood allowing fresh air to circulate over the faceplate. Dr. Bishell turned and yelled, “Simms, if you’re scrubbing with me, you’ve got to learn how to scrub quicker. We’re ready to go here.”
Simms looked through the window as his water shut off at five minutes. He came through the door, and the sterilizing technique was repeated.
“Actually, Dr. Bishell, I need a few minutes to get a catheter into his subclavian vein. He has lost a lot of blood, and the fluids will be flowing in three ports, so I need to know that wedge pressure. Can you hold your start just a moment?” the anesthesiologist asked.
“You’ve got two minutes, and we’re going in. Simms, the other side. Who’s chief nurse here?” he asked, addressing the nonsterile members of the team.
“I am,” answered one slender figure in pink scrubs. “I’m Jackie France. What can I do for you?” she asked.
Bishell looked at her for a moment and turned, saying, “I just wanted to know who to yell at when things go wrong.”
The nurse stole a quick glance at the other nonsterile nurse and walked back to work on getting the scrub buckets closer to the table.
“OK, I’ve got good pressures now, and we’re inside with access. You are cleared in from my side,” Dr. Pengill said.
Dr. Bishell looked toward the monitor bank that was now blinking a fast heartbeat and wiggling pressure readings on three major screens and said, “I think you might need a pocket full of quarters to get through the case.” It was then that he noticed the woman at Dr. Pengill’s side and said, “I thought we lost you in the emergency room. What is your role here?”
The woman looked quickly at Dr. Pengill and started to say something when Dr. Pengill said, “She is with my department. We are training nurses to monitor elective sedation, and to see sedation, they have to come here. Please, Dr. Bishell, we are ready.”
Dr. Bishell turned from the head of the table and held his hand out flat, pointed toward one of the scrub technicians. This was a signal to place the drape for the patient into his hand, and the cue was not missed. The drape was placed in his hand in such a manner that he simply needed to place the center fold on the center of the wound. The drape expanded as it unfolded, quickly obscuring Dr. Pengill. Dr. Pengill grabbed the drape and started to clamp it to the utility pole to her right. Her assistant reached for the drape in the same manner to hold it near the left pole. As she did, something metallic fell to the operative floor.
“OK, what hit the floor? Do I have a chest set, or did you drop the expanders?” Dr. Bishell said.
Dr. Pengill’s assistant said, “No, sir, it is mine. I dropped my Personal Digital Assistant.”
Dr. Bishell looked for a moment and said, “You must have the biggest PDA in the world to sound like that.”
“Suction, cutter, Simms, get that drape down. Cautery to stun. Come on, folks, we’ve been screwing around for ten minutes,” Dr. Bishell yelled.
The assistant to Dr. Pengill leaned down and started picking up what she dropped.
“Leave it,” Dr. Bishell yelled. “We need you to scrub and hold retractors. Get going!” he yelled at Dr. Pengill’s young assistant.
“She cannot be exposed to surgery, Dr. Bishell. Her pre-employment screening blood work is still pending, and I have not signed her off for patient contact.”
Dr. Bishell looked up momentarily from his work. “Shit! OK, we’ll make do. What’s your name?”
Dr. Pengill nudged her assistant, who said, “Shelly.”
“Well, Shelly, you missed
a good case. Simms, hold this. Suction. Vacuum. Heads up. Get X-ray in here for more rads; we’ll need it in ten. Suction, Simms, you’re spending too much time looking at Shelly’s tits. Come on, people.”
By this time, the chest was open on the side of the gunshot wound.
“OK, gas passer, pull back your tube and inflate this lung, too. We need to see the holes. That’s it. OK. Gel-foam please, lots of it. OK. Folks. We need to get a picture. I don’t feel a bullet in the chest. Simms, did you see an exit?” he asked.
“Sir, I was just getting to that when you came in,” Dr. Simms began.
“Who’d a thunk it?” Dr. Bishell said. “Anybody here talk to the ambulance crew? Well I guess I’m the only one that’s paying much attention. I talked to them, and they say there was no exit. That’s something I tried to confirm as I helped move him to the table. Simms, you have to think of those things. OK, we’re getting a seal on the lungs. Drop the lung again. Get me that X-ray. Simms, feel along the vertebrae on the open side, see if you can feel anything special, then check the aorta. What do you think so far?”
Two radiology technicians entered the suite and started setting up their portable X-ray machine. Dr. Bishell threw bloodied towels and sponges into a waste basket at his side, and a circulating nurse pulled the towels and sponges out to line them up along the back wall in rows of ten. The monitor continued beeping the pulse, and the sterile scrub nurses tried to keep up with cleaning the used instruments to prevent the blood from caking on them and making them useless.
“Well, not enough blood to have an aorta lacerated, most likely. No exit says either it went through the mediastinum and into the left lung, or is lodged in a vertebrae,” Dr. Simms said as he reached elbow deep into the chest cavity, slowly working his way along structures in the chest.
“Great, what do you feel?” Dr. Bishell asked, holding his blooded arms to his chest and stepping back.
“I think there is a bullet in a vertebrae here,” he said.
Shoot Not to Kill Page 1
