Shoot Not to Kill

by Daniel L Stephenson

  “Exactly. Now, it is the sixth, I do believe. Do we need to get it?” Bishell asked.

  Dr. Simms looked confused for a moment, and said, “Sure. I think we would only leave it if we thought it was close to the spinal cord. It seems to be on the lateral and a bit anterior border.”

  “Give the man a bone. Correct. Rads, call rads, and get me the C-arm up here for fluoroscopy. I need live imagery of this thing. Oh, there you are, what kept you? Get my pictures, then pull the C-arm over for fluoroscopy.”

  Dr. Simms and Dr. Bishell stepped back away from the table. The radiology technicians came up with a large projector and passed an X-ray cassette to the chief nurse. She leaned down and pulled up the sterile drape from the underside and began sliding the cassette into the surgery table. As she let the drape down, light reflected momentarily off of a shiny object on the floor. Dr. Bishell’s eye caught the object only for a moment and could not place the somehow familiar shape before the drape fell back down, darkening the floor.

  “Get my C-arm up. Rad, get that up here on the double,” he barked.

  Dr. Bishell was just stepping back to the table when the object’s shape came to him. It was a set of handcuffs. He froze for a moment, then looked at Dr. Pengill, and then to her assistant. He did not immediately look to the table. The operative suite felt the moment’s pause, and all paused with him. Seeming to realize the attention, Dr. Bishell said, “OK, anesthesiology, how is he doing for fluids? Vitals stable?”

  Dr. Pengill checked her instruments and touched the screens on several monitors before answering, “We’re holding very nicely. Seems the urine is steady and the wedge is climbing. I think we are ahead of it.”

  “Good. Simms, can you close?” Dr. Bishell asked.

  “Sure, but what are we going to do with the bullet in his back?” Dr. Simms queried.

  Dr. Bishell hesitated for a moment, “Oh, yes. C-arm please. Can we get that in the field?” he asked as he stood with his arms crossed.

  The scrub technicians had been assembling their tables around the complex fluoroscopy equipment. The control footpad was pushed across the floor and hit something as it passed under the drape. Dr. Bishell looked for a moment, fearing he would see the handcuffs again, but the control pedal was pushing on his foot.

  He reached up to the shrouded C-arm’s sterile handle and idly turned it on. The video screen became black, then slowly lit up, revealing a beating shadow of the heart. Ribs were outlined slightly darker than the heart. Several ribs seemed shattered. Dr. Bishell moved the C-arm’s gun around, attempting to get a good look at the vertebrae.

  “OK, Simms, did you notice how much of the bullet you could feel?” he asked.

  “Dr. Bishell, I think it was most of it. I almost felt that I could wiggle it out myself,” he answered.

  “Well, this confirms your bullet. Do you see the spinal canal?” Dr. Bishell asked. “I can see the vertebrae, and there seems to be nothing in the canal. The bullet seems confined to the anterior right body of the vertebrae. Do you confirm that?”

  Dr. Simms looked closely and said, “I need to see the plain chest. The vertebrae are too washed out.”

  “Rad, turn it down. There, now do you see the vertebrae?” Dr. Bishell asked.

  “Yes, but Dr. Bishell, I’d still like to see the conventional view,” Dr. Simms said as he leaned away from the monitor.

  Dr. Bishell seemed angry. He stood away from the table and took in all there was in the surgery suite. The only one that seemed unoccupied was Dr. Pengill’s assistant. He looked away as soon as it was obvious to Shelly that he was studying her.

  The door swung open. A technician came in holding a mask to his face without pulling the strings over his head.

  “This good enough?” the technician asked Dr. Bishell.

  “I don’t know, you’ll have to ask my assistant, Dr. Simms. He’s the one that is holding everyone up to see it,” Dr. Bishell snapped.

  Dr. Simms walked to the view box. There in the sixth vertebral body was a bullet. There were fragments of the vertebral body near the bullet, but the bullet was clearly lodged in the vertebrae in such a manner that it was far removed from the central canal.

  “One view is no view, Dr. Simms, but in this case, since you can feel the damn thing in the anterior, I don’t think you will need a lateral. Now, I’m comfortable with you pulling it out. How would you like to do that?”

  Dr. Simms turned to the scrub techs. “Applanators, please.”

  The surgery was quiet as Dr. Simms carefully explored the wound with one hand, and followed the hand with the other hand holding the tool that would have passed for a pair of pliers in any workshop.

  Dr. Simms worked on the bullet for a moment and then slowly moved out of the chest with both of his arms held in position. Inside the applanators was a bullet about the size of the patient’s little finger. It was mushroomed, flat, and deformed.

  “C-arm, to the chest please,” Dr. Bishell called. He swung the unit over the chest and turned it on. “Confirm and record no metallics. OK, Simms. Start closure. Pengill, blow up the right lung again. What are your vitals?”

  “We’re still stable. Can you confirm inflation for me, Dr. Bishell?” Dr. Pengill asked.

  “You’re up. Simms, close. Can you do it?” Dr. Bishell asked.

  “Yes, do you want anything special?” Dr. Simms asked, somewhat confused that he was to close the chest without assistance from the more experienced trauma fellow.

  “Intercostal blocks to all the ribs with bupivacane. Leave two tubes, and I’ll pick him up in ICU. He’s all yours,” Dr. Bishell said as he began backing out of the room. He pulled the air hose off the mask and began pulling the gown off, dropped it on the floor, and was gone in seconds.

  Shelley reached down, picked up her handcuffs, and backed away from the table. She pulled a special department phone from her belt clip and called, “Six, tell Geech, he’s out, and he’s hot. Think he’s on to us. Can Geech pick Clinker up in the hall?”

  The surgery team all stood shocked, speechless. Shelly realized she had let slip all the secrecy she had so painstakingly created over the last year. She turned to the group and said, “Special Ops, LA Police. You will be interviewed, and there will be a gag. Do not, I repeat, do not speak of this outside this room.” She pulled up her radio and called again, “Six, we need detectives and legal assistance with the crew here when they are done.” She pulled her wallet from her belt and flashed her badge to the room as she left.

  “Copy, we’ll cover that.,” the voice came back.

  Somewhere else in the hospital, two senior physicians walked along a corridor, white coats neatly pressed, hands in their pockets. One, shorter and exceedingly skinny, said to the taller physician, “You know, Bob, seems like it is getting harder to fill the residency all the time. What do you think of the crew coming up?”

  “Steve, I’m pleased with all of them. We’ll need to look at getting one of the residents into the chest program to replace Stan Bishell, though. Moving him to staff is OK, but we’re still going to need someone as senior fellow,” Dr. Cranfield said. “You know I pitched him today; that’s what I called you about earlier.”

  “Yeah, I figured that was what the call was. I’m sure surprised at that guy. He’s done a lot better than I thought he would. He was the only one that seemed weak. Hell, only a year ago I was willing to pull the call myself rather than let him be on call. He’s seemed to have a real good run of luck here, and skill, too, I mean, with these last few cases.”

  “He certainly has had his run of trauma. He’s still having some difficulty with scope work and some other techniques, but I’ll have to give it to you … he seems to be doing pretty well in the chest wound department. I was worried, too. Almost pulled him from the call list at one time.”

  “He’ll be hard to replace, but we’ve got to look at that soon.”

  Chapter 2

  Bishell Offered a Position as a Staff Physician

  Earlie
r that day, an older physician sat at his desk. The room was well lit from the window, and the paneling in the room suggested what would have been considered luxury twenty years ago. Bookcases held volumes of books, few of which had seen the light of day in many years, but all were good, basic reference texts. Pictures were placed on the wall in a pattern that suggested they were hung on existing nails originally placed for a different collection of pictures, diplomas, and the like. One shelf held figurines of physicians sitting in chairs pondering patients or listening to the hearts of a little girl’s doll. After a tap on the door, he called out, “Come in.”

  Dr. Bishell walked confidently into the room and sat in a chair before the desk without preamble. “You called me, sir?” he asked, his stethoscope draped around his neck.

  “Yes, I’ve been asked to discuss your plans when you graduate. Dr. Bishell, we’ve been very pleased with your work as a trauma fellow, and have a problem. The program is designed for three years, and you are finishing up June of this year. We had three staff surgeons working with your class, as you know, but for reasons that are best left private, we’re going to be losing Dr. Galbote. It is not a professional matter, but something to do with his ability to get an extension on his visa. I have been asked to offer you his position on our staff.”

  Dr. Bishell raised his eyebrows and stared at the older doctor for a moment, then said, “Staff out of training is an honor, Dr. Cranfield. I am not certain that I deserve it.” Dr. Bishell pulled a large pen from his pocket and began flipping it between his fingers in a very complex pattern. The pen was a drug-company advertising pen, fancy purple and chrome.

  “If I may be informal, Stan, I will also be direct. Three years ago your record on surgery was modest, at best. Dr. Galbote was discussing the fact that you might not be continued into the second year, but then your work in thoracic surgery started picking up, and since then you’ve had quite a run—a sterling run, I might add. The hospital data for the discharge diagnosis of chest trauma has your name on it more than any other fellow, which is remarkable, and I must say you’ve done well. The position is well established and well funded.”

  Dr. Cranfield stood and walked around the desk to approach Dr. Bishell, and continued, “I am aware that fellow to staff is a transition that rarely occurs. The last time we did it, we were not disappointed, and I am certain we would not be in your case, Stan. Please think about it. I’ll need to know in a few weeks. The hiring process here is a month at the minimum, and that’s when we’re looking at a new class here in a few months,” the older physician said as he leaned on his desk.

  “Well, Bob, I am flattered and will give it due consideration and let you know soon. I had no idea my name would be highlighted so prominently on discharges. I’ll let you know soon,” Dr. Bishell said as he stood and extended a hand.

  The older doctor stood as well and shook Dr. Bishell’s hand, saying, “I hope you do.”

  Dr. Bishell walked from the room and nodded pleasantly to the secretary as he walked into the administrative corridors. So, I’m the prominent attending on the fucking discharge summaries. That’s something I never thought of. I’d better get the resident surgeons to accept them, maybe tell the ER to change their admission orders. Damn, Dr. Bishell thought.

  Dr. Cranfield sat again and spun a reflex hammer in his hand. The silver handle reflected the sunlight about the room in quick flashes. He picked up the phone and asked for Dr. Wilkinson, “I’ll hold, he’s just getting out of noon rounds.”

  “Steve, I just pitched Bishell. He sure is a confident little bastard. I wish we had more choices for Galbote, but the short notice there makes it tough. No. Said he’d think about it and strutted out of here like he just snuck a golden egg from under me without me seeing it. Yeah, I know he’s a surgeon, and we trained him, but still, damn, he’s cocky. OK. I’ll meet you at the recruiting meeting. Yeah, OK.”

  Dr. Cranfield slid the reflex hammer into his white coat and wondered when the hammer had last been used—probably when he was the senior resident back in Boston, all those many years ago.

  Chapter 3

  Bishell on the Run

  Michelle[LE4] ran out of the surgery suite into a hall that contained a dozen surgery suites. Half of them were busy, and doors from the surgical floor were spaced everywhere. She started out of a door, and a nurse yelled, “Hey, your scrub covers have to stay in here, honey. It will be a hell of a flap if you’re out of here in those!”

  Michelle shed her scrub covers, grabbed a white lab coat, and exited into the hall where she was immediately lost. After the few weeks in the hospital, she was fairly sure she could get to the main lobby, and then backtrack, but finding her mark would be impossible. It took her the better part of ten minutes to find the room they had set up as their control room, and inside she found the rest of her crew. Colin was working a computer at the desk with Geech, and Richard Smothers had a phone to his ear. Food trays sat on several horizontal surfaces. Mark Ashley, their senior partner, sat at a chair with two phones to his ears, looking at Michelle and shaking his head.

  Colin looked up and asked, “What happened? He was fine one minute and ran the next.”

  “I dropped my handcuffs. At first they were just under the drapes, so I kicked them deeper into the drapes. Someone pulled the drape back to get an X-ray, and he must have seen the cuffs. He froze like a deer in the headlights for just a second, and then he was off.”

  “I think I saw him on a monitor here in security. He was hightailing it, but the damn monitor was one of those that rotated the shots, and by the time it came around again, there was nothing. That hall leads to the administration building. That would be where he has an office. We could head over there, I suppose, check it out,” Colin suggested.

  “Might as well. I’ll need to change. Let me do that, and then we’ll check it out. I’m in the female nurses locker room, and will be back in five minutes.”

  Geech turned to the computer and said, “I’ll try to follow him on the hospital network. The computer will show who has been paged, where passkeys are being used and which computers everyone is signed into. I hacked into the system while we were waiting.”

  Michelle laughed and said, “Good job, Geech.” Then she thought for a moment and asked, “Is his key flagged?”

  “Yup,” Geech said. “I can tell you what he’s done with it for the last six years.”

  “When was the last time he used it?” Michelle asked as she picked a spot to sit.

  “Looks like it was door E226,” Colin said. “Now you are going to ask me where E226 is located, and I’ll tell you I haven’t a clue. It was ten minutes ago, though,” Colin said as he paged along a large file.

  “Geech, can you find that room?” Michelle asked.

  “Sure, easy. I’ll do it while you’re changing, maybe,” Geech said as he leaned past Colin.

  Colin stood and said, “Let me walk you to the locker room. He knows you, doesn’t know the rest of us yet.”

  “Good idea,” Michelle said. “Our first operation, and we screwed the pooch. At least we have a good lead on this one, after three weeks in this hole. OK, come on, Colin, my escort. Richard, can you get the data from this case? Go to the ER and ask them to get the ambulance record. Tell them you’re working for the hospital, but don’t flash your badge around. Maybe we can get some information on the case without a court order. I’ll be, no, we’ll be back in five minutes.”

  They walked along the main corridor. There seemed to be the usual stream of patients and staff, always changing yet always somehow the same. Michelle bumped Colin and pointed down a hallway, “Locker’s down there and up a floor.”

  They made the stairs and started up. The door to the next floor was painted a bright orange, in a 1970’s gayness that seemed trite. After entering the floor, they walked toward the locker, and Michelle fished out her passkey.

  Colin bumped Michelle into a recessed door that was near the locker. She turned and asked with some irritation, “What
are you doing?”

  Colin pointed to above the door where there were the letter and numbers that indicated the room number, it was room E224.

  Michelle pushed against Colin as she peeked down the hall and said, “Oh, no, he entered the locker room. That’s E226. Good catch, Colin. Now I’ve got to go in there, and you’ve got to cover me. I’ll go in, you stay at the door, and I’ll call you in if it looks clear. I’ll not close the door. The lockers are to the left, door swings left to block the view.”

  “Let’s go,” Colin said as they started toward the door.

  The door burst open and two large nurses emerged. Each had a pack of cigarettes and a lighter in her hands, scrub hat on her head, and a white lab coat wrapped around her scrubs. They hardly glanced at Colin and Michelle while walking past. The door swung shut.

  Michelle stepped into the scrub room and quickly motioned Colin to follow. Several banks of lockers lined the walls, and there were more set in the middle of the room. Dirty scrubs littered the floor, and a collection of discarded shoes filled the area under the bench seats. Michelle walked past the main locker bank and turned, looking at her locker.

  “Colin, my locker is open. I’m sure I locked it. My stuff is a mess; someone’s been through it. Damn and nation, now we’re cooked. That had my purse and gear in it. Now I’m really blown.”

  The door opened and the nurse from the surgery station that had cautioned Michelle to take off her scrub covers came in. She looked around and assessed the situation per her experience, and said, “Honey, if you’re looking for privacy, this ain’t the place. You need to go to the old ward that they’re remodeling all the time. There’s always a room or two over there, and that’s were most of the girls take their boys.”

  Colin laughed and said, “We went there, but the place was full.”

  Michelle did not appear amused, and instead replied, “My locker has been forced open, and I asked my friend to come in here because I’m scared.”