Stress Test

by Richard Mabry

  Matt strode through the halls with no fixed destination. It didn’t matter where he went, so long as it put some distance between him and that last encounter. No matter what came his way today, it couldn’t begin to compare with what he’d just experienced. Bring on the emergencies. I’m ready.

  Although it was broad daylight, in the midst of a busy hospital, Matt still found himself looking over his shoulder. One kidnap attempt had gone awry, and two men with guns had failed in an attempt to kill him. But he remembered his mother saying that most things come in threes, and he wanted to take no chances.

  Matt decided to hide out in the surgeons’ lounge until it was time to start his shift in the ER. By this time of the afternoon, most surgeons had finished their morning cases and were back in their offices, seeing post-op and pre-op patients and probably working their way through a mound of paperwork between appointments. Matt had loved the patient contact, the sense of satisfaction when he made a particularly difficult diagnosis, performed a bit of surgical magic, even saved a life. But the ever-increasing regulations, the morass of forms, the constant battle with insurance companies and the occasional attorney had helped make his decision to leave private practice easier.

  He realized there’d be the same problems in academic medicine—the paperwork and hassles wouldn’t go away—but he’d hoped there’d be more structure, maybe even more free time as he shared call with his fellow faculty members.

  Matt had hoped that the change would please Jennifer as well. But now she’d disappeared from his life, taking with her any chance of a deeper relationship, maybe even marriage. As these thoughts rolled through his mind, the cloud of despair hovering over him since he awoke in that ICU room returned with a vengeance. If there was no Jennifer in his life, why had he—

  His cell phone buzzed in his pocket. The caller ID was no help—private name, private number. Matt thumbed the button. “Dr. Newman.”

  The connection was poor, with static overriding some of the words, but the voice was unmistakable, and Matt felt a smile playing around his lips when he recognized it. “Matt, it’s Joe. I heard what happened to you. Are you all right?”

  “Where are you?” Matt asked. “I thought you were somewhere in the Amazonian jungle, and as best I recall, there aren’t a lot of phones or cell towers there.”

  “Home base sent word to a nearby missionary via his amateur radio that my brother had been injured and was in trouble. It’s taken me a few days to make it to a phone, but the bonus is that I get to take a hot shower and sleep in a real bed while I’m here.”

  “Oh, man, is it good to hear your voice,” Matt said. “I had a head injury, but I’m recovering. The real bad news is that somehow, the police suspect me of murder, but I have a good lawyer working on that.”

  “What? What happened?”

  Matt filled him in. It helped him organize things in his mind as he related them to his brother.

  When Matt finished, Joe said, “I’m glad you’re recovering from your injury. I know it must be tough, being unfairly accused. All things considered, how are you holding up?”

  Matt took a deep breath. “If you’re inquiring about the state of my psyche, I’m hanging on. As for my soul, I’m not sure. I think maybe God’s mad because I’ve been ignoring Him for the past few years.”

  “God doesn’t work that way. Even when you’re ignoring Him, He’s not ignoring you. And I’m sure He’ll be glad you’re getting back on speaking terms.” Joe’s laugh was like a tonic to Matt. His brother had always been able to get him through even the darkest times. Joe managed to hold it together and help Matt do the same when their parents died in a plane crash. “We’ve still got each other. And we’ve got God,” Joe had said. Matt needed that assurance now.

  “Would it help if I came back to the US?” Joe said. “The Mission Board would probably approve an emergency furlough.”

  Matt had thought about this and reached the hard conclusion that Joe’s physical presence couldn’t help. “No, there’s not really anything you can do if you were here, but I’m glad you called. And there is one thing you can do for me while we’re talking.”

  “Name it, little brother.”

  Matt looked around to make sure he was still alone in the surgeons’ lounge. “Would you pray for me?”

  “I’ve been doing that ever since I got the news,” Joe said. “But one more time won’t hurt.”

  Matt bowed his head, closed his eyes, and felt himself relax as he heard his brother’s voice, from five thousand miles away, lifting him up and asking for strength, peace, and grace in the midst of trials.

  The cell phone was almost lost in the massive hand of Detective Virgil Grimes. “Yes?”

  The detective looked around the squad room, but none of the few people there seemed interested in his conversation. He listened intently for a few minutes, then responded, “No, nothing new. What we have is a dead woman in the trunk of Newman’s car, with his wallet under her. His story’s thin, but there’s nothing so far to disprove it.”

  The response was louder this time, and Grimes was torn between moving the phone away to spare his eardrums and leaving it tight against his ear for privacy. Privacy won. He received his orders silently and without any display of emotion. “Got it. I’ll look harder.” And if I have to be a little creative with evidence, I can do that.

  The voice on the other end of the phone spoke a few more words, and Grimes nodded. His response was almost a whisper. “I understand.” You want Matt Newman to go down for murder.

  The detective shoved the phone into his pocket and left the squad room. He had work to do.

  TWELVE

  Matt was well into his ER shift when a nurse stuck her head through the door. “Dr. Newman, we need you in Trauma One stat!” The words weren’t spoken loudly, but there was no mistaking their urgency.

  Matt hurriedly covered the area he’d just sutured with a sterile gauze pad. “You’ll need to see your doctor in about a week to have the stitches removed from your arm. Call him or us if the wound gets red or starts oozing pus.” He turned to the LVN assisting him. “Will you finish putting on the bandage and give Mr. Tomlinson instructions?”

  He didn’t wait for an answer. Matt strode to the door, stripping off his gloves as he moved rapidly toward trauma room 1. As he went through the door, Matt took in the scene with a practiced glance: two EMTs, a nurse, and an aide surrounded a patient lying on the ambulance stretcher. The unresponsive man’s face was streaked with blood from an oozing cut above his eye.

  “What have we got?” Matt asked, moving beside the patient.

  The lead EMT answered. “Thirty-nine-year-old male ran his car into a concrete abutment on I-35 at high speed. Police think he fell asleep. When we got him, he was shocky, breathing hard. EKG looked sort of funny. Wondered about a heart—”

  “Let’s have a look,” Matt said. He nodded with approval at the two IV lines already in place, the oxygen mask on the patient’s face. The monitor displayed low-voltage EKG complexes.

  A quick neurologic exam told Matt there was probably no serious brain injury. On the other hand, the heart situation . . .

  Matt first noted the fullness of the veins in the young man’s neck. The recorded blood pressure was low. Two-thirds of Beck’s triad already. He pulled his stethoscope from around his neck and listened to the patient’s chest for a moment. Matt held his breath and concentrated. No question. Decreased heart sounds. Three signs out of three. Cardiac tamponade. Bleeding into the fibrous sac that surrounded the heart. A true medical emergency.

  Untreated, continued bleeding would press on the heart like a giant hand grasping that life-giving organ, squeezing it to death. Matt had to relieve that pressure, and fast.

  First get the blood pressure back up. He spoke to the nurse. “Put a vial of Dobutamine in 250 milliliters of saline and piggyback it to his IV. I’ll adjust the dosage in a moment.”

  Matt turned to the lead EMT. “One question. Was the air bag deployed?�
��

  “Funny thing. No, it wasn’t. I wondered about that.”

  “Some people disconnect them,” the second EMT added. “Think they might do more harm than good.” He shook his head.

  “This patient has cardiac tamponade. We need to get a cardiac surgeon here stat,” Matt said. The aide hurried away to make the call. “Meanwhile, let’s intubate him.”

  Matt hadn’t put an endotracheal tube into a patient for a while, but was pleased to find that he hadn’t lost his touch. The tube slid between the man’s vocal cords and into his windpipe on the first attempt. When he had the airway secured, Matt said, “Let’s hook him up to the respirator.”

  “How’s his blood pressure?” Matt asked. The EMT turned the monitor slightly so Matt could see it. The pressure had dropped further. “Speed up the Dobutamine drip.”

  The oxygen saturation, measured by the pulse oximeter on the patient’s finger, was low despite the pure oxygen being delivered under pressure. The man was being smothered by his heart’s inability to pump blood throughout his body.

  The phone in the corner of the room rang, and the nurse moved to answer it. She listened for a moment, hung up, and turned to Matt. “The cardiac team is tied up with another emergency case. It may be half an hour before someone can shake loose.”

  “That’s too long.” Well, I guess it’s up to me. “We’ll need to do an emergency pericardiocentesis.”

  “Don’t you want a chest film?” the EMT asked.

  “Sure. I want a chest film, an echocardiogram, and a cardiologist standing beside me. But we don’t have time for any of that.” Matt nodded toward the patient. “This man is dying.”

  The group went into action, and in a moment Matt looked down at the bared chest of the young man, bronzed by antiseptic, outlined with sterile green draping sheets. There’d been no time to run to the hospital library and check his knowledge of a procedure he’d never performed and only seen two or three times. The ER secretary was trying to locate a thoracic surgeon, a cardiologist, anyone who could help, but right now this was up to Matt. Welcome to ER medicine.

  After injecting a local anesthetic, Matt used a scalpel to make a small incision under the breastbone. Careful. Just enough to let the needle slide in easily. With his gloved hand, he took a large syringe from the instrument tray, attached a long needle, and loaded it with a bit of sterile saline.

  “Do we have an electric lead with an alligator clip? I need to put it on the needle and link it to the EKG,” Matt said. No one could find one.

  Great. Well, there was one more option. Matt turned to the nurse and the EMTs. “Are you familiar enough with EKGs to tell me if the ST segments start getting higher?”

  “I am,” said the nurse.

  “Yes,” replied both EMTs.

  “That’s the only warning I’ll have that my needle is touching the heart. If that happens, sing out loud and clear.”

  Matt paused with the needle tip poised against the man’s bare chest. Please, God. Give me this one. Slowly he inserted the needle, working to maintain a forty-five-degree angle, aiming at the patient’s left shoulder. Every few millimeters, he pushed the plunger and injected a few drops of saline, just enough to keep the lumen of the needle clear. He needed to insert the needle to a depth of about two inches. Wasn’t he there yet? It seemed like he should be. Maybe distance is relative when the target is a beating heart.

  Matt pulled back on the plunger. Nothing. He advanced the needle a bit farther—and blood swirled in the saline remaining in the syringe.

  “ST elevation!” Three voices rang out in unison.

  Immediately Matt pulled the needle back a bit.

  “EKG’s back to normal,” the nurse said.

  “Thanks.” Matt advanced the needle again, a millimeter at a time, and with each movement he felt his gut tighten. Once more he pulled back on the plunger of the syringe. Blood, darker than the bright blood of a moment ago, began to flow into the barrel of the syringe. He was in the pericardial sac, and it was filled with blood. You got the diagnosis right, Matt. Now help the man.

  When the syringe was full, Matt handed it off and attached a fresh one. “What are his vital signs like?”

  “Blood pressure is going up,” the nurse reported.

  Matt repeated the aspiration twice, pulling the needle back once more when the EKG changes showed he was touching the heart again. “Now how’s he doing?”

  “Vital signs looking better. Oxygen saturation back to almost normal,” the nurse said.

  “You guys need me down here?”

  Matt steadied the needle in place before he looked at the doorway. The speaker was a cardiac surgeon he recognized. “Glad to see you, Lonnie. I’ve just done my first pericardiocentesis. Let me tell you about it.”

  “Just the usual this morning?” Elaine asked. “I had dinner last night with Charlie Greaver. That should entitle me to something fancier.”

  Sandra sipped from her own cup and settled into the visitor’s chair across the desk from Elaine. “Maybe tomorrow. Depends on what you learned.”

  “Mainly I learned that Charlie wanted to talk about Charlie—specifically, about what he’s going to do when he’s elected DA next year after Jack Tanner retires.” Elaine sampled her own coffee, frowned, and blew across the mouth of the cup. “Too hot to drink.”

  “So let it cool. What about Matt’s case?”

  “Charlie wants to get things sewed up before moving for an indictment, but Frank Everett is champing at the bit to go with the case. Frank has ideas about moving into Charlie’s number two slot when Jack retires and Charlie’s the new DA.”

  Sandra frowned. “So are they ready to move forward?”

  “Not yet. But Everett told Charlie he’d have some new evidence soon. And when he’s got that, he wants to hotfoot it to the grand jury.”

  New evidence? Where could they be digging that up? “Is Frank Everett still scheduled to prosecute?”

  Elaine tried her coffee, found it to her liking, and drank deeply. “Not sure. Frank’s doing the work right now, but depending on how the case looks, Charlie may end up first chair.”

  Not so good. Charlie is no pushover. Sandra rose and headed for her office. “I have to make a phone call. Buzz me if you need me.”

  Matt stood in the middle of the emergency room, surrounded by patients hooked up to every imaginable device and monitor. A harsh noise assaulted his ears—one of the devices sending out its electronic warning. He turned in a slow circle, letting his ears search for the source of the noise. Had an electrode from an EKG come loose? Was a patient’s oxygen saturation level dropping to dangerous levels? Had an IV being pumped into a patient’s system run dry? Or—most dangerous of all—had a patient’s heartbeat stilled?

  Matt turned this way and that, but everything seemed to be in order. The noise stopped just as he opened his eyes. Then he heard his own voice. “This is Dr. Matt Newman. I can’t take your call, but if you leave a name and number, I’ll get back to you as soon as I can.”

  “Matt, this is Sandra Murray—”

  He snatched the phone off the bedside table and scrambled to turn off his answering machine. “Sandra, I’m here. Just give me a second.”

  Matt put down the phone and hurried to the bathroom. He was back in a moment, his face still wet from a dousing with cold water. “Sorry. What’s up?”

  “We need to talk about your case,” Sandra said. “Can you come by my office before noon?”

  Something about Sandra’s tone was different, and it worried Matt. “Is something wrong?”

  “Maybe. We’ll talk about it when you get here.”

  They settled on eleven o’clock. Matt hung up the phone, straightened his rumpled covers—what a nightmare that had been—and headed for the shower. He wondered what new development had prompted the call. Whatever it was, apparently his attorney didn’t like it.

  He tested the water with his hand and adjusted the mix. As he stepped under the spray, he wondered if he was
in hot water in more ways than one.

  Jennifer’s fingers glided over the keyboard of her computer like those of a concert pianist, producing an accurate reproduction of the words she heard through her headset while her own thoughts flew in different directions.

  The more time she spent with Frank, the more she seemed to think about Matt. All of the good qualities that had drawn her to him—the way he was willing to leave an established practice for a less-stressful position, just to please her—kept whirling through her mind. Why hadn’t she just told Jack Tanner from the get-go that Matt was her boyfriend? When had she gotten so career-focused that she was ready to give the first husband material she’d met in a long time, the boot? From what she’d heard, even though Frank Everett and Charlie Greaver seemed ready, even anxious, to pursue an indictment, the case was built on circumstantial evidence. True, the police had found a dead woman in the trunk of Matt’s car, but if his kidnapping story held up, he had been the victim, not the perpetrator, and there was nothing of substance to support prosecution.

  Then again, if that detective, whatever his name was, found anything more substantial, Matt would undoubtedly be arrested and tried. And she’d been around long enough to know that a not-guilty verdict didn’t always wash away the suspicion that surrounded being tried for murder. Did she really want to be the wife of a man who’d been called a murderer, even if he was acquitted? For that matter, could she afford to have her name associated with him and maintain the confidence of the DA and his associates?

  Although Jennifer always considered herself levelheaded, making decisions on the basis of practicality instead of emotions, something about her actions continued to bother her. True, she was seeing someone else. But Matt at least deserved a proper good-bye.

  Jennifer went back and forth until it seemed her head would explode. She needed to get out of here, take a break.