“Listen,” Kim said when she had returned. “How about if I cover for you and you try again to get him down here? It’s only, like, a five-minute drive, and the motorcade is probably still standing by.”
Darlene smiled at her friend. “Did you just read my mind?”
“No, I read your eyes—probably the easiest thing I’ll have to do all day.”
“Do you need my talking points?”
“Darlene, I might not spend my free time dissecting every global conflict like some First Lady that I know, but trust me, I could give this speech in my sleep. For now, I’ll just stall them—maybe do a little soft-shoe.”
Darlene stepped back to the microphone, introduced Kim, and then excused herself from the platform stage. A few feet away, she stopped at a relatively secluded area and, with Secret Service agents keeping close watch, called her husband for the second time.
“Darlene, what is it? Is everything all right?” Martin sounded genuinely worried, probably fearing that the protesters had turned violent.
“Everything here is fine, Marty,” Darlene said. “In fact, it’s better than fine. It’s really something special, except you’re not here and you should be.”
“Is that why you’re calling me?”
Darlene heard the anger in her husband’s voice. He had never had much of a temper, but lately outbursts to one degree or another had been coming more and more frequently. At the podium, Kim was entertaining the crowd with stock humorous stories about Darlene’s college days.
“Look, I know you’re concerned about the polls, honey,” Darlene said to Martin, “but you need to stand up for what you believe. Polls don’t mean a thing. Polls didn’t get you reelected; people did. And these people care about you.”
Martin breathed heavily into the phone. “Darlene, what the hell is wrong with you! Are you blind?”
Darlene’s pulse accelerated the way it did in the moments before they fought. She felt defensive and was surprised at how quickly her husband had angered. “Please don’t speak to me that way, Martin,” she said in a harsh whisper.
“Agent Siliphant radioed me. I know how many protesters are there. Do you think I want to come just to get shouted down by an angry mob? Do you know what my approval rating is right now? Do you?”
“Marty … I…”
“Thirty-eight! Down in less than a year from sixty.”
“Please, Martin. Do this for the children.”
“You better have made a good excuse for why it is I’m not there, Darlene. I don’t want to hear on the news tonight that President Mallory is a coward, or doesn’t give a shit about needy kids. That club wouldn’t exist except for my initiative.”
There was a click and the line went dead. Darlene stood shaking, breathing deeply to calm herself. At the podium, the mayor had taken over and was regaling the crowd with a story about his childhood on the harrowing streets of D.C.
Kim appeared by her side. “Let me guess,” she said. “It didn’t go well.”
Darlene’s hands were still shaking. “I’m really worried about him,” she said. “It was never like Martin to behave this way. He’s never run from a fight in his life. What do you think we should do?”
Kim answered with an impish grin. “I say once we’re done here, we’ve got two choices for what we should do next.”
“And those would be?”
“Either we go shopping, or we go get a drink.”
CHAPTER 4
Fighting to control his speed and to maintain at least a modicum of concentration, Lou made the thirty-mile drive from D.C. to DeLand Regional in forty minutes. He hadn’t bothered to change out of his scrubs.
Over the years, like most people with a television, he had sat riveted to the set countless times, watching reports of pathetic souls who had, for whatever reason, lost it and gone postal—murdering at random. In most cases, the explanation for the carnage remained a mystery, cloaked in the catchall of crazy. After a short stay as the lead, the stories inevitably slipped from the news. The killers who didn’t take their own lives, or weren’t shot to bits by the police, vanished to prison someplace, or into an asylum. To everyone aside from their shattered families, and the shattered families of their victims, the memory of them vanished like April snow.
Lou could not recall the name of even one of the killers, no matter how many lives they had taken. But this killer was different. This killer was John Meacham—for nearly four years, his client, and more recently, his friend.
Flipping the tuner on the radio of his Toyota, he checked in on a series of stations. The story was front and center on many of them, and a bulletin on most of the rest. Within fifteen minutes, there was nothing new, and Lou settled back on 103.5 FM, the all-news station.
“… Meacham, a fifty-two-year-old internal medicine specialist had been practicing in Kings Ridge for three years. His partner, sixty-two-year-old Carl Franklin, was one of the seven victims. At this moment, Meacham is listed in critical condition at DeLand Regional Hospital. Police speculate that the recoil of his pistol jerked his shot off line enough to keep it from being immediately fatal.
“They report that all seven victims were pronounced dead at the scene of the carnage, Meacham’s medical office on Steward Street in the Kings Ridge Medical Park. Only one of the victims, a female, whose name is still being withheld, survived long enough to say anything to authorities. A source in the department has told reporters that all she said before she died was, ‘No witnesses.’”
No witnesses.
Lou shrugged and shook his head. Seven dead and one life hanging by a strand.
No witnesses.
What in the hell does that mean?
Emily had gone home with Renee, and the chief of the ER department at Eisenhower had rushed over to finish out Lou’s shift. The severe weather, which had been on and off stormy all day, was on again—fog, wind, and a chilly, pelting rain.
From what Lou knew, Kings Ridge, population maybe ten or fifteen thousand, was a bedroom community for D.C., surrounded by expansive farms, mostly corn. He had driven through it a couple of times, and remembered the downtown as being fairly affluent and well maintained, with a quaint village green, coffee shops, and restaurants spaced along on the main street.
DeLand Regional, a few miles west of the town, was a level-two trauma center, which meant that orthopedics, neurosurgery, and plastics were covered, although not necessarily in house all the time. According to the news, John Meacham had survived a gunshot wound to the right temple. Under usual circumstances, patients with such an injury would have been transported by chopper to the nearest level-one facility, in this case, Eisenhower Memorial itself. Perhaps a neurosurgeon was available at DeLand, Lou speculated, and didn’t want to lose a juicy case. Or perhaps the weather was too chancy.
Poor goddamn Meacham.
What in the hell happened out there?
John Meacham was tightly wound, but not this tightly wound. In fact, he had a better-than-decent recovery program, and had mellowed considerably. Word was bound to get out that he had been attending Alcoholics Anonymous meetings for four years, and a few hundred alcoholics and drug addicts in need of the program would decide that they were better off going it on their own.
Any excuse in a storm.
Meacham was one of the first docs Lou had been assigned after he went to work part-time as the assistant to the director of Physician Wellness. A father of three, and a history buff, the internist was a lifelong Virginian, working in D.C. at the time. He played bluegrass on several instruments and could take his motorcycle apart and put it back together. The only two drawbacks in his life were his temper and alcohol. The day he exploded at one of his patients for continuing to smoke following a coronary, Meacham admitted to Lou that he had a ferocious hangover after drinking the night before. The result of his outburst was a report by his patient to the board, a six-month suspension, and a referral to the PWO.
Lou ordered an immediate psych evaluation and sent Meac
ham away for a month of rehab and anger management. As soon as he was discharged home, Lou signed him to a legally binding monitoring agreement—random urine testing twice weekly, regular psychological therapy, frequent face-to-face sessions with Lou, and involvement with AA.
What could go wrong?
Much to his chagrin and that of his dentist, Sid Moskowitz, Lou was a teeth clencher and grinder. Moskowitz had been pushing forever for some kind of mouth guard, but even in the ring, Lou could barely handle an appliance jamming up against his gag centers like two stalks of rubber celery. He could kick the grinding habit, he insisted, even as Moskowitz was totaling up the cost of the crowns he would soon be installing. He could kick the habit just as he had kicked the drugs.
But not today.
With the wipers slapping steadily, Lou turned into the crowded physician parking lot of DeLand Regional. Four cruisers, strobes flashing, were parked near the ER entrance. Twenty-five yards away was a phalanx of sound trucks. Lou estimated that the glass-and-redbrick three-story hospital had a capacity of somewhere between 150 and 200 beds. It had a decent reputation from what little he knew, although he had no firsthand experience with the place.
Before he made it to the elevator and up to the second-floor ICU, Lou’s credentials were checked three times. There were two uniformed cops—a woman and a man—posted outside the unit, and another man, a broad-shouldered African American in plainclothes, whom Lou guessed might regularly rehearse his air of authority in front of a mirror.
“No one’s allowed in there,” the man said, performing a heavy-lidded inspection of the new arrival.
“I’m a doctor.”
“So’s the guy in there who just killed seven people.”
“Nice comeback. How about if I said I was a close friend of his?”
“ID?”
Lou passed over his driver’s license and wallet-sized medical license. “Neither of these say I’m a close friend of his. I left that one at home.”
“I can be a wise-ass because I’m in charge,” the detective said. “You can’t, because you’re not. And the head nurse left word that no one is to be let in until she says so. They’re going after the bullet in your close friend’s head.”
“They’re what!”
Incredulous that they were going after the bullet in the ICU and not the operating room, Lou stared across at the man, who looked perfectly serious. Not possible, Lou was thinking. Even in the most ragtag level-two trauma center imaginable, no one would be fishing for a bullet while inside the ICU. Generally, what remained of the slug were fragments, and more often than not, the brain trauma caused by trying to remove them wasn’t worth the benefits. But no matter what, any procedure, whether an exploration or a decompression maneuver to reduce swelling, would be performed in the operating room.
“Going after the bullet,” Lou said. “Of course. Just like they do all the time in the movies. Usually, that’s when I snatch up my popcorn and leave.”
“Too gross?”
“Too absurd.”
The remark appeared to have sailed over the cop’s head. “What kind of doc are you, anyway?” he asked.
“Emergency. I work at Eisenhower Memorial in the city. Who’s going after the bullet?”
“I have no idea. I don’t live around here. I’m state police. We were called in to take over for the locals.”
Lou was about to grill the man for information when the glass doors to the unit glided apart and a trim, olive-complexioned woman in scrubs emerged. Tension was etched across her face. It took only a second for Lou to recognize her.
“Sara!”
Sara Turnbull and he went way back—almost to the beginning of Lou’s residency, when he was razor sharp, thrilled to be having his dreams come true, and enthusiastic as the Energizer Bunny—back to before his father’s financial implosion, and Lou’s subsequent moonlighting jobs, and the extra shifts, and the utter exhaustion; back to before the unstoppable downward spiral and the amphetamines, and the visits from the drug-enforcement people.
“God, am I glad to see you,” Turnbull said. “When they called from downstairs to say you were on the way up, I nearly jumped through the phone. They’re killing him in there, Lou. I don’t care what he’s done, it’s not our job to judge.”
CHAPTER 5
“Okay if I go in there, Officer?”
“Sorry to give you a hard time,” the cop said. “It looks like you have a boxer’s knuckle, there. I’m not used to seeing doctors with boxer’s knuckles.”
“I work in a really tough ER,” Lou replied.
Sara Turnbull was a crackerjack nurse—as smart and intuitive as she was compassionate. There was a time when Lou could have added passionate to her list of attributes, but those times were long past. The last he had heard from her was a get-well card forwarded to him in rehab.
“How long have you been working here?” Lou asked as they joined the crowd milling in the gleaming ICU.
“Just four months. My husband’s a nurse on med/surg. We have a one-year-old son. It’s not Eisenhower, but it’s a decent-enough place—at least it was. This is a mess, Lou. An absolute mess. I’m charge nurse today, and I can’t follow some of the things that are happening.”
“Like someone blindly jamming a hemostat into a patient’s brain, fishing for a bullet?”
“Exactly. That’s Dr. Prichap. As far as I know, he’s a decent-enough neurosurgeon, but I’ve never seen anyone do that.”
“It may be a while before you see anyone do it again,” Lou said. “What else?”
“Dr. Meacham is going downhill fast, but no one seems all that alarmed. Do you know him?”
“For a few years. We’ve actually gotten to know one another pretty well. This came right out of the blue. I can’t believe he did it.”
“He’s over there in three. Dr. Schwartz, the intensivist, has been in and out, but mostly it’s been Dr. Prichap. It looks as if things have quieted down now. Prichap may have given up hunting for the bullet.”
“I hope so,” Lou said, almost to himself.
Lou followed Sara into the cubicle, which was crowded to near overflowing with nurses, radiology, lab, and respiratory techs, what appeared to be a resident, and a short, copper-skinned man—probably from India. ANTHAR S. PRICHAP, M.D. was stitched in blue over the breast pocket of his lab coat. Although he wore scrubs beneath his white coat, it appeared that he had performed surgery just as he was. Next to Prichap was a tray with bloody sponges and instruments piled on it.
No bullet.
On the bed, barely visible in the crowd, was John Meacham. His trachea had been intubated through his mouth, and he was being ventilated mechanically by a state-of-the-art machine that occupied most of the space the crush of bodies did not. A tall man—six feet or so—Meacham looked lost, almost diminutive. He appeared to be unconscious. His eyes were taped shut, and his head had been shaved on the right side. The bullet hole, just above his right ear, seemed to have been widened. On the wall view-box were anterior–posterior and lateral skull films showing a deeply embedded slug, fragmented into one small and two larger pieces, none of which were easily accessible to the entrance wound itself.
Dr. Schwartz, the hospital-employed intensivist, was apparently off with other patients. Why hang around for a plain old everyday gunshot wound to the head?
Lou introduced himself to Prichap, and received an uninterested nod in return. No handshake. Then, without a word, the neurosurgeon drifted into the background as Lou conducted a quick visual scan of Meacham. What he saw immediately disturbed him. There were two intravenous lines—one inserted in the elbow crux of Meacham’s left arm, and the other at the wrist of the right. The line at the elbow was barely running, despite a blood pressure reading on the monitor screen that demanded fluids and pressor medications—eighty over forty. Surrounding the spot where the catheter had been inserted was a large swelling. The line was infiltrated, and rather than pouring life-supporting fluid into the circulatory system, it wa
s pooling fluid in the tissues.
Careless, dangerous medicine.
“Sara, that needs to be replaced,” he said, pointedly ignoring Prichap, who, at that moment, was looking rather pleased with himself for whatever reason.
The Sara Turnbull he remembered would never have allowed a critically traumatized patient to have only one working IV. Perhaps in the chaos, she simply had not noticed. In seconds, she was taking down the dressing and preparing to replace the IV line—this time at the wrist.
Lou glanced up again at the perilously low blood pressure reading, which had dropped from a systolic of eighty to seventy-four. Unless the cause could be identified and reversed, John Meacham was heading out. Quickly, Lou began mentally ticking through the possibilities. It took only a few seconds to connect with the right one.
Stunned at what he was seeing, Lou worked his stethoscope into place and listened to Meacham’s chest. There were no breath sounds on the right side. The exam was not really necessary. All the information he needed was visible in the distension of the jugular veins along the sides of the man’s neck, the slight bowing of the trachea toward the left, the persistently low oxygen saturation, and the asymmetrical hyperexpansion of the right chest.
A tension pneumothorax—collapse of the right lung due to a tear, probably caused by excess pressure from the ventilator. Air was being forced by the vent through the ruptured lung and into the chest cavity. The midline structures including the heart, esophagus, aorta, and other great vessels were being pushed to the left. The absence of breath sounds on the right merely confirmed the diagnosis.
Lou noted that the vent pressure was dangerously high and turned it down. From beside the machine, the respiratory tech—a tall, pencil-necked man in his late twenties—stood smiling at him blandly.
Did you do this on purpose? Lou wanted to shout. Did you?
“Everyone, please, listen to me,” he called out, louder than he’d intended. The commotion immediately stopped. “I’m Dr. Lou Welcome from the ER at Eisenhower Memorial. This man has a rapidly expanding tension pneumothorax. We need to dart his chest immediately to get the air out of there. Then we’ll get a chest tube in. I need an IV angiocath in a number sixteen or fourteen needle. Quickly, please.”
Oath of Office Page 3
