by D P Lyle
She sniffed, turned her gaze toward the lemon tree that grew just outside the kitchen window. “It already has.”
“It might be time to consider some assisted-living arrangement.”
She swallowed hard and then shook her head. “No. I’ll keep doing this as long as I can.” She looked back at me. The tears that welled in her eyes seemed to magnify them to large brown orbs. “He’s a good man. We promised each other fifty-two years ago that we were together forever. That included sickness and health.”
I hate these situations. The ones where there is no solution. The ones where I don’t have any tricks in my bag or clever words of comfort. I had nothing to offer.
“I understand,” I said. “Just think about it.”
She didn’t respond but rather dropped her gaze to her lap, where her hands continually wound and unwound the handkerchief.
Divya and I said good-bye, telling Maria that one of us would come back by in a couple of days and check on Oscar. Outside, I opened the door to Divya’s SUV for her.
“It’s so sad,” she said. “They’ve lived together all those years and now this. I don’t know which one I feel for the most.”
“It’s an uncomfortable situation and unfortunately there isn’t a thing we can do about it.”
“You want me to see the two new patients? They’re both over in East Hampton, so it’s easy for me to go from one to the other.”
“That would be great. I’ll go see the three follow-ups and meet you back at the house.”
“Works for me.”
Chapter 17
The three follow-ups were scattered, two in Southampton, the other in Westhampton. If traffic cooperated, a couple of hours should do it. I was making good time on one of the back roads when I came on an odd scene. A wad of cars, blocking the road, doors flung open, apparently abandoned by the drivers. Beyond, they seemed to have gathered, along with a group of road-crew hard hats, near a bridge abutment. I pulled onto the shoulder, got out, and hurried toward the bridge. I passed a man, cell phone to his ear, screaming for the person on the other end to hurry up and get the medics rolling.
As I approached the crowd, I saw a mangled bicycle on the roadside and then something really odd: a young man pinned to the bridge abutment. Literally. As if he were a butterfly on a collection board.
I pushed through the crowd until I reached the impaled cyclist.A large, thick-armed man stood nearby, hands clinched at his sides, frozen as if he wasn’t sure what to do.
“I’m Dr. Hank Lawson,” I said. “What happened here?”
The big man turned, a grim look on his face. “You’re a doctor?”
“Yes.”
“Man, am I glad you’re here.” He wore an orange reflective vest over a black T-shirt. “I’m not sure what happened. I think he lost control of his bike and took a header into the bridge. Hung himself up on that rebar.”
The injured man, who looked to be twentysomething, wore a bicycle outfit: black pants and a bright blue shirt with SHIMANO in white lettering across the front. The shirt was torn and bloody. A piece of rebar protruded from his right lower chest. His face was pale and contorted in pain, his breathing labored and raspy.
Someone behind me said that the medics had been called, but they were at least twenty minutes away.
“I’m Dr. Lawson,” I said to the cyclist. “Let’s see what we can do here.”
I gently ripped away his shirt. He groaned.
“Sorry, but I need to get a better look.”
“Go ahead,” he said, his voice weak, almost a whisper.
The rebar had entered his chest from behind, just beneath his right scapula, and had come out in the area of his seventh or eighth rib. Blood soaked his chest and right pant leg, and pooled on the ground beneath him. Each breath produced a gurgling sound and bloody bubbles erupted from his chest.
I used his shirt to wipe away the blood and could now see the wound more clearly. It was large, half as big as my fist. The real problem? It was a sucking chest wound. Not that all chest wounds don’t suck, but a real one constitutes a true medical emergency.
With this type of injury, not only does the lung on the side of the injury collapse and therefore become useless, but the entire chest becomes less effective. When we take in a breath, the diaphragm moves downward and the muscles between the ribs expand the chest. This creates negative pressure that pulls air through the mouth and nose and into the lungs. When the chest has another opening, such as a large wound, air is more readily pulled in through that wound than it is into the good lung. Means one lung is useless and the other can’t get a good breath. Not a healthy situation.
Sucking chest wounds are seen in war injuries from large-caliber rounds, shrapnel, and things like that, but are uncommon in the real world and particularly from a bicycle accident.
“What’s your name?” I asked the young man.
“Owen. Owen Cooper.” He spoke between gasps.
“Okay, Owen. We’re going to help you.” I turned toward the men who had now formed a semicircle around us. “We need to get him down.”
“Are you sure?” the big man said. “We were afraid to touch him.”
“If we don’t take care of his chest wound, he won’t live to see the paramedics.” I looked him in the eye. “What’s your name?”
“Paul Doocy. I’m the foreman here.”
“Get a couple of your guys and let’s gently lift him off this rebar and get him on the ground.”
He hesitated as if unsure what to do.
“Look, I’m a doctor. A former ER doctor. I know how to handle this, but I need your help. I take full responsibility.”
Now Paul didn’t hesitate. He snapped a finger at a couple of his guys. “You heard the doc. Let’s get him down.”
I looked back at Owen. “This is going to hurt, but there’s no other way.”
“Just do it. I can’t stand this anymore.”
I nodded toward Paul. “Let’s go.”
Two men grabbed Owen’s upper arms. Paul wrapped his massive arms around the young man’s legs. He lifted while the other two men slid Owen from the metal spike. I stabilized his chest as best I could as the rebar disappeared back into his chest.
“Oh, Jesus,” Owen moaned.
“Quickly,” I said. “Get him off there.”
The men pulled, Owen groaned, and then he was free.
“Lay him down. Here on the grass.”
Air and bloody foam squished in and out of the ragged opening with each breath. Visible bone spicules meant that at least one rib had been trashed. I grabbed the shirt I had ripped off him, wadded it into a ball, and pressed it against the wound. He moaned and recoiled, but I held it steady.
“You have what we call a sucking chest wound and we have to close it.”
Sweat dotted Owen’s face and his pulse was weak and rapid, maybe 120. He was descending into full-blown shock and I had nothing to work with. I wished Divya were here. Her SUV had IV fluids and all the bandages I needed. I had none of that.
The wadded shirt didn’t make a good seal. I needed something airtight, something that wouldn’t let air move in or out. That would make the other lung, the good one, more efficient, more able to move air and to supply oxygen to the blood and the brain. Plastic wrap, petroleum jelly on cloth, even a trash bag, would work, but I didn’t have any of those either.
I nodded toward the mangled bicycle. “Look in the seat pouch. See if there’s a spare inner tube.”
One of the guys stood the bicycle upright while another unzipped the bag that hung beneath the seat. He began pulling things out. A couple of Allen wrenches, a bottle of sunscreen, a granola bar—make that two—and a pair of tightly wrapped inner tubes.
“Toss me those tubes,” I said. “Anybody have a knife?”
Three pocketknives appeared. Nice to know that road crews were so well armed. I took the largest of the knives and snapped it open. I cut a twelve-inch section out of one of the inner tubes and then slid the bl
ade down its length. Now I had a black rubber rectangle. I slapped it over the wound.
“Hold this,” I said to Paul.
He knelt beside me and placed his large hand over the rubber patch.
Owen moaned.
“Hang in there,” I said. “We’re almost finished here.”
I cut the other tube crosswise and stretched it out on the ground. It looked like a long snake. I slit it lengthwise, and opened it out flat. I then divided it into two long strips. I wrapped them around Owen’s chest, positioning one across the top of the patch and the other near its lower end. I stretched and tied each securely. I listened but couldn’t hear any air leak.
“You feeling any better?” I asked Owen.
“A little.”
His voice sounded stronger and that awful sucking sound had faded. I heard sirens in the distance.
Chapter 18
Although Divya wasn’t really in the mood to deal with Evan on the two new patient consults, she hadn’t really objected when he climbed into her SUV as she was backing out of her parking space. She just wasn’t up for an argument, so she simply said, “Buckle up.”
But a moment later she slipped the SUV into PARK as she looked at him and asked, “Why are you so eager to come with me today?”
“Who says I’m eager?”
“You jumped in the car while it was moving.”
“Slowly.”
“It was still moving.”
“This isn’t the first time I’ve gone with you to see new clients.”
“Unfortunately that’s true,” Divya said.
“You like my company.”
“I do?”
“My new marketing campaign is to get to know all our clients.”
“You already do.”
“No. I know most of them but not all.”
“So this is going to be a regular event? You tagging along with me all the time.”
“Sure.”
Divya sighed. “I suppose I have nothing to say about that?”
“Why would you? It’s a great idea.”
“It’s an idea all right.”
“Since I set up our clients’ accounts, I think they’d like to meet me. Know who they’re dealing with.”
“I’m not sure anyone is prepared to deal with you.”
“I’m the CFO. I take their money. Wouldn’t you want to know who you’re giving money to?”
“That would be Hank and I. The actual earners.”
“I’m an important cog in the machine.”
“You’re a cog all right.”
“You know what I mean,” Evan said. “An essential part. Component.”
“I know what a cog is. Even a component. I’m trying to understand exactly what this machine is. The one you are cogged into.”
“The HankMed machine.”
“Silly me. I thought it was a medical practice.”
“And a business. One that should run like a well-oiled machine.”
“You make it sound like a Chicago political outfit.”
Evan twisted toward her in his seat. “Anybody ever tell you you’re funny?”
“Constantly.”
“They’re lying.”
Divya rolled her eyes. “Why did you choose today to launch your new and improved CFO patient-relations scheme?”
“Never thought of it before.”
“I thought maybe it was to aggravate me.”
“You have to admit this will make any money issues go more smoothly.”
“Somehow you and smooth don’t belong in the same sentence.”
“Still not funny.”
She refrained from saying that she was amazed he could have formulated such a plan on his own. Or, and most important, that she thought his idea actually made sense. That would have stroked his ego and puffed out his chest more than she could handle today, maybe any day.
Instead she said nothing. Evan no doubt had an agenda and he wasn’t going to be swayed from it.
She slipped the SUV in gear and pointed it down the long treelined drive that led away from Shadow Pond. Evan rode shotgun, as he called it. To her, that was an odd American expression. She remembered reading somewhere that the term had originated in a 1920s pulp-fiction story but had first reached a wide audience in the movie Stagecoach.
“Have you ever seen the movie Stagecoach?” she asked.
“John Wayne? You bet. Probably a dozen times. Why?”
“No reason. Just wondering.”
“I love old John Wayne westerns.”
“I thought you loved James Bond?”
“Him, too.”
The first patient visit went well, taking only forty-five minutes. Evan stayed in the client’s living room, saying he needed to call a couple of clients and then Paige to see how things were going in California. At least he was out of the way and occupied. A good combination.
Divya interviewed and examined the middle-aged man in the den. All was okay except for some indigestion and mild right-upper-abdominal discomfort, symptoms that suggested he might have gallbladder disease. She drew some blood, scheduled an abdominal ultrasound over at Hamptons Heritage, and told him she’d call when all the test results came back.
Back in her SUV she asked Evan, “How’s Paige doing?”
“Great. Just getting up. She said her dad had some meeting in Beverly Hills, so she and her mom were going to the Beverly Hills Hotel for breakfast.”
“Sounds nice. Better than the bagel I had.”
As they neared the next patient’s home, a huge mansion in East Hampton, Evan’s real agenda became clear.
“You have no idea who this guy is?” Evan asked.
“Nathan Zimmer. Works on Wall Street.”
“Not just works on Wall Street. He is Wall Street. He’s one of the hottest investment bankers around. He won’t talk to anyone unless they have over a hundred million dollars in business to conduct.”
“Actually he’s fifty years old and has high blood pressure.”
“I’ll let you worry about that. I’m more interested in how he makes his money.”
“You do know this is a medical visit and not a high school economics class?”
“Maybe it’s a multitasking opportunity.”
Divya pressed on the accelerator and swung the Mercedes SUV hard through a sweeping left curve, pressing Evan against the door. He righted himself as they came out of the curve, and looked at her.
“Are you trying to toss me out?”
“I wouldn’t dream of it. But if you want to open your door, I can try that maneuver again.”
Evan ignored her and went on about Nathan Zimmer. About how he’d made his first billion by the time he was twenty-five and was considered a moneymaking wizard. How his clientele list read like the Forbes 400. How he appeared almost weekly on the pages of the Wall Street Journal and was a fixture on many of the financial television shows. He had been married and divorced twice, had no children, loved to hunt big game in Africa, and fished for marlin all over the globe. Six years earlier, he had almost reached the summit of Mount Everest, nasty weather forcing a harrowing descent. Vanity Fair had done a huge story, Nathan gracing its cover.
“How do you know so much about Mr. Zimmer?” Divya asked.
“When I worked in New York, this was the guy everybody listened to. Sort of the guru of finance.”
“From what I’ve seen of the medical history he sent, if he doesn’t start taking care of himself, he won’t be a guru much longer.”
“That’s your job. Keep this guy around so I can learn from him.”
She laughed. “It is all about you after all.”
“I’m just saying that HankMed can always benefit from sound financial advice.”
“If we have Evan R. Lawson, CFO, why do we need Nathan Zimmer?”
Divya turned into a long Italian-cypress-lined drive that passed between a pair of massive gates and led to Nathan Zimmer’s home. The drive ended at a cobblestone circle that surrounded a th
ree-tiered fountain. She settled the SUV between a midnight blue Bentley convertible, top up, and a bright red Ferrari, top down.
Divya began climbing the marble steps that led to the entry but stopped when she realized Evan was no longer with her. She turned to see him snooping around the cars.
“Are you going to stay out here or are you coming in?”
“You have to admit he has great taste in automobiles. I’d love to own either one of these.”
“Maybe Mr. Zimmer will teach you how to do that.”
Evan began to climb the stairs. “Let’s hope.”
“I don’t want your little lovefest with Mr. Zimmer interfering with why we’re here.”
“Wouldn’t dream of it.”
A handsome young man in a gray suit and an open-collared black silk shirt answered the front door. His blond hair swept casually across his forehead and he smiled warmly.
“I’m Todd Hammersmith,” he said. “Mr. Zimmer’s assistant. Welcome.” He stepped aside, letting them enter.
Divya shook hands with him. “I’m Divya Katdare, Dr. Lawson’s PA.”
Evan pumped his hand. “Evan R. Lawson, CFO of HankMed.”
“Oh yes, we spoke on the phone.” He led them through a massive entry foyer. “Nathan is on the patio.”
The house was modern, glass and steel, straight lines and sharp angles everywhere. The south-facing wall was all glass and looked out over a broad patio that was embraced by a series of marble statues and more Italian cypresses. Beyond, a pair of tennis courts and an Olympic-sized pool, complete with two diving boards and a ten-meter platform, nestled in the parklike grounds.
Nathan Zimmer sat at a round teak table, shaded by a huge lemon yellow umbrella. He wore red jogging shorts, a white Shinnecock Hills golf shirt, black rubber flip-flops, and wraparound sunglasses. His tightly curled black hair had retreated significantly and was lightly salted at the temples. An open seventeen-inch MacBook Pro and stacks of papers littered the table before him. A pulsing Bluetooth device hung from his left ear. He didn’t look up as they approached but rather kept shuffling through papers and talking.
“You’ve got to get those reports out today. I promised the client we would have this wrapped up before the weekend, but if the bank in Zurich doesn’t get the paperwork today, they’ll never be able to transfer the funds in time.” While he listened, he motioned for them to sit down, and then went back to his conversation. “Tell him if he misses the deadline on this, he’ll be working somewhere else tomorrow.” He reached up and touched the Bluetooth device and then smiled at them. “Welcome.”
