Solemn Oath

by Hannah Alexander

  Clarence gestured toward his sister, Darlene, who occupied the only chair in the room. She was as slender as Clarence was huge, and she kept her prematurely graying hair cut short—and she cut it herself. She never wore makeup, never dated, always kept busy. And she treated Clarence to the same adoration with which she had treated him since they were children.

  Today she sat bent forward, shoulders stiff, back straight in what was known in the E.R. as the respiratory position, with obvious inspiratory and expiratory wheezing. The expiratory was much worse. Classic signs of an asthma attack.

  “I tried calling your office this morning, Mercy,” Clarence said in his growling voice. “All I got was your machine.”

  Mercy stepped to Darlene’s side and put her things down. “You have my home number, Darlene. Why didn’t you use it when you started having trouble?”

  “She wanted to try to treat herself before she called you,” Clarence answered for his sister, heaving himself up to a sitting position, quaking the bed in the process.

  “And did it work?” Mercy pulled out her stethoscope and listened to Darlene’s chest. “No need to answer that.”

  “I tried to get her to call,” Clarence said. “The weather changed last night, and she was out in it, cleaning out the rain gutters. That’s what made her worse.”

  Mercy grimaced at her patient and took her blood pressure. “Darlene, you know better.” She kept her voice gentle but could not hide all the frustration she felt. “Independence is a wonderful thing, but risking your health like that could make you more dependent in the end.”

  Darlene’s blood pressure and heart rate were a little elevated. She was agitated, but not crashing. Her skin wasn’t cool or clammy, and though her capillary refill was a little sluggish, it wasn’t bad. Yet. The peak flow meter didn’t register great numbers when Darlene exhaled into it.

  “She ran out of her inhaler,” Clarence said.

  Mercy reached into her bag and pulled out two different types of inhalers. “Time for a breathing treatment. And, Darlene, I want you to start taking your steroid again. I want to see you first thing in the morning in my office.”

  Darlene shook her head. “Not tomorrow.”

  “Please don’t argue with me. This is your life we’re talking about.” Mercy began the treatment, giving Darlene no further chance to reply. Between treatments, she did a bedside glucose test on Clarence and was glad to see that his blood sugar was 260, much lower than it had been, even though it was still high. His blood pressure was lower, as well, at 160 over 98.

  “How’s that strain doing?” Mercy asked him as she reached down and kneaded the huge calf of his left leg. At his size and in his eagerness to recover, he had a bad habit of moving too quickly or overdoing his walks through the house. Strained muscles were common. He seldom got outside because of the steps.

  “A little better,” he said. “I’m trying to stay in bed, but I’m doing arm exercises.”

  “Do you still get short of breath when you get up?”

  “Not as much.”

  “Still getting depressed?” She warmed the stethoscope in her hand and placed it on his chest.

  “I hate being on welfare.”

  “I know. Just keep losing that weight and we’ll get you healthy again. Are you still taking your Lasix?”

  He grunted. “Don’t you see that path to the bathroom?”

  She heaved him forward and listened to his back, then nodded and straightened.

  Clarence lay back after the exam, his bulk causing the bed to groan. He watched his sister with worry. “Wish you’d drag her to the hospital with you, Doc. I know I’m okay, but she just seems set on staying here with me. I can’t talk sense into her.”

  Mercy sighed and bent over with another breathing treatment for Darlene. “She’s your sister, Clarence. What do you expect?” His brow lowered in what appeared to be an angry glare, but Mercy had learned over the months that was his worried look.

  “You’ve kept her breathing this long.” He shrugged his burdensome shoulders. “I guess she thinks you can do miracles right here in the house, so why leave me alone to go to your office?”

  “Stop talking about me like I’m not here,” Darlene wheezed.

  Mercy knelt beside her. “Darlene, I know what you’re thinking—that you’ve been this bad before and our treatments kept you going. But you’re not using your medication as often as you should be, and I’ve warned you about the danger of hoarding it for an emergency. If you wait to take it until you can’t breathe, you’re just guaranteeing that there will be an emergency.”

  Darlene nodded, still concentrating hard on each inhalation.

  “You’ve pushed your body to the limit, sis,” Clarence growled. “What’s gonna happen to me if you…don’t take care of yourself?” He glanced quickly at Mercy, then away. Mercy had used that very same argument on him this spring when his refusal to accept medical care endangered not only his life but Darlene’s.

  Darlene’s jaw set in a firm line. “What happens to you if I leave now and end up in the hospital?”

  Brother and sister held each other’s stare for a long moment. Unfortunately, during that moment Mercy felt her skin tingle with the precursor to another bout of weakness and hot sweats. She nearly groaned aloud. Not now!

  Clarence sighed heavily. “I can get my own food, sis. You need medical help.” He had come a long way from the angry, belligerent man who hated all doctors and partially blamed them for the shape he was in.

  “So are you going to come see me tomorrow, Darlene?” Mercy started to get to her feet, but her legs quivered from the sudden weakness that had overtaken her. She stayed where she was.

  “Not tomorrow,” Darlene said. “I feel better. I’m breathing better.”

  “Not much,” Mercy said, breathing deeply herself to try to fend off the wave of heat she knew would attack her soon.

  “Just until Monday,” Darlene said. “I’ve got a deadline.”

  Clarence bent his huge upper body forward. “Is it worth your life?”

  Once again, Mercy pulled out her peak flow meter and tested Darlene’s air flow. This was so frustrating! But she knew from experience that it wouldn’t help to argue with either of the Knights. She also knew that it had taken just this streak of stubborn independence on both their parts to fight their way out of a second-generation welfare family. Clarence intended to fight his way back to health and discontinue state aid.

  The wave washed through Mercy in spite of her silent, desperate attempts to stop it. Beads of perspiration attacked her from every pore, but she resisted the urge to grab a handy piece of paper or magazine and fan herself.

  Stress. That was all this was. That, and lack of sleep last night because of Tedi, and worry about what Theo might do now that he was out of the detox center.

  “You need to be resting, Darlene,” she said at last, wondering if they could see the sweat dripping from her face and neck and darkening her clothes.

  “I need to make a living. This house isn’t paid for.” Once again, Darlene’s jaw jutted out stubbornly. “Monday. I said I’ll come in Monday if I’m still having trouble.”

  Clarence explained. “Darlene got her check late last month, and we had trouble making the house payment.” A hint of old bitterness entered his voice. “We had trouble like this before, and they threatened to call in the loan, even though we got the payment to them.”

  Mercy finally pushed herself to her feet. “I thought you had your house paid off.”

  “Second mortgage,” Darlene said. “Had to get a new computer and have some work done on the car.”

  The heat continued to spread across Mercy’s body. She took a slow, deep breath.

  “Doc, you okay?” Clarence asked, his voice softening. “Something wrong?”

  “I’ll be fine, just a little flushed.” Probably nothing that couldn’t be cured by a disappearing ex-husband. “Darlene, I want to see you in my office as soon as you can get there. Don’t wo
rry about waiting for an appointment.” She turned to Clarence. “If she refuses to come in, I want you to sit on her. We need to keep ahead of this thing, or she’s going to be in serious trouble. I want both of you to drink plenty of water, no sodas, not even diet sodas. Try not to stress out too much, and get plenty of sleep.” In other words, she wanted them to do a better job of taking care of themselves.

  Estelle Pinkley was well acquainted with the hot seat, and she knew she could hold ground against Bailey Little. She refused to be intimidated by his steely glare at her across the conference table—the crafty attorney had seldom won a case against her in the courtroom when she practiced law. That this morning’s combined meeting of twenty people held not only medical staff but also influential business owners and elected city officials did not frighten her, either. They knew and respected her for her ability to lead, especially the doctors. Besides, one did not show fear when facing down the enemy, and Bailey Little was a ravenous wolf in attorney’s clothing.

  As hospital board president, Bailey called the meeting to order and dispensed quickly with preliminaries. Several had complained about the suddenness of this meeting.

  “I’d like to know why three active members of our medical staff are not present,” Estelle interjected before Bailey could continue.

  Bailey raised a silver brow that matched the steel of his hair. “It isn’t my responsibility to take roll call, Mrs. Pinkley.”

  “But it is your responsibility to contact all members when you call a special meeting.” Tension that had already permeated the room now crackled with energy. “Dr. Mercy Richmond, Dr. Robert Simeon and Dr. Lukas Bower are all absent, and I would like you to state for the record if you called them.” All three doctors had, from time to time in the recent past, resisted Bailey Little’s requests and suggestions. “I’m sure we are all aware of the reason for Dr. George’s absence.”

  Bailey waved his hand dismissively. “A secretary was issued a list of people to contact. If they weren’t available it’s no longer my responsibility.”

  Estelle did not pursue the issue further. Her point was made. The medical staff could usually be counted on to support one another, except in cases of negligence.

  “In fact,” Bailey continued, leaning forward and making eye contact with as many as possible, “of the three points we’re gathered here to discuss, two of them involve two of our absent physicians.”

  Estelle glanced around the room. No one was surprised. Bailey was suing both Dr. Bower and Dr. George for medical malpractice. He had also attempted to use his influence to sway opinion within the hospital board to have Dr. George permanently removed from the medical staff. The best he could do was relieve Jarvis of hospital privileges until the doctor was completely recovered from the TB encephalitis. Ironic that tonight was Jarvis’s get-well party.

  “However,” Bailey continued as his sharp, glinting gaze returned to Estelle, “first I need to share some news with you.” He held up a one-page letter, and then a stack of pages that looked like a contract. “We have here a possible answer to all our problems, ladies and gentlemen. I’m sure you’ve all heard of RealCare Medical Group, one of the largest and most profitable heath-care organizations in the Midwest.” He indicated Estelle with a nod of the head and a practiced smile. “Our esteemed administrator has done such an outstanding job with this hospital that RealCare wants to buy us out.”

  The room grew silent. No one squeaked in their chair, no one moved. Estelle had trouble breathing, but she thought she managed to keep all expression from her face. While Bailey’s eyes shot her a triumphant glare, it seemed as if everyone at the huge conference table began to talk at once.

  “That’s crazy! We’ll be sucked dry!”…“How much are they offering?”…“I won’t practice medicine for that company. They’re sharks!”…“What’ll happen to our county taxes? Knolls County may go for that, especially if it’ll give the fire department more funds.”

  Estelle continued to hold Bailey’s stare. A buyout could destroy everything the people of Knolls prized in their county hospital, and Bailey knew that better than anybody. The small-town warmth, the sense of community, the pro bono cases they took for those truly in need, would all be gone. It was what Bailey wanted. Estelle knew what was going through his mind, knew he was remembering his visit to her house soon after his son died.

  He had brought a sheaf of papers with him then, too—reports from the hospital and from the autopsy. Not only had Dr. Jarvis George given Dwayne an injection of morphine and a script for more, but he’d let the young man drive away high on the drug. And when Dwayne had been brought back to him, battered from the wreck, Jarvis hadn’t even checked for the internal bleeding that had killed Dwayne. Jarvis, in his own stupor from undiagnosed tuberculin encephalitis, had concentrated on Dwayne’s head injury.

  “Your doctor killed my son,” Bailey had snarled. “My only child is dead, and Jarvis George and Knolls Community Hospital are going to pay for that death!”

  As Bailey called for order in the meeting, Estelle fervently hoped these people remembered that Bailey Little was not only taking Jarvis George to court for malpractice, but Knolls Community Hospital, as well. Further, he had not removed himself as hospital board president, which Estelle had protested fervently and often as a serious conflict of interest.

  “In light of the circumstances,” Bailey said, raising his voice to be heard over the din in the room, “I once again advise that we permanently drop Dr. Jarvis George from the medical staff before he can return to work and damage our reputation any further than it has already been damaged.” As two of the doctors began to protest, he held up his hand. “Whether or not you agree with the idea of a buyout, I’m sure you agree that the reputation of our medical staff must remain immaculate. To that end, I also must disclose that this hospital and Dr. Lukas Bower are scheduled for investigation by the government watchdog COBRA.”

  A collective groan stopped his words for a moment, then he continued. “If Dr. Bower is found guilty, both he and our hospital could be fined. We could be denied all federal support, which means we would not receive a penny for Medicare and Medicaid. If COBRA so desires, however, they can limit the hospital’s involvement if we dismiss the offending physician.”

  This time Estelle did not hide her amazement and outrage. “So in essence you’re requesting termination of two staff physicians who are at this time being named in medical malpractice suits by the estate of Dwayne Little?”

  “Perhaps everyone but you can see the logic.” Bailey’s voice dripped with condescension. He glanced at the rest of the group. “Do I have a motion?”

  They stared at him in silence, and Estelle held her breath.

  Bailey’s brow lowered in sudden, amazed annoyance. “Don’t everyone speak at once.”

  No one made a motion.

  Dr. Wong stood up. “You’re wasting our time here today, Mr. Little. I have patients, as I believe most members of the medical staff do.” He turned toward the door. Chairs moved back on the thick carpet as others followed.

  Bailey’s eyes narrowed, and his face flushed with color as he sprang to his feet, pointing at Estelle. “What have you done?” He slammed the flat of his hand onto the table, and the sound of it froze the others for a moment. He studied the face of each member present, then turned to glare again at Estelle, who remained seated, her hands folded calmly on her lap.

  “What did you do, call every member and poison their minds against me before the meeting? What did you tell them?” He glared around at the rest of them again. “What did she say?”

  “She didn’t have to say anything.” Greg Frost, the bank president, stepped over behind Estelle’s chair. “I think we are all intelligent enough to see the issue here for ourselves. Why don’t you save the histrionics for the courtroom, Bailey.”

  Dr. Wong shook his head and left the room. One by one, the rest followed, except for Greg, who continued to stand where he was.

  Estelle finally pushed h
er chair back and stood to her feet, facing her old nemesis across the table. “What they know, they’ve learned from you, Bailey. I think it’s long past time you resigned.”

  Bailey’s lips whitened. His steel-gray eyes burned with growing fury. “You’re the paid employee here, Mrs. Hospital Administrator. I can have you fired.”

  His whole body quivered visibly with suppressed emotion, and Estelle only hoped he could retain enough self-control to leave without making a further scene.

  “I don’t think so, Bailey.” Greg put his hand on Estelle’s arm. “Mrs. Pinkley, may I walk you back to your office?”

  “Dr. Bower, you got a minute?”

  Lukas turned from his charting to find Buck Oppenheimer leaning against the counter of the circular central E.R. desk, his broad, thick shoulders drooping, his eyes bloodshot. He wore an old pair of gray sweats, which meant he was off duty—a rare condition for him lately.

  “Sure, Buck.” Lukas shoved aside his charts and waited for Buck to talk.

  Buck glanced at Carol, the secretary, who clicked at her computer keyboard a few feet away, then he looked back at Lukas. “Alone?”

  “Hmm, must be serious.” Lukas got up and led the way across the pale green tile floor toward the private waiting room. “Come on in here.” He opened the heavy oak door and stepped into the carpeted silence of the small, comfortably furnished room. He indicated an overstuffed chair for Buck.

  “Kendra didn’t take me back.” Buck sank down on the edge of the chair with his head bowed and his hands clasped between his knees.

  Lukas sighed. “I’m sorry.” What was he supposed to say? Admit that he thought Kendra was behaving like a spoiled brat? “Maybe she just needs more time, like Lauren said.” He knew Buck didn’t have any kids, so at least no one else was being dragged through this ordeal. He’d heard a rumor that they couldn’t have children, but he tended to ignore hospital gossip.