Fatal

by Michael Palmer

  Matt followed the litter to the ortho room. Out of the corner of his eye he saw mine safety officer Blaine LeBlanc, dressed in pressed chinos and a hundred-dollar shirt, speaking to the driver of the pickup while making notes on a clipboard. Too late for Matt to avoid eye contact, LeBlanc turned toward him. His face was pinched and pallid. Matt flashed on what the humorless mine officer might be thinking.

  Oh, no, here we go again. Another goddamn crusade by Dr. Do Little. Well, go ahead and try causing us more trouble, asshole. No one pays any attention to you anyhow. . . .

  LeBlanc shook his head derisively, and Matt responded with a cheery thumbs-up. As long as Matt continued his efforts to make BC&C own up to its safety shortcomings and corner-cutting, they would be enemies.

  Brian O’Neil, the orthopedist on team B, reached the cast-room door simultaneously with Matt. At six-three, O’Neil was two inches taller than Matt was, and a couple of years older. He had added two or three dozen pounds to the hard-nosed linebacker he had been at WVU, but at forty he was still a hell of an athlete. He was also a top-notch surgeon and Matt’s closest friend on the medical staff.

  “You first,” Matt said. “I take enough of a pounding from you under the hoop.”

  “Since when did Gunner Rutledge ever mix it up under the hoop? You’d need a map just to show you where under the hoop is. Get a line in please, Laura. Normal saline. Usual bloods. Type and cross-match for six units. Portable films of his chest and leg. As soon as Dr. Gunner here has finished examining him, give him seventy-five of Demerol and twenty-five of Vistaril I.M.”

  “We’re on it,” Laura Williams replied, unflappable as always.

  “You know, pal, Laura and some of the other nurses were betting that you’d sleep through this one.”

  “They may still be right. Seeing you here on time makes me think I might be dreaming.”

  Together, they moved to the bedside and assisted the nurse in cutting away the young miner’s clothes. He might have been nineteen or twenty, with reddish hair and wide, feline eyes. His narrow face was etched with pain, but he forced his lips tightly together and took the jostling to his shattered leg without a sound.

  “I’m Dr. O’Neil, the orthopedist,” Brian said. “This is Dr. Rutledge. He’s a veterinarian, but he’s a damn fine one. We’re going to take good care of you.”

  “Th-thanks, sir,” the young man managed. “I’m Fenton. Robby Fenton.”

  “What in the heck happened down there, Robby?” O’Neil asked as Matt began a rapid physical assessment.

  “It was Darryl Teague, sir. He . . . he went berserk. He’s been actin’ a little tetched for a while, but tonight he was operatin’ the C.M. an’ he jes went off. You know what a C.M. is—a continuous miner?”

  “That monster machine that scoops up coal and puts it onto the conveyor belt?” Matt said.

  “Exactly. Twelve ton or more every minute.”

  “You never cease to amaze me, Dr. Rutledge,” O’Neil said. “No wonder you don’t date even though people tell me you’re the prime catch in the region. You scare all the women away with your vast knowledge.”

  “Don’t pay any attention to him, Robby. He’s lucky he’s a darn good bone doctor, or no one would even talk to him. Go on.”

  “Well, early on in the shift Teague got into a shovin’ match with one of the guys, Alan Riggs. I don’t know what it was about. Teague’s been like that for a while—pickin’ fights, complainin’ that people were out to get him, that sort of thing. Well, a bunch of us broke it up between him and Riggs. Then, a little while later, Teague goes after Riggs with the C.M. He runs right over him, I mean right over him. Then he goes on an’ takes out maybe half a dozen supports. That’s when the roof caved in. How are the rest of the guys?”

  “We don’t know yet, Robby. You’re the first arrival.”

  “Alan’s got to be dead. You shoulda seen it. Blasted Darryl Teague. I don’t usually wish nobody no harm, but I hope he got hurt but good.”

  “Dr. Rutledge, we need you,” Laura Williams said from the doorway.

  Matt had been so mesmerized by Robby Fenton’s account that he had completely forgotten about the deluge that was about to hit. Now the ER was in beehive mode. Six of the beds were occupied by miners in varying degrees of distress and pain. Technicians, nurses, and physicians were in constant movement, but the chaos seemed organized and nothing looked out of control.

  “We don’t need your internist skills right now,” Laura said, “but we sure could use your ER talent. There’s a lac in three. A beauty. I’ve ordered skull films, but they’re going to take a while. He’s low on the triage totem pole.”

  Matt stopped in the on-call room and quickly changed into scrubs. He was on his way to room 3 when Blaine LeBlanc intercepted him. A New Yorker with a dense accent, LeBlanc was a fit fifty, just an inch or so shorter than Matt, and broader across the shoulders. His thick, jet hair was slicked straight back and held in place with something from a tube. His trademark white stripe, an inch and a half across, glistened beneath the fluorescent overheads.

  “What did that kid in there tell you?” he asked.

  “Nice of you to inquire after the lad, Blaine. He has a compound fracture of his femur. That’s when the ol’ thighbone is sticking out through the skin. He won’t be pushing coal for you for a while.”

  “Back off, Rutledge. What did he tell you?”

  Matt met LeBlanc’s icy stare with one of his own. The man was potentially dangerous. Of that, Matt had no doubt. It was possible that before Ginny died, he had held his contempt for LeBlanc and BC&C in better check. But with her gone, he simply didn’t care. A lifelong health nut and nonsmoker, Ginny had no family history of lung cancer. She was only thirty-three when the diagnosis was made, and her tumor was an unusual cell type—the kind of unusual cell type that might, might, have been caused by some sort of toxin.

  No one could deny that BC&C’s coal processing plant was awash in carcinogenic chemicals. Whether they were handling and disposing those toxins in a safe, legal manner was another story. Matt had plenty of theories and some hearsay about illegal dumping or storage, but no proof. There was never any proof. Still, he was certain that if there were shortcuts in any aspect of mine safety or toxic waste disposal, the directors of BC&C would choose to take them. It had been that way when his father was killed, and Matt felt certain it remained that way today.

  Over the years he had kept up a steady stream of letters to MSHA—the Mine Safety and Health Administration—demanding investigations and spot inspections. Once, two years ago, they had actually responded to his demands by sending a man in. Nothing—absolutely nothing except some minor maintenance log omissions. Now his credibility was at an all-time low. The folks at the agency either refused to return his calls or, when they did, as much as laughed at the notion of acting on his “information” with another surprise intrusion.

  Despite his contempt for Blaine LeBlanc, Matt could see no reason why the safety officer shouldn’t know what had happened in his mine.

  “Fucking Teague,” LeBlanc said when Matt had finished the account. “Stupid fucking Teague.”

  Mickey Shannon, the miner Matt had been sent in to suture, was fifty-four—positively ancient for mine work. In fact, he actually remembered working the coal face with Matt’s father.

  “Good man . . . Real good man . . . Stayed one of the guys even after they made him a foreman.”

  A sharp chunk of rock from the tunnel roof had glanced off Mickey’s forehead right below the hairline. Three-quarters of an inch higher would have meant a direct hit on his skull, and his name might have been added to the list of fatal mine casualties kept on the wall of The Grub Pit Bar and Grill. Instead, the rock had peeled a five-inch-wide flap down over the bridge of his nose and across his eyes.

  “I’m going to put some novocaine in to numb this thing up,” Matt said.

  “Don’t bother, Doc. Just sew me up an’ get on to someone who needs your help more’n I do.” />
  Matt knew from experience that this was no false bravado. Mickey Shannon and the rest of the miners had been dealing with physical punishment and pain nearly every day of their adult lives. Caring for them and folks like them was one of the main reasons he had returned home to do medicine. It was the rugged, scramble for every dollar, help your neighbor even though you hardly ever have time to speak with him type of mountain people who made up much of his practice.

  “Hey,” Matt said, “you handle the mining, I’ll handle the doctoring.”

  “If you say so. People round these parts speak real highly of you, Doc. I been thinkin’ lately of gettin’ me a doctor, and you’re the one I ’uz gonna call.”

  “Do that,” Matt said, dreading what an X ray of the man’s chest might reveal.

  He numbed the margins of the huge wound with 1 percent Xylocaine, prepped the area with Betadine, clamped a set of sterile drapes around it, and carefully lifted the flap back in place. There was going to be a scar. There always was when skin had to be sutured. The question was whether to do a meticulous, microscopic closure with tiny sutures that might pull out if tested by Mickey’s going back to work too soon, or a quicker job using thicker suture material, guaranteed to hold under almost any circumstance.

  “What’s the deal with your qualifying to collect disability?” Matt asked.

  “We get full salary so long’s we have sick time available. Then it’s a month waitin’ period before the disability kicks in. With a doctor’s note sayin’ the problem is work-related, we start collectin’ disability immediately with no loss of sick time. But I’m—”

  “Shhhhhhh.”

  Matt selected dissolving sutures for a careful, layered closure, and fine, 6-0 nylon for the actual skin. Then he donned magnifying goggles and a new pair of gloves. Mickey’s lined, weathered face showed every day of three decades in the mine. But there was no way he was going to leave the ER with anything but the thinnest of scars from this one.

  “You’re out for two weeks,” Matt said. “I’ll give you the note. In fact, make that three weeks. And if you have any kind of a headache, any kind at all, we’ll tack on a few weeks more.”

  Twenty minutes later, he was halfway done with a closure that would have satisfied a movie star, when Laura Williams, breathless, called to him from the doorway.

  “Matt, Dr. Easterly needs you right away in the crash suite. You’ll have to finish in here later.”

  Matt placed some saline-soaked gauze over Shannon’s wound and set the sterile drapes aside. Then he stepped back from the table, flexing some of the tightness from his neck.

  “Mickey, you hear that?” he asked.

  “Don’t worry about me. Who’s he got to see, miss?”

  “A man named Darryl Teague,” Laura replied. “Some sort of heavy equipment fell over on him.”

  “Let ’im die!” Mickey Shannon snapped.

  CONSIDERING THAT EVERY bed in the ER was occupied and most of those patients were being attended to, there was quite a crowd working in room 10. One glance at the overhead monitor told Matt why. Heart rate 140. Blood pressure 80/40. Oxygen saturation only 89 percent. Jon Lee, the nurse working beside the gurney, caught Matt’s eye and made a brief thumbs-down sign. It seemed as if Mickey Shannon’s and Robby Fenton’s prayers were being answered. Somewhere beyond the wall of technicians, nurses, and GP Judy Easterly, Darryl Teague was on the verge of checking out.

  “What’s up?”

  Startled, Judy Easterly swung around, then came over to him. Not the most energized or enthusiastic of doctors under any circumstance, she was currently in her seventh or eighth month of pregnancy, and looked as if she would have chosen to be anyplace in the world at that moment other than where she was.

  “This is the guy who caused all this,” she whispered.

  “I know,” Matt whispered back. “Is he bleeding somewhere?”

  Easterly thrust out her gravid belly and arched her back, trying to relieve some tightness somewhere.

  “Not that I can tell,” she replied, still whispering. “He drove some piece of heavy equipment over two guys. No one knows why. One of them’s dead. The other’s up in the OR right now, and I don’t think he’s going to make it. After he did that, he knocked down some supports and the roof collapsed. He was trapped beneath a load of rock. The rescue guys said his BP was all right on the way in. I think the triage nurse assigned him to me because he looked pretty good when he got here.”

  “Not anymore. Obvious fractures?”

  In addition to the usual sources of hidden blood loss—the chest and abdominal cavities—a fractured leg, or even an arm in some cases, could cause enough bleeding into muscle to throw a victim into shock.

  “None,” Easterly said. “He’s moving all extremities. Joe Terry was just hanging around waiting for the OR to be ready for his case, so I had him put an arterial line in.”

  “Nicely done.”

  Matt meant the compliment, although it was also obvious that except for the arterial line, Easterly hadn’t been nearly aggressive enough with a man this hurt. At the moment she seemed close to tears.

  “You know,” she said, “if I had known I was going to end up with this sort of crunch in the very guy responsible for the disaster, I would have stayed home.”

  “Listen, Judy, why don’t you go ahead home right now,” Matt said. “You’ve got things under reasonable control here, and it looks as if you and the kid could use some rest.”

  Easterly started to protest, then suddenly thanked him.

  “Bloods are off for the usual labs plus six units,” she said rapidly. “I ordered a portable of his chest and abdomen. I really appreciate this.”

  “Just name your kid after me,” Matt said.

  “Matthewina,” Easterly said. “I think she’d like that. Hey, thanks. Good luck.”

  Before Matt could even respond, she was gone. It was just as well. She clearly had other things on her mind and was already hovering between not-much-help and downright dangerous. He glanced again at the monitor and moved into Easterly’s spot at the bedside, across from Jon Lee. Then he stopped short, staring down in disbelief at the man whose insane rage had just killed one and possibly two co-workers. Darryl Teague’s face was covered with fleshy lumps, at least twenty of them, some pea-sized, but some quite a bit larger, and one, just in front of his left ear, approximating a walnut. Almost certainly they were neurofibromas—bundles of nerve tissue mixed with spindly fibrous cells. Cause: unknown. Cure: none known. Darryl Teague was well on his way to becoming an Elephant Man.

  Even more startling to Matt was that Teague was the second case of such a condition he had seen in the past four or five months.

  “Laura, Dr. Hal Sawyer is part of our disaster team. Could you please call him in the lab and ask if he can come over as soon as possible.”

  “You’ve got it.”

  Matt quickly turned his attention to the miner. Teague was conscious and still breathing on his own, but his skin was mottled and his lips were a grayish purple.

  “Jon, anything ordered for his pressure?”

  “Nothing yet, Doctor.” Lee’s tone made it quite clear that he was grateful for the change in medical command.

  “Hang some dopamine, standard drip. Run it wide open until we see what happens. Get a catheter in him and keep his volume up.”

  Laura Williams returned. “Dr. Sawyer will be over shortly,” she said.

  Matt peered up at the EKG monitor. The size of the beats on the tracing appeared much smaller than normal. He filed the information away for the moment and began an efficient exam. Teague’s heart sounds were muffled and distant. There was tenderness in the center of his sternum—enough tenderness to cause the semi-comatose man to cry out when the spot was pressed. His belly was soft and not the least bit tender. His lungs were clear. Legs, arms, unremarkable. Skull and scalp also normal, except that there were a dozen or more neurofibromas hidden beneath Teague’s long, strawlike, dirty blond hair.


  In short, there was no evidence for bleeding anywhere. So why was Teague in shock?

  The likely answer at the moment centered around trauma to the miner’s breastbone, and beneath it, his heart.

  “Laura, where’s Dr. Crook?” he asked.

  “On his way in. Turns out his beeper was accidentally shut off, and his phone wasn’t working. The Sandersonville police went out to his place and woke him up.”

  Sandersonville was twenty minutes from the hospital and Crook was hardly the sort who would simply jump into a pair of sweats and race on in—especially when there was no definite indication in any of the victims that a cardiologist would be needed.

  “Dr. Rutledge?”

  Lee gestured at the monitor—70/30.

  “Prepare to intubate him, Jon. Anesthesia around?”

  “In the OR.”

  “Radiology?”

  “Same. She’s doing some sort of procedure with Dr. Terry.”

  Inwardly Matt groaned. He had intubated dozens of patients, many of them critical, so that was no problem. But his ability to interpret an ultrasound was average at best. In a life-and-death situation like this one, he would want a radiologist’s opinion.

  “No problem,” he said. “Get me a seven-point-five tube, please. Laura, could we talk out there?”

  The nurse looked at him curiously.

  “Of course,” she said.

  “Jon, just shout if you need me.”

  Matt walked Laura to the nurses’ station. She was a straight-laced grandmother in her early fifties, traditional in her approach to medicine, and a damn fine nurse. She was never comfortable with Matt’s open style, manner, and dress, and she had said so on several occasions. Still, over the years, they had managed to co-exist with few problems. Now, he knew, he was about to put their mutual respect to the test.