Sacred Trust

by Hannah Alexander

  A few moments later he sauntered toward the central desk, where Beverly stood talking softly to Rita, the night secretary. He heard his name mentioned, then Dr. George’s; then they saw him and stopped talking. Beverly avoided looking at him.

  “Dr. Bower, the first call came in about an elderly man who is unresponsive,” Rita said.

  “What’s the ETA?”

  “He’ll be here in about four minutes.”

  “Vitals?”

  The phone rang again. Rita reached over to answer. “I wrote them down. His neighbor found him in the grass out in his front yard.”

  Lukas stepped toward the central desk and glanced at her note while she spoke with an apparently distraught mother with a sick baby.

  The incoming patient was an elderly man with a blood pressure of 109 over 68, a heart rate of 114, respirations of 14, pulse ox of 92 percent.

  “Did they mention any signs of injury?” Lukas asked when Rita disconnected from her call.

  “No, they didn’t say anything about it,” Rita said. “But they do have him fully immobilized and an IV established, and his pulse ox is 100 percent on a nonrebreather.”

  “What about the other ambulance?”

  “It’s BLS, and they’re worried that this patient might be cardiac.”

  Lukas grimaced. A BLS ambulance—basic life support—was not set up for cardiac under the service here, but the area only ran one BLS and one ALS—advanced life support—per shift.

  “The ETA for the BLS is probably about six minutes now,” Rita continued. “They had some trouble understanding him. He doesn’t speak English, and they couldn’t find a Spanish-speaking interpreter at this time of night.”

  “So what have they done?”

  “They’ve got an eight-year-old boy translating right now. The patient is about forty-five years old with chest pain, severe headache and nausea. He was fine until he went to work—” The phone rang again, and she pushed another note with vitals toward Lukas while she answered.

  Lukas read the note, then motioned to Beverly. “Looks like we have a couple of serious ones. Let’s call another nurse down from the floor.”

  “Okay.” She still avoided looking at him. “I have room four ready for the first arrival and five for the second.”

  “Good.” He turned to see Connie, the paramedic, and a male EMT wheel the first patient in on an ambulance cot with an IV pole. A young woman followed directly behind them.

  Lukas recognized the woman and glanced with concern at the patient. He was still unresponsive. The man’s features showed clearly, even through the nonrebreather mask. It was Frankie Verris. Disappointment overwhelmed Lukas. Had Frankie taken another overdose?

  “Hi, Shelly.” Lukas reached out and took her hand.

  Again, as before, she had been crying. In her hand she carried a damp, wadded tissue.

  Lukas turned to Beverly. “Are we getting another nurse?”

  “No. The floor supervisor said she wouldn’t send one down unless it was a real emergency.”

  “Did you tell her this was an emergency?”

  “Yes.”

  “Who is the supervisor?”

  “Rachel Simmons tonight.”

  Lukas nodded. He was becoming aware of some serious attitude problems among the staff, especially between the E.R. staff and the nurses on the floor, at least while he was on duty. Rachel Simmons was especially bad about refusing to send the float nurse down when they needed one. According to the grapevine, Rachel was having marriage problems and was difficult for everyone to get along with. She was also close to Dr. George. Bingo.

  Lukas picked up the phone and dialed Rachel’s number. He told her as kindly as possible that they were having an emergency and that he expected to see another nurse in the E.R. by the time the next ambulance arrived. She hung up on him.

  The entrance door opened, and ambulance attendants brought in the next patient.

  Lukas motioned to Connie, the paramedic with Frankie Verris. “We’re ready for you in room four. Have you done a bedside glucose test?” He turned to walk beside them into the exam room.

  “Yes, Doctor, it was 122. Nothing there. The patient has also received one amp of Narcan, IV push and 100 milligrams of thiamine.” She pushed the cot up beside the bed and raised the bed up even with the cot.

  “Any response?”

  “None noted. The patient also received an IV fluid bolus of 250 CCs.”

  “I noticed the BP was a little low on report. Do you have a current BP?”

  “It’s 130 over 85.”

  Lukas stepped to the other side of the bed and reached across to help with the transfer.

  Connie grasped the edge of the backboard from above Frankie’s head. “On three. One. Two. Three.”

  They transferred the patient to the bed, and Connie snapped off her monitor leads.

  Lukas bent over him. “What about the monitor?” He snapped his own leads onto Frankie’s chest and checked the rhythm.

  “Occasional PVCs and mild sinus tach,” Connie replied.

  He nodded with approval. She seemed to know her stuff. Nevertheless, the PVCs worried Lukas. They could be a signal for cardiac irritability.

  While Lukas checked Frankie’s pupils, listened to his chest and searched for signs of injury, the neighbor, Shelly, explained that, once again, she had not seen the elderly man fall.

  “Did he flush his pills when he got home from his last trip to the hospital?” Lukas asked.

  “You’d better believe they got flushed. I cleaned out his medicine chest when I took him home, all except for his aspirin. I nag him to take one every day.”

  “Good for you.” Lukas looked up at her with a relieved smile. “I don’t think it’s an OD this time. Could be his heart.”

  Beverly entered the exam room. “Dr. Bower, another nurse just arrived from upstairs, and she says Rachel is having a fit. Too bad, huh? Need some help?”

  “Thanks, Beverly. I need you to assist with Mr. Verris while we try to figure out what’s going on. Get me an EKG. He’s already on a monitor and an IV. I want the new nurse to help with the next one. Does anyone here speak Spanish?”

  “Uh, I do, a little,” the EMT who had helped bring Frankie in spoke up. The technician was a big guy with big ears and short hair.

  “I know you,” Lukas said. “Buck Oppenheimer. You’re supposed to be in a class-two trauma center recovering from a fake tension pneumothorax from the drill. Quick recovery time. I’m impressed.”

  The man grinned. “Yeah, I’m feeling better so I opted to work tonight. I’m usually first responder for the fire department, so I don’t get in here much. Right now I’m moonlighting.”

  “We may need your services with the other patient. He doesn’t speak English.”

  “Sure, Doc.”

  “Hey,” Beverly said, looking with dismay at the spider straps that secured Frankie to the backboard. “Dr. Bower, how can I get an EKG with him strapped down?”

  “You may remove the spider straps, but leave the c-spine immobilized,” Lukas said. “We still can’t rule out a neck injury.” He turned to Rita and gave instructions for blood tests and X-rays. “That’s enough for now.”

  He led the way into the next room, where the nurse from upstairs was helping transfer an overweight man, Mr. Mancillas, onto the bed. Through Buck’s halting translation, Lukas explained what he was doing as he auscultated the man’s chest. Information from the ambulance team revealed that Mr. Mancillas had felt fine until he had been at work for about an hour; then he began having trouble with confusion and blurred vision, as well as the chest pain.

  “Where does he work?” Lukas asked.

  “We picked him up at the school bus garage,” the tech told him. “We thought it sounded like his heart.”

  Lukas frowned. The patient’s skin was very red. “Buck, ask him if he has ever had any problem with his heart before.”

  Buck grimaced. “I’ll try. Like I told you, I just speak a little Spanish.�
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  “Understood. Just do the best you can. Nurse, we need to hook up a cardiac monitor.” He ordered an IV, EKG, X-rays and blood work. “Keep him on his O2.”

  Beverly came in with the printout of the EKG for Frankie.

  Lukas read the lines depicting the intricate rhythm of the elderly man’s heart. He was having a heart attack. “Okay, Beverly.” He gave orders for the meds needed.

  Still without eye contact, Beverly nodded and left to prepare for another IV. Lukas frowned as he watched her walk away. Was it something he’d said? His breath, maybe? Whatever it was, he had no time to worry about it now.

  “Rita, get me a chopper,” he called along the hallway as he stepped over to exam room four. He walked in to find Frankie waking up and blinking. As before, the man looked helpless and vulnerable, and Lukas felt a wave of compassion.

  “What’s going on?” Frankie asked, his voice weak and shaky. He winced and grabbed at his chest. “Why am I here?” His thin, pale fingers played at the leads of the EKG machine.

  Lukas gently moved the man’s hands away. “Shelly found you unconscious. Now we know why.”

  Mr. Verris groaned. “It hurt so badly.”

  “Your chest?” Lukas asked.

  Frankie nodded.

  Lukas squeezed his arm reassuringly. “On a scale of one to ten, how badly does it hurt now?’

  Frankie frowned and thought about it. “Maybe a five or six. Not as much as it did.”

  “Okay, we’ll take care of your pain. I’m sorry, Frankie, but you’re having a heart attack.” He turned to find the nurse coming back into the room. “Beverly, I need morphine. Start at two milligrams, slow IV push; then we’ll see how much more we need to relieve his pain. I’ll contact Dr. Simeon to see which cardiologist he wants me to call. Frankie, do you remember what you were doing when the pain started? What time was it?”

  “About ten o’clock tonight. I was watching the stars, just getting ready to go to bed, when it started. I tried to get over to Shelly’s house, but I didn’t make it.”

  Ten o’clock. If they got him to the cardiac cathlab as soon as possible, they might be able to save a lot of muscle.

  Frankie reached out and touched Lukas’s arm. “Can you do it again, Doctor? Can you save me?”

  Lukas patted the man’s hand and leaned forward. “We’re going to take good care of you, but it’s never up to me.”

  Frankie nodded. “You’re going to preach again, aren’t you?”

  Lukas grinned, once again feeling a rush of tenderness for this gentleman. “I’ll spare you if you’ll just keep in mind what I said last time.”

  “Maybe you shouldn’t spare me. Maybe—” Frankie winced. “Really hurts.”

  “Just hang in there, and we’ll try to get rid of that pain,” Lukas said as Beverly came back into the room with her supplies. He hesitated. “Frankie, do you want me to pray with you?”

  The man held his gaze for a moment, then nodded. “Maybe just a short one. I know you’ve got other patients.” He grimaced as Beverly stuck him for an IV, then relaxed when Lukas laid a hand on his shoulder and bowed his head.

  “Lord, we know You’re the Great Physician and that You’re all-powerful. No healing comes about except through You, and that healing begins when our spirits come into contact with Yours. Please touch Frankie’s heart physically, Lord. Ease his pain, both in his body and in his soul, and draw him to You. Show him Your love, and give me Your guidance as I treat him. Help us to work together as a team as we seek Your will. Lord, please help Frankie to understand that he really does matter to You, and that his next home can be with Doris if he will only accept Your gift of love.”

  After Lukas closed his short prayer, he raised his eyes to see Frankie watching him. “You can sneak a sermon in as well as Doris used to.”

  Lukas returned to his other patient, who seemed better. His face wasn’t as red, and the vitals didn’t look bad. This probably wasn’t even a cardiac.

  “Did you notice if there was a motor running in the bus garage when you picked him up?” Lukas asked the ambulance tech.

  The man looked surprised. “Yes, there was. He was working on it.”

  Lukas nodded. Of course. Carbon monoxide poisoning.

  Dr. Simeon called about Frankie, and they arranged for helicopter transport for the elderly man to Cox South. Since Simeon was the physician on call for the night, he also admitted Mr. Mancillas to his service at Knolls since the carboxy-hemoglobin level could be managed here. As Lukas made the arrangements, he heard voices in the waiting room, both in Spanish and English.

  Beverly saw Frankie off on the helicopter, then came back inside.

  “Got any more patients?” Lukas asked.

  She sighed wearily. “We have three darling little children bouncing off the walls over in three, another elderly gentleman being checked in, and while I was seeing Frankie off, another car drove up and parked in a patient parking slot. We’re in for a long night.”

  “Just what I always wanted.”

  Chapter Eleven

  Theodore Zimmerman awakened in the gray morning darkness with a heaving stomach and a skull that threatened to scatter against the four walls of his room. After three attempts he managed to force open sleep-encrusted eyes to peer toward the digital alarm clock.

  No illuminated numbers presented themselves. No night-light glowed from the hallway. Electricity must be out. Had there been a storm?

  He forced himself to sit up and swing his legs out of the bed. His left foot hit something hard and sharp, and sudden pain on the inside ankle bone rivaled his headache for a moment.

  With a blast of cursing he reached out, disoriented, and felt the hard top of a table. A coffee table. He’d kicked the corner.

  He wasn’t at home. He was on the lounge sofa at the agency. It was Tuesday morning.

  He groaned and laid his head back against a cushion. He’d left Tedi alone last night. He’d failed her. Again. Failed himself, too. He’d tried to sell that albatross for two years, and it just wouldn’t sell. Last night he’d been so sure those men would buy, but after their second walk through the building, they’d found more rotted floorboards, and in spite of all his fast talking, they’d balked, then left. And Tedi…

  What if Mercy found out about last night? She could take him back to court, take Tedi away, stop child support. She could even have him evicted….

  With difficulty, he slowed his panicked imagination. “She wouldn’t.” He allowed himself a tentative smile. She had too much to lose, and she knew it.

  Twice he’d requested more money for child support, and both times Mercy had complied without court intervention. Unfortunately, her resentment was becoming more and more obvious, and her sharp tongue had always cut deep. Recently it had been rubbing off on Tedi, who always made such a big deal about the money Mercy sent him. Good grief, didn’t the kid even think he had a right to child support? Mercy was the big, important doctor with the big bucks. Sometimes lately, with that long, dark hair and dark brown eyes, Tedi looked too much like her mother. Mercy had always been capable of infuriating him. She always had to prove she was better than him, so much smarter than a lowly real estate agent.

  Sometimes the real estate agent called the shots.

  Theo pulled himself up from the sofa and felt his way toward his office cubicle. The lighted display on the desk read 6:15 a.m.

  In the bathroom he swallowed some Tylenol and splashed his face with cold water. He didn’t remember much about last night after the sale fell through, but what he did remember worried him. He’d called Julie to meet him at the Golden Lion for a drink, and she’d refused, accusing him of being drunk already. She’d hung up on him. All he’d wanted was a little companionship after his disappointment about the building, and she’d hardly ever complained about his drinking before. In fact, she drank with him a lot, so why come across as some perfect Miss Priss when he was already down?

  He really needed to sell the Polsner building. Sales
were down all over this year. Prices continued to drop, and profits from that handy little land investment he’d made two months ago looked as though they might slip through his fingers. With the cost of improvements, it was a good thing he hadn’t gone into it alone. His other investors, however, could become a problem.

  Theo looked at himself in the mirror and nearly gagged. Bags puffed out from beneath his eyes, and his face looked as if he’d been drained of blood. He always took pride in his appearance because he knew it helped him sell property, especially to female buyers. But lately the dark circles under his eyes from lack of sleep might even be hindering sales. Who wanted to buy a house from a zombie? He had to figure out how to cut his stress level.

  Maybe it was a good thing he hadn’t gone home last night, even though Tedi had probably been afraid. It was better to be afraid of the dark than of your own father. That day a couple of weeks ago…That had been too close. Must’ve gotten ahold of some bad booze. He didn’t usually get that mad, especially not at his own daughter.

  And since Tedi was on his mind, he’d better take care of a situation he should have dealt with earlier. Mercy was due a telephone call. He punched the speed dial on his speakerphone.

  Mercy stood in the trickle of lukewarm water that passed as a shower in her rental house, hoping the warmth wouldn’t dissipate before she rinsed again. Last time, she’d gotten carried away and stood under the showerhead for a full five minutes. Had to rinse her hair bent over the faucet to keep from freezing in the cold water.

  She was washing shampoo out of her eyes when the telephone rang. She finished rinsing, grabbed a towel, and turned off the water as she plunged out to catch the phone. Her answering machine had broken three weeks ago, and she didn’t want to miss any possible patient calls.

  She dripped water all over the kitchen counter as she grabbed up the receiver. “Hello?”

  “Good morning, Dr. Richmond.”

  The too-familiar male voice dripped sarcasm, and Mercy almost dropped the telephone. Old anger surfaced in her like hot lava.

  She held the line without replying. He hated it when she did that. It scared him, made him wonder what she was thinking. He was intimidated by people who thought for themselves.