Medical Judgment

by Richard L. Mabry M. D.

  Each time a pair of headlights came down the street, the man slid down behind the wheel until he wasn’t visible through the windshield. Twice he’d done it, only to see the headlights pass and be replaced in his rearview mirror with the twin red dots of taillights receding in the distance.

  This time, the vehicle bearing the headlights slowed as it approached the doctor’s house. After it turned into the driveway, he eased up from his hiding place behind the steering wheel and watched the car stop with its nose just feet from the locked garage door.

  He knew it was locked, because less than an hour ago he’d parked farther down the street, walked innocently past Gordon’s house, then ducked back to try his coat hanger trick on the door. He could trip the emergency release lever but was unable to budge the door. So she’s discovered how to lock it. That may make her safer in the short term, but it’s inconvenient for her, and all it means for me is that it’s time to step up the action.

  Dr. Gordon sat for a moment in her car, apparently deciding how to proceed. Either way, the man was prepared. He pulled his pistol from his waistband, lowered the driver-side window of his vehicle, and, resting the pistol barrel on the window ledge to steady it, aimed the Beretta toward Gordon’s front door.

  When the car door opened and she started her dash toward the house, the man smiled. He took in a deep breath, let it partway out, and gently took up the tension on the trigger. The noise of the gunshot was no more than a flat clap that quickly died away. A dog a few houses down the way let loose a series of sharp barks. Then everything was quiet once more.

  The man rolled up the car window, carefully stowed the pistol, and drove away, not turning on his lights until he reached the end of the block.

  6

  Sarah stood in her living room and tried to ignore the noises coming from the darkness outside the closed front door of her home. Instead, she concentrated her attention on Bill Larson, who was saying, “Tell me one more time what happened.”

  She’d been over it so many times Sarah almost had the words memorized. She described again the events of less than an hour ago. “When I heard the shot, I dropped to the ground. I reached up, unlocked the front door, rolled inside, and locked it behind me. Then I pulled out my cell phone and called 9-1-1.”

  “You’re certain you only heard one shot?” Bill Larson said.

  Sarah Gordon forced herself to relive that terrifying moment. “Yes. One shot.”

  “And what happened before that?”

  “I sat in my car, trying to decide if it would be safer to get out, unlock the garage door, and pull in, or simply make a dash for the front door.” She took a deep breath. “I chose to run for it. I had almost reached the front door when I heard the shot. At about the same time something hit the door frame above my head.”

  The front door opened and a patrolman stepped into the room. “Here’s the slug,” he said. He held out a small plastic envelope containing a misshapen piece of gray metal. “We dug it out of the wood just above the door. Looks like it could be a 9mm, but I imagine it’s too deformed for ballistics to tell us much.”

  “I guess I’m lucky it didn’t hit me,” Sarah said.

  “Either that, or he wasn’t trying to hit you,” Larson replied. “If we assume the same person is behind all these episodes, then consider the progression of events. First, some phone calls after midnight. I understand why you’d ignore them. It was easy enough to write them off as the work of a practical joker, maybe some kids getting their kicks. And you were still trying to recover from the death of your husband and child.”

  Sarah nodded, trying without success to relax the tight knot growing in her stomach.

  “Then you saw a man standing outside your window, something you should have reported to the police, but didn’t.”

  “I wasn’t sure I saw him. Maybe I should have called them, but I was—”

  “I understand,” Larson said. “Let’s focus on what happened afterward. You had a fire that was set in such a way that it probably wouldn’t burn down the house. Then you saw a suspicious person sitting in a dark sedan parked outside your house. And now someone puts a bullet into the door just above your head.”

  “So . . . ”

  “So, I think someone is trying to frighten you. There’s been a definite progression to the attempts, but so far it seems he may only want to scare you. But what he’s doing is a little more serious each time. That’s not to say he isn’t going to make an attempt on your life at some point, but first it seems he’s getting his jollies making you sweat.”

  “Well, he’s succeeding,” Sarah said. “And you’re right about the escalation. Now I find myself constantly worrying what will be next . . . and whether it will be fatal.” She reached behind her, felt the couch, and collapsed onto it.

  “Are you still adamant about staying in the house?” Larson asked.

  “Yes. I’m not going to let him drive me out of my home. It’s the one Harry and I bought. It’s the one I brought Jenny home to from the hospital. It’s . . . ” She shook her head. No need to say it yet again.

  “Then you’d probably better get that security system we’ve talked about,” Larson said. “I also recall mentioning a pistol for you. Unofficially, that’s not a bad idea.”

  “Security system, maybe. Gun, never,” Sarah said. “Are you any closer to finding the person behind this?”

  Larson shook his head. “It’s too soon, I’m afraid. I have that list of people you’ve seen in the emergency room, and I’ll start interviewing them tomorrow.” He looked at his watch. “Or actually, later on this morning. While I’m doing that, I’ll probably ask the other detective with whom I work to look into some other areas.”

  “And if nothing comes of what you’re doing?”

  “Then we’ll keep at it,” Larson said. “Don’t worry. I’ll catch the person behind this.”

  “But meanwhile, I have to go about each day with a target on my back, wondering when and where the next event will take place. And, of course, not knowing when he’ll get tired of playing the game and decide to end it . . . and my life.”

  * * *

  Tom Oliver’s voice carried traces of sleep when he answered his phone at half past seven the next morning. “Dr. Gordon, the caller ID showed it was you. If it were anyone else calling at this hour, I’d have let it ring, but I figured you wouldn’t call this early if it weren’t important.”

  “You’re right, Tom, and thank you for answering. I’ve thought about what you said, about a security system. How soon can you or someone from your crew get to my place and put one in?”

  There was a pause. She guessed the man was thinking about his schedule.

  “Since it’s for you, I guess I could shake loose and install it myself. I’ll do it today. There are several choices, though. What did you have in mind?”

  They spent the next fifteen minutes discussing options. Sarah’s decision was to arm every door and window so that a breach would not only set off an alarm in the home, but also notify the security company. Sarah had a number of questions, and Tom seemed prepared to answer all of them.

  “How do I use my garage door opener and not call out the police or National Guard or whoever?” she asked.

  “You’ll be able to arm and disarm the system a number of ways, including a key fob you can put on the same ring as your car keys,” Tom said. “When you leave, you’ll arm the system after you watch the garage door close. When you return, you disarm it, open the garage door, close it behind you, and rearm it.”

  “So I can go back to using my garage opener?”

  “Right. Any other questions?” he asked.

  “Can you have it done today before I leave for work this afternoon?”

  Another pause. “I guess I could do that. I’ll pick up the material and be at your house by nine. I should have you ready to go by noon.”

  “Thanks,” Sarah said. “Oh, and while you’re here, I’m going to need you to patch a bullet hole above my front
door.”

  Sarah hung up. Then two thoughts crossed her mind. The first was that her final words of the conversation should give Tom something to think about as he gathered the material for the job. The second was more troubling. Was it really a good idea to have Tom, whom she’d known for just a few days, install the security system on which she’d depend for her safety? Or had she made a mistake—a big one?

  Suppose Tom was in some way involved in this game of cat and mouse. Maybe he or his son . . . No, that made no sense. You’re getting paranoid, Sarah. Well, sometimes paranoia wasn’t such a bad thing. In this case, she could only hope it would keep her alive.

  * * *

  The hairs on the back of Sarah’s neck prickled as she walked into the emergency room of Centennial Hospital that afternoon. The trip from her home, where Tom Oliver had just completed the installation of her alarm system, was a terrifying one for her. She wasn’t sure why her fears seemed to have heightened. Maybe the installation of the security system had made it all more real to her. But whatever the cause, Sarah was more nervous than usual today.

  She’d kept her eyes moving, scanning in all directions for someone who might ram her car or shoot at her. Once in the hospital parking lot, she debated phoning for a security officer to escort her, a tactic she decided with some regret to forego. Get real. It’s broad daylight and shift change time. People are coming and going all around you. You’re safe, Sarah.

  Sarah shoved her backpack into her locker, closed the door, and spun the dial of the combination lock. As she was turning away, Connie Douglas hurried into the break room of the ER. “Are you coming on duty?” Connie asked.

  “I thought I’d check first with Dr. Perkins to see if there’s anything special I need to know,” she said, “but, yes, I’ve got this shift.”

  “Well, don’t bother talking with Dr. Perkins. I need you now,” Connie said.

  She hurried away without another word, leaving Sarah to follow. Connie had worked in this ER or others like it for a couple of decades. She was no rookie, and when Connie said to hurry, it was best to do just that.

  As she exited the break room, Sarah noted a flurry of activity in one corner of the emergency room. The curtains weren’t completely drawn around one of the spaces, and she could see Dr. Craig Perkins bending over an elderly man, doing cardiac compressions. She recognized an anesthesiologist at the patient’s head, evidently trying to place an endotracheal tube, a polyethylene tube inserted into a patient’s airway to administer anesthetic gases, or in this case oxygen. Other people were there as well, although Sarah could catch just a glimpse of them as they worked.

  This explained why Connie needed Sarah in a hurry. Apparently, she was aware of a patient needing immediate medical attention, and it would take a few moments to get another doctor down here. Sarah quickened her pace.

  Sarah wasn’t sure what she expected to see when she followed Connie through the curtains into a cubicle opposite the one where Craig was working. On the gurney parked in the center of the space was a young woman, no more than a teenager was Sarah’s guess. Beside her was an older female who bore a slight resemblance to the patient—perhaps a mother or other relative, Sarah thought.

  An IV was running into the patient’s hand. The two prongs of an oxygen catheter led into her nostrils. A monitor beside the gurney displayed her heartbeat and blood pressure, and the leads from another monitor led under the sheet onto her distended belly. She was obviously pregnant, and although it appeared she was in labor, she remained silent.

  “Miss Young has been having contractions for a couple of hours,” Connie said, slightly emphasizing the Miss in case Sarah missed that information on the clipboard she was handed. “She has no obstetrician. I phoned the OB on call when she arrived, but in the meantime the fetal heart tones have dropped.”

  Connie’s voice never displayed the concern Sarah knew she was experiencing. Sarah felt it as well. As soon as the situation became clear, Sarah felt tentacles of fear grip her heart. This was one of the true emergencies in obstetrics—fetal distress.

  “How far along in your pregnancy are you?” Sarah asked as she moved to the patient’s side. “Do you know when the baby’s due?”

  “I . . . I think I’m about nine months along.”

  “First child?” Sarah figured that, given the age of the patient, the answer was probably “yes,” but she’d learned never to assume anything.

  “I . . . I had an abortion about a year and a half ago. My boyfriend wanted me to do the same thing with this pregnancy, but I . . . I refused. I want this baby, even if he doesn’t.”

  Sarah placed her hand on the young girl’s abdomen. There was no fetal movement, and although that wasn’t a definitive sign, it was enough to concern her. What she could feel, though, were frequent and somewhat irregular contractions of the uterus. “What FHT rate did you get?” she asked Connie.

  “Here. Take a look at the electronic fetal monitor tracing.” Connie handed Sarah a broad paper strip with two irregular lines, one below the other.

  Sarah’s own pulse quickened as she noted that the baby’s heart rate wasn’t the normal 120 to 160 beats per minute. The FHT, the fetal heart tones, demonstrated wide swings in rate, dropping and peaking in a pattern that told her there was definite fetal distress. And the monitor confirmed that the uterus was contracting frequently.

  “Let’s have a quick look,” Sarah said, reaching for exam gloves. What she feared was evident the minute she looked beneath the sheet. The young girl was bleeding. She undoubtedly had some degree of placental abruption, a turning loose of the placenta that left the fetus starved for oxygen. Whether the contractions had caused this or vice-versa was a chicken-and-egg question, one she didn’t need to address. The important thing wasn’t the cause—it was the solution. The situation called for an immediate Caesarian section to save the baby.

  “Who’s the OB on call?” she asked Connie.

  “Dr. McClelland. I called him already,” Connie said. “His service was going to give him the message.”

  “Call again. Do whatever’s necessary to get through to him. I’m going to call upstairs and alert OB to prepare for a C-section.”

  The patient looked up at Sarah, fear obvious on her face. “What’s happening?”

  “The placenta—the thing that gets blood to the baby—part of it is coming loose from the wall of the uterus. We’ll need to take the baby surgically—what we call a Caesarian section—as quickly as possible.”

  “I . . . I don’t have a doctor,” the young girl said.

  The woman at her side spoke for the first time. “I’m her sister. We don’t have insurance. But I’ll make sure the doctor and the hospital are eventually paid every penny. Just do whatever you have to. This baby is important . . . to all of us.”

  Sarah looked to make certain the IV was running. The girl’s vital signs were abnormal, but Sarah’s real worry lay in the tracings from the fetal monitor, still showing significant swings in the heart rate of the baby. She pulled out her cell phone and started to dial the labor and delivery section of the hospital. “It’s important to me, too. And I promise you we’ll do whatever’s necessary to make sure this baby gets here safely.”

  * * *

  Connie sat just off the ER in the room that served the staff as both lounge and locker room. She held a cup of coffee, occasionally blowing across the surface of it before sipping, as she took advantage of her supper break. Connie often chose to combine eating her meal with reading a few pages in her Bible, and that’s what she was doing today.

  She didn’t flaunt her religion, but neither did Connie try to hide it. She’d discovered that some of the patients she dealt with in the emergency room appreciated a nurse with a spiritual connection. As for the others—well, she simply tried to witness to them in whatever way she could. Matter of fact, that’s what she’d been doing to her friend Sarah for several months. She looked up to see the doctor coming into the room.

  “Hiding out, are
you?” Sarah asked.

  “No, just taking my supper break,” Connie said. She motioned to Sarah to sit down. “Have a seat. What’s the latest on the Young baby?”

  Sarah eased down onto the sofa beside her friend. “I took the patient up to the delivery room, hoping Dr. McClelland would arrive on time. As it turned out, he was already up there, waiting for a patient to deliver. He agreed with us about the placental abruption and took Ms. Young right in for a C-section.”

  Connie watched as Sarah touched the corner of her eyes with a tissue, blotting away tears. “Did everything go okay?”

  “I had to hurry back to the ER, but I just called labor and delivery, and mother and baby are doing fine.”

  “So why are you crying?”

  “The mother had already picked out a name for the baby. It’s a little girl.” She took a moment to gather herself. “She named her Jennifer.”

  Connie reached for the hand of her friend. “Then let’s take a moment and pray for Miss Young and Jenny.” And for you, Sarah. Definitely for you.

  7

  It had been an emotionally draining shift, as well as a physically tiring one, in the ER. Sarah made certain the doctor relieving her was clued in on the patients she’d sent to X-ray, the ones awaiting lab work, and the few other bits of information he’d need to make the transition seamless. At last, she trudged to the break room and pulled her backpack from her locker. Although her inclination was to put an audible full stop to the day by slamming the locker door, she gently closed it.

  “Want me to walk to your car with you?” Connie said from a corner of the room.

  “Oh! I didn’t see you there,” Sarah said. She slumped onto the sofa. “No, I’ll be fine. I’m going to sit here for a minute while my thoughts sort themselves out. Then I’ll probably get one of the security guards to walk me to my car.”

  “Is that what you’re going to do every night until the police catch the creep who’s behind these attacks?”