Medical Judgment

by Richard L. Mabry M. D.

  The door crashed open, sending the gunman staggering forward onto his knees.

  “Police. Drop the gun!” The policeman held his service pistol in a two-handed grip. “On the floor! Now!”

  Instead, the gunman, still on his knees, twisted to face the policeman, his own pistol extended. The next seconds were filled with gunfire.

  When he heard the first shot, Mark reached across the patient and shoved Kelly to the ground. “Get down,” he screamed.

  It seemed to Mark that the gunfire went on for a full minute, but he knew better. It always seemed that time either sped up or slowed to a crawl in emergency situations like this. His ears were still ringing when he raised his head and looked around. The gunman lay sprawled on his back, open eyes unseeing, his gun a foot away from his outstretched hand. Mark had seen enough death to know the gunman no longer presented any danger.

  The policeman was crumpled in the doorway, one hand clenched over his abdomen, a fountain of blood issuing from between his outstretched fingers. The other hand still clutched his service pistol. He was breathing, although his respirations were labored.

  Mark took in the scene in less than a second. He jumped to his feet and called to Kelly, “We need a gurney. We have to get him to the OR, stat.” To the aide, he said, “Stick your head out the door. Have them call for help. Alert the OR I’m coming up.”

  “He looks familiar. Who . . .who’s he?” Kelly asked.

  “Sergeant Ed Purvis. He brings patients here sometimes. I’d just finished with one when all this started.” Mark moved to the side of the wounded policeman. “Now help me get him onto a gurney.”

  “What . . .what about the wounded man already on the table?” Bob asked over his shoulder as Kelly and Mark slid their hands under the fallen officer.

  “Don’t worry about him. He was dead by the time Kelly wheeled him into the ER.”

  2

  In the operating room, a germicidal solution splashed on Ed Purvis’s abdomen by the circulating nurse turned the pale skin bronze. The scrub nurse hurriedly placed sterile green sheets around the operative area. While the anesthesiologist was still injecting medication into the patient’s IV line to relax him, Mark, now clad in a sterile gown, reached out a gloved hand for the scalpel and made a vertical incision that opened Purvis’s abdominal cavity wide.

  “Is one of the surgeons on the way?” Mark asked.

  “We’ve put out a call,” the circulating nurse said.

  “Guess it’s up to me until one shows up,” Mark said. He looked to the anesthesiologist at the head of the table. “Can you give me more relaxation?”

  Dr. Buddy Cane nodded. “Coming up. You’ve got a pretty good head start on me, you know.”

  Mark worked on, assisted by the scrub nurse. His attention was riveted on the operative field when a husky contralto voice from across the room said, “Tell me what we’ve got.”

  Dr. Anna King stood in the doorway, dripping hands held high in front of her. The scrub nurse turned away from the table to help the surgeon gown and glove.

  For a moment, Mark had almost forgotten that Anna was a surgeon. In his mind, she was an attractive blonde he’d dated occasionally. Of course, he’d heard rumors . . .Never mind. He wanted help and now he had it. “Multiple gunshot wounds of the abdomen,” he said. In a few sentences, he related how Purvis had been shot. “He’s hanging on by a thread. I think we need to—”

  “I’ve got it, Mark. Thanks.” This was a different Anna King from the one with whom Mark had shared dinner just a week ago. That one was funny, easy-going. This one was, in every sense, the surgeon. The attitude was “I’m in charge,” and Mark had the feeling that if he crossed her, he’d regret it. He was already wondering what a long-term relationship with her would be like. Never mind. He’d deal with that later.

  Within less than a minute, Anna was gowned and gloved. She moved to stand at the patient’s right side, and Mark slid around to a position opposite her. Anna readjusted the self-retaining retractor and held out her hand. “Let’s get some suction in here. Adjust that overhead light.”

  For a few minutes, the OR was quiet except for the murmured conversation of the surgeon and assistant as they bent over the operative area. Once, the circulating nurse darted in to mop Anna’s brow with a cloth. When she eased up behind Mark, he shook his head and she backed away.

  “How many units of blood?” Mark looked toward the head of the table.

  The anesthesiologist checked his notes. “Six.” He paused. “More coming. But his vitals keep slipping.”

  Mark’s deep breath resonated inside his surgical mask. “Let’s—”

  “Mark, you called for help. I’m here. Let me be in charge, would you?” There was no anger in Anna’s words, just a simple statement of fact.

  Mark nodded, but didn’t reply. He’d have to be careful not to cross Anna while she was in this mode.

  His mind moved from the Anna he’d known socially to the surgeon, Anna King. So far she seemed to be doing fine. There were too many smells in the operating room for him to pick up any scent of alcohol drifting through her surgical mask. Still, Mark wondered . . .

  Anna spoke without taking her eyes from the operating area. “Mark, I know you feel responsible for this patient, but you did your part by getting him up here as quickly as you could. Now it’s my responsibility.” She held out her hand and the scrub nurse slapped a hemostat into it. “We’ll do our best. But we can’t save every patient.”

  “I got him into this,” Mark said, clamping off another bleeding point. “It’s my fault he got shot.”

  “No,” Anna said. “Like every police officer, he knew the risks the first day he put on that uniform. You took the only chance you had to save the lives of three people.”

  “And it cost the life of another one,” Mark said.

  “Not yet,” Anna said. “Now, if you’re going to assist, don’t focus on assigning blame. Just help me.”

  * * *

  Anna King pushed her surgical mask down to hang beneath her chin. She stripped off her latex gloves and tossed them in the designated waste receptacle, then turned around so the nurse could unfasten her surgical gown. “I’m sorry, Mark.” She balled the gown into a mass and threw it after the gloves. “We did what we could. We just couldn’t save him.”

  Mark opened his mouth, then decided he had nothing to say, so he simply shook his head. Let her assign whatever meaning she liked to the gesture.

  Anna paused with one hand on the operating room’s swinging door. “I’ll see if his family’s here yet.”

  “No!” Mark hadn’t meant to bark the word, but, considering the state of his emotions at this point, he wasn’t surprised at the way it came out. “No,” he said more softly. “Let me go out there and talk with them. They need to know more than that he was shot dead.” He swallowed hard. “I need to tell them that he saved my life.”

  “Mark, you can’t take this personally. You see gunshot wounds in the emergency room all the time. Some of those patients we can save, some not. What’s so different about this one?”

  Mark knew what was different, but he wasn’t prepared to say the words. Not yet. Instead, he snatched the surgical cap off his head and held it in front of him like a penitent presenting an offering. “When they come into the ER—makes no difference which side of the law they were on when the bullets hit them—when they reach the ER, they’re mine. I’m going to do my best to save them. Some I do, some I don’t. I accept that.” He looked at the body of Ed Purvis, now covered by a sheet. “But this wasn’t someone who showed up with a gunshot wound. This was a man I knew—admittedly, not well—a man that I literally asked to put his life on the line to save mine.” Mark bowed his head.

  Anna put her hand on Mark’s shoulder, probably the closest she could come to a gesture of tenderness in this situation. “And he responded the way you hoped he would. He did what law enforcement officers do every day in this country. He did what he’d signed up to do, and in
doing so he saved your life.” She opened the door. “Come with me if you like. I know his family would appreciate it. But don’t take the responsibility for his death on yourself. And don’t think you have to spend the rest of your life making up for it.”

  * * *

  “Thanks for doing this, Steve,” Kelly said. “The adrenaline from what happened has about worn off, but I just couldn’t be alone . . .not for a while, at least. Besides, I . . .I think it might help if I sort of talked this out, and you’re a good listener.”

  Before he took a seat in the booth opposite her, Steve Farrington, pastor of the Drayton Community Church, handed Kelly one of the two steaming cups he’d obtained from the service counter at this all-night fast food establishment. “No problem, Kelly.” He blew across the surface of his cup. “When I heard about the gunman in the ER, I headed for the hospital. I found out you were one of the hostages, and after you were freed I stuck around to see if you needed anything.” He took a sip of coffee. “But, to be clear, did you want me here because I’m your pastor or your friend?”

  “Both, I guess,” Kelly said. “So you can wear whichever hat you want . . .so long as you stay here with me for a while.”

  “I’m happy to sit and talk with you, but don’t you need to call anyone else? Family, maybe?”

  Kelly thought for a moment. “No. My family wouldn’t understand or even care.”

  He looked into his coffee cup but didn’t drink. “Why don’t you tell me about it?”

  Kelly leaned across the table. “I was at the triage desk in the emergency room tonight when a man came in, supporting a gunshot victim. I was about to call for an aide to get a gurney for the patient when the first man grabbed a wheelchair and told me to push his brother back into the ER. I started to argue. Then he pulled a gun . . .” She bowed her head, closed her eyes, and took several deep breaths. “Sorry. He pulled a gun, held it to my head, and said, ‘Take my brother back there and get a doctor to fix him up, or I’ll kill you.’ ”

  “Obviously that was frightening,” Steve said. “So what happened then?”

  Kelly worked her way through the explanation of the next few minutes, ending with the shooting of the gunman by Sergeant Purvis. “We rushed the policeman into the elevator and wheeled him into the OR. The night crew had just finished an emergency case, and they took over. I went back down to the ER and spent the next hour or so talking with the police.”

  “How do you feel now?”

  Kelly shook her head. “I’m still shaky, but it’s getting better. Talking about it helps, I guess.” She looked down. “Now that I have time to think about it, during that time I was as worried for Mark as for myself.”

  “About what?”

  Kelly stared into her cup. “I didn’t want him to die.”

  “Why is that? Is it because Mark isn’t a Christian?” Steve asked.

  “I . . .I’m not sure where he stands. I’ve broached the subject a time or two, but Mark always deflects the conversation. I get the impression he doesn’t like to talk about religion.” She drained the cup and shoved it aside. “He says he got too busy for all that when he was in medical school.” Kelly patted her lips with a paper napkin. “I think talking about religion embarrasses him.”

  “You and Mark have been going out for a while, haven’t you?”

  “Several months,” Kelly said.

  “Is it serious?”

  “It’s not exclusive for him, I guess—he went out with one of the surgeons from the hospital last week—but I haven’t dated anyone else since I started seeing him.”

  Steve started to stand. “Would you like some more coffee?”

  Kelly shook her head.

  He sat down again and took a sip from his cup. “Is Mark’s spiritual status the main reason you were concerned about him?”

  “I . . .” Kelly shook her head.

  “This probably isn’t the time for you to talk with Mark about this, but that time will come soon. I think you’d better try to sort out your feelings before then.” He reached over and placed his hand on top of hers. “Until then, maybe you should pray about it.”

  Kelly nodded silently. Yes, for both Mark and me . . .because I didn’t tell you the rest of the story.

  * * *

  Mark struggled to keep his voice steady as he stood face to face with Dr. Eric McCray in a relatively quiet corner of the emergency room. “Tough night,” Mark said. “Thanks for taking over down here.”

  “No problem, man. When I got the call from the hospital about what happened, when they told me you had to go up to the OR to try to save the policeman’s life, I jumped into my car and headed here, praying all the way.” He pointed around the ER. “Everybody pitched in. Jim’s coming on duty in another hour, but I think I’ll stick around to help him clear out the backlog.”

  “No need. I’m okay to get back to work.”

  “Forget it,” Eric said. “I don’t have anyone at home waiting for me. You need to clear out of here.”

  “I . . .I appreciate it.”

  “Listen, how’s Kelly doing?”

  Mark shrugged. “I don’t know yet. The ER people told me she’d left as soon as the police were through with her. I wanted to talk with her, but they grabbed me when I got down from the OR.”

  “Well, give her my best, and tell her I’m glad she’s okay.” Eric clapped Mark on the back and walked away.

  Mark’s pulse still wasn’t fully back to normal when he collapsed onto the sagging couch in the break room, holding in one hand a Styrofoam cup of what had to be the world’s worst coffee. He’d retrieved his cell phone from his locker, but right now it was still in the pocket of his scrubs. He should call Kelly, but he wasn’t quite ready to talk with her.

  Mark thought about everything that went through his mind when the gunman first entered the ER. He was ashamed of his first reaction. Fortunately, it had all worked out in the end. Thank goodness the gunman believed his friend was still alive and might respond to treatment. Of course, that only worked because Kelly picked up on the idea immediately. Matter of fact, as Mark thought more about what happened, Kelly might have had the idea first.

  If she hadn’t . . .don’t go there, he reminded himself. He’d survived, and so had Kelly. The gunman was on his way to the morgue to lie alongside his brother. As for the policeman who’d killed him . . .Mark pushed thoughts of Ed Purvis aside. Anna was right. The man knew the risks. And despite what his heart told him, Mark’s head reminded him he couldn’t save everyone.

  As soon as Mark returned to the emergency room from the OR, the police had grabbed him for questioning, asking the same things again and again. No, he had no idea of the identity of the gunman or the patient. No, he’d never seen them before. No, he was pretty certain the gunman fired first, but it all happened so fast. Yes, Sergeant Purvis identified himself as a police officer and ordered the gunman to surrender. And on and on and on it went.

  Actually, Mark had some questions of his own. Who were the men who’d invaded the emergency room—both the gunman and the wounded man? How did the shooter get past the metal detector at the ER door? What was the condition of the hospital security officer the gunman struck down? After his first couple of questions went unanswered, Mark decided the police weren’t interested in giving out information. Maybe he’d learn more eventually.

  The questioning was finally over, but Mark had the feeling there’d be more. But, for now, he was alone. He crumpled his empty cup and flung it toward the wastebasket in the ER staff lounge, missing by a foot. It lay amid two other cups and a wadded candy wrapper, a testament to poor aim by staff called away before they could pick up their trash. Mark started to get up to clean up the mess, then decided he’d do it in a moment. He leaned back on the couch and looked at his cell phone as though it could provide the answer to his frustration. Come to think of it, perhaps it might, if Kelly would only answer.

  * * *

  Kelly was relaxing—or at least, trying to relax—in a hot tub whe
n she heard the ring of her cell phone. Her first instinct was to get out of the tub, wrap herself in a towel, and trudge into the bedroom to answer the call before it rolled over to voicemail. After all, that’s one of the first reflexes instilled into medical personnel. It could represent an emergency. The hospital—or, in this case, the police—might need something.

  Then again, the call might be from Mark. After it was all over, she wanted to hug him, tell him how brave he’d been, to say how glad she was that he was alive, to pour out her heart to him. But now Kelly wondered if that talk should wait until they both calmed down some more. She hadn’t even dared share with her pastor what she’d really thought tonight. Maybe neither she nor Mark was ready for this conversation right now.

  Kelly turned on the tap to run more hot water into the bath. She needed to relax muscles that were tense as bowstrings. She sighed, eased back into the water, closed her eyes, and went over the events of the evening for what must have been the twentieth time. Her pastor had been right. What happened tonight was a natural springboard for a conversation she needed to have with Mark. But there was more there than the pastor knew . . .and she wasn’t certain she was ready to tell Mark everything.

  * * *

  Mark’s call went to voicemail. His message was brief: “Kelly, this is Mark. I’m sorry I couldn’t see you right after the shooting. Please call me.” But she didn’t. Finally, after waiting as long as he could, he called again . . .and yet again. The results were the same, except that he didn’t bother to leave a message on those occasions, although perhaps the chip responsible for voicemail picked up the sound of his grinding molars.

  Even though Kelly, like Mark, relied on her cell phone, she had a landline number. He tried it now, but there was no answer. Many hospital personnel, including Mark, complied as inexpensively as possible with the hospital’s requirement they have a landline by using a “voice over Internet protocol” or VoIP phone. Most of the calls Mark received on that line were either wrong numbers or telephone solicitors, so usually he simply ignored the phone when it rang. Maybe Kelly was doing the same thing. After what they’d been through, he certainly couldn’t blame her.