She went into the front office and e-mailed the final pages they would need at Cox North for Kendra’s admittance.
The telephone rang beside her as the information was posted, and she picked up quickly.
“Hi, Dr. Mercy, this is Vickie over at Knolls Community. I thought you might still be in your office. I just wanted to let you know that Crystal and Odira are both settled in, and Crystal was already asleep when I left the room. We’ll keep a close eye on both of them tonight.”
Mercy felt a little easing of tension at the nurse’s reassuring tone. “Thank you, Vickie. I’ll be over in the morning to check on Crystal.”
After hanging up, Mercy walked back into her office.
She stepped over to her desk and plopped down into the leather chair for a moment. She stretched out her arms and flexed her shoulders, rolled her head around and took a few deep breaths. Odira hadn’t looked healthy tonight. Maybe in the morning Mercy could check her out.
Time to go home, but right now she was too tired to move. Would she ever again get a whole eight hours of sleep in a row? Should she consider getting a partner to take part of the load? At one time she’d hoped Lukas might stay around and help her with the influx until the E.R. was complete. She’d even dropped a few hints on several occasions, during those rare times the two of them had been together in the past three months. He hadn’t caught the hint. She hid her disappointment, telling herself that he was, at heart, an emergency physician. Family practice would probably bore him.
But deep down she found herself wondering was he, for some reason, avoiding her?
She knew he cared for her. She knew it. She could see tenderness in his eyes when he looked at her and hear gentleness in his voice. He cared a lot about Tedi, as well, and the two of them spent hours together laughing and talking and working on homework assignments when Lukas was in town.
Mercy couldn’t help the doubts that surfaced, memories of last fall when Lukas had told her he couldn’t see her anymore. But hadn’t all that changed? During the explosions at the hospital, Mercy experienced a more powerful explosion in her own life—she’d realized she could no longer deny God’s power or her need for Him. She had accepted Christ and had announced her newfound faith to a congregation of people at the Covenant Baptist Church. Since then she had witnessed the power of her new faith in many ways. The most obvious was her sudden ability to get along with Theodore—not with perfect ease and not always without resentment, but enough to make Tedi comfortable when they met together.
She glanced at the framed snapshots she kept of Tedi on the credenza—baby pictures, and then school pictures from kindergarten to the most recent sixth-grade shot. Tedi was the joy of her life. Just spending time with that bubbly, outspoken child renewed her, made her laugh and gave her courage. After everything Tedi had been through, from the divorce nearly six years ago to the near-death experience last year, she was recovering and growing every day. No parent could be more proud.
And then Mercy’s gaze drifted to the unframed snapshot of Lukas, the only picture she had of him. She still remembered the day she’d snapped it. He was covered in mud from a hike in the rain. His glasses were steamed up enough to camouflage the blue of his eyes, but not enough to hide the smile that radiated across his face, relieving a habitually serious expression. In the picture, his light brown hair was darkened to coffee. His well-built five-foot-ten frame carried him well, and somehow the way he stood and looked at the camera revealed his affection for her. Or maybe his demeanor had impressed itself upon her so much since last spring that she automatically saw it when she looked at him.
She laid her head back and closed her eyes. She would never forget their first hike together in the Mark Twain National Forest in August last year. The spiderwebs were thick across the narrow, overgrown logging trail they followed. Lukas had insisted on walking ahead of her, watching for snakes, knocking down the webs for her, even though he hated spiders. His thoughtfulness was one of the many traits about him that endeared him to her. She didn’t have the heart to point out that she’d been hiking those trails for years and was used to the spiders and the snakes and the ticks and the chiggers. She let him help her over the rough spots, as he had been doing in her life since April. But she was in another rough spot now, and he wasn’t here.
Did he know how much she needed him?
Lukas paused at the threshold to the E.R. call room. A big black spider at least an inch in width skittered across the wall and behind the curtain beside the twin-size bed. Lukas hated spiders. His oldest brother, Ben, had been bitten by a brown recluse years ago and would always bear a deep, ugly scar on his right forearm, just above the wrist. He’d been in the hospital for a week and a half. Lukas was only eight at the time, and the memory had scarred his psyche worse than it had Ben’s.
Good thing Mercy wasn’t here to see Wimp Bower in action. Of course, if Mercy were here, he would put on a brave front and chase the spider down and kill it, gritting his teeth and shuddering with every move. And Mercy would be laughing because she knew how much he hated spiders. And he wouldn’t mind, because he loved to hear her laugh. She laughed so much more now than she did when he first met her.
And here he was thinking about her again.
Ignoring the slight scent of mildew that hovered throughout the call room, he stepped inside and crossed to the student desk placed beneath the wall phone.
And just then it rang. He jumped backward, as if the spider hovering somewhere in the darkness had suddenly growled an attack signal.
Irritated with himself, he grabbed up the receiver. “Yes.”
“Dr. Bower, a man just came in by ambulance,” said the new, inexperienced secretary, Carmen. “They say he looks like a stroke. He’s strapped down, and Tex had just left to go down to the cafeteria to find something to eat, and I’m all alone here.”
“Is he responsive?” Lukas hadn’t heard an ambulance report, and he’d only walked back here a couple of minutes ago.
“Just a minute and I’ll ask.”
“Never mind. I’ll be right there. Have Tex paged over the speakers.” Lukas hung up and returned to the E.R. to the overhead blare of Carmen’s voice. He walked into the cardiac room to find Quinn Carnes and Sandra Davis—the paramedic and emergency tech—transferring a seemingly unconscious elderly man from a gurney to the exam cot. The patient was fully immobilized, arms and all, to a long spine board, with head blocks, C-collar, the works. He had a hundred percent nonrebreather mask over his face. But no IV. No ET tube, so his airway was not protected.
“Hey there, Doc,” Quinn said, walking over to the desk in the exam room and tossing his paperwork down. He reached up in a habitual gesture and scratched at the thick, wavy brown-gray hair that grew to his shirt collar. “Got you a gomer here.”
Lukas flinched. He hated that term. Gomer meant “Get Out of My E.R.” and was used by burned-out, unprofessional personnel who felt the patient wasn’t worth their trouble.
“His wife found him down and unresponsive and dialed nine-one-one,” Quinn continued. “Looks like a stroke. Finger-stick glucose was one-oh-seven on scene. The wife’s on the way in her own car, but no long-playing record here.”
Lukas cringed as he stepped over to the side of the bed, and he saw Sandra glare at her partner with obvious disgust. Although Quinn was probably in his midforties, he apparently had only been on an ambulance crew for a couple of years. Lukas believed he never should have been allowed to work with patients in the first place, but there were probably few contenders for the job in a town like Herald. Lukas knew the man was presently working as many hours as possible with the ambulance service and bugging hospital personnel to give him some shifts in the E.R. If Lukas had anything to say about it, that wasn’t going to happen.
“What’s the gentleman’s name?” Lukas asked, unable to keep irritation from his voice.
“Mr. Wayne Powell,” Sandra replied for Quinn. Her voice was hesitant, soft, as it had been the other time Lukas
had seen her in here. “His poor wife was almost hysterical when she called.”
Lukas leaned forward and squeezed the patient’s upper arm. “Mr. Powell?”
“Told you he’s out of it, Doc,” Quinn said over his shoulder as he sat down to do paperwork.
Lukas took the patient’s arm in a firmer grip. “Mr. Powell! Mr. Powell, can you hear me?” he called more loudly. “I’m Dr. Bower. Try to open your eyes if you can.”
No response.
Tex walked into the room, slightly breathless from her rush back down the hallway. Her large frame and broad shoulders seemed to fill the already crowded little exam room. “Can’t leave this place for two minutes without—Uh-oh, what’ve we got here?”
“I’m still trying to find out.” Lukas rubbed his knuckles hard against the man’s sternum and didn’t even get a groan. The sternal rub would rouse him if anything would. “Tex, we’ve got an unresponsive patient with an unprotected airway,” he said. “Set up for an intubation, but first let’s get the suction set up.” He couldn’t believe Quinn hadn’t intubated this patient.
Tex turned to the cabinets on the left and opened a door to pull out some equipment.
Quinn looked over at them and gave a quick chirp of irritated laughter. “Would you relax, Doc? Don’t you think I’d have done that if he needed it? He’s not throwing up or anything. His airway’s clear.”
Lukas grabbed the black box that Tex handed to him. He broke the safety lock and opened the box, pulled out the laryngoscope and endotracheal tube and snapped the blade into place. “An unobstructed airway is not the same as a protected airway. If this is a stroke patient, he’s at high risk for aspiration.”
Tex came around with the suction. “Got it, Dr. Bower.”
Lukas reached over to pull off the oxygen mask just as Mr. Powell retched. “Tex, get the suction catheter in. Quinn, Sandra, help me here.” He reached for the grips and turned the patient toward him as Sandra rushed to help. Good. The man’s body didn’t slip. They’d done a good job of securing him. Quinn ambled over to help.
“Sloppy job, Quinn,” Tex snapped above the sound of the suction. “Sloppy, sloppy. Why didn’t you intubate this guy on scene? I’d have taught you how if you needed me to. Maybe I could teach you how to do an IV, too, while I was at it, and how to hook up a monitor. And I didn’t hear your radio report. I was gone less than a minute. Trying to sneak up on us?”
“No time,’ Quinn said. “We were busy, and we were just about a mile away. There wasn’t time for little nonessentials.”
“You call lifesaving and preparation nonessentials?” Tex snapped. “If you’d spend a little more time worrying about your patients and less time whining about your bank account, you might make a good paramedic someday.”
“You try going on scene every once in a while.”
Tex returned his glare and shook her head. “I did it for five years.”
“Sure, but most of that was years ago,” he taunted. “Things have changed. You think being a med-school dropout makes you special.”
“I didn’t drop out, you stupid jerk.”
“Tex,” Lukas snapped, “keep your mind on what you’re doing.”
“Sorry, Dr. Bower.” She suctioned for a couple more seconds, then pulled the tube back. “He looks clear.”
“Good, let’s get him back over. I need an IV now, and give him Ativan, two milligrams. Sandra, take over that suction and keep it handy, just in case.” He called over to the secretary across the E.R. “Carmen, I need an EKG, CBC, electrolytes, PT and PTT—”
Carmen turned around in her chair, eyes widening in panic. “What? Slow down, I can’t get all this down.” She grabbed a pen and a pad. “Now, what was that?”
“Just do a standard cardiac workup,” Lukas said gently. “It’s taped on the wall to the right of the phone.” He turned back to Mr. Powell and tried to wake him up again. No response. He pulled out his penlight and checked the man’s pupils. They were sluggish, and the one on the left looked a little dilated. Nothing obvious.
“Call for a helicopter launch. He’s going to have to be flown to Columbia.” Lukas slipped off Mr. Powell’s shoe and, with the point of an ink pen, ran the tip up the bottom of the man’s foot. The big toe curled upward.
Positive Babinski’s. The abnormal reflex was found in stroke victims. Quinn should have intubated.
“Dr. Mercy, help me.” The feminine voice drifted to her from the dark mist, soft and indistinct. A sudden, frantic pounding reached her, and then the quiet voice again. “Help me.”
Mercy awakened suddenly with her face pressed against the hard surface of her desk. The overhead light blared down on her, and her right shoulder and arm were splayed across the back of her chair, cramped and stiff. The pounding continued to sound in her head from her dream, but as she listened all she heard were soft puffs of wind against the window and the scratch of branches from the cedar tree against the rain gutter.
She got up, stretched and walked to the darkened waiting room. All was quiet. Was she dreaming about Kendra? Were the worry and stress of the past few months finally taking their toll?
Just in case, she opened the entrance door, and freezing wind rushed in, mixed with a powdery feathering of snow. She shivered and stepped back into the warmth but didn’t close the door for a moment.
“Hello?” she called out into the cold. She felt foolish. Of course it had been a dream. “Is anybody out there?”
The snow had barely frosted the walk, and there probably wouldn’t be any accumulation. There hadn’t been much in the forecast for the weekend. Of course, that could change.
She shivered and started to close the door and lock it when she caught sight of something in the swirling snow, just outside the door—the bare outline of a footprint. Even as she watched, the force of the wind obliterated it.
“Hello?” she called again.
No one answered.
Lukas sat at his tiny workstation in the E.R. a few feet from the secretary. Carmen muttered under her breath every time she picked up a new chart to code. She had asked him so many questions in the past thirty minutes that he’d almost decided to offer to do the coding himself, but he wasn’t sure he knew the routine, either. Every E.R. had a different office procedure.
He rested his chin on his fist and fought to keep his eyes open, listening to Marin’s snores in the curtained exam room across the small aisle from the desk. Tex and Carmen were making bets on whether or not the bikers would return to get their buddy.
Carmen whistled suddenly. “Who’da thought Catcher would have such good insurance? Too bad he left AMA. Now we’ll probably be stuck with the bill.”
Lukas shook his head and picked up the phone to check on Mrs. Flaherty, who, at his request and upon agreement by the attending physician, had been placed on telemetry on the floor. He knew it wasn’t his responsibility, but he wanted to know how she was doing and if she’d had another episode of syncope—unconsciousness.
Finally a harried, breathless female voice answered. “What is it?”
“Uh, yes, hello, this is Dr. Bower checking on our telemetry patient, Mrs. Flaherty. Is everything okay there?”
There was a short silence, then a sigh. “Sorry, Dr. Bower, we didn’t have a unit available. Dr. Cain downgraded the admission for us so we could keep her here.”
Lukas let that sink in for a moment. “Mrs. Flaherty isn’t on telemetry?” Nobody was watching her? His request had been ignored? “Dr. Cain specifically agreed with me that—”
“Look, we’re operating on a skeleton crew, Dr. Bower. The patient looked fine to us, and she’s just a couple of doors down. We check on her when we can. Mr. Amos wouldn’t allow us to transfer her.”
Lukas clamped his teeth down on his tongue for a moment. Since when did the administrator for this hospital have a license to practice medicine? There had been a few guarded remarks about the fact that the man was paranoid about spending money, but when did money become more precious than h
uman lives?
“How many nurses are on the floor tonight?” Lukas finally asked.
There was a pause. “One RN and one LPN.”
“That’s it? What’s the census?”
“We have nineteen patients on the floor.”
“And you’re the only RN in the whole hospital?”
“That’s about the size of it, Dr. Bower,” she said, sounding suddenly weary. “And you’d better not let Mr. Amos hear you complaining, or we’ll have one less doctor.” She hung up.
Lukas groaned. What else was new?
Chapter Five
The loud, piercing cry of a hungry newborn baby streaked through the darkness of nineteen-year-old Marla Moore’s dreams, echoing through the small room like a ricocheting bullet. It was her baby. Her little Jerod. And only she could stop the crying.
Even as she opened her eyes to the dim room illumined by the night-light, her hands automatically pushed back the blankets and pillows. With stiff limbs and swollen feet, she climbed from bed as if Jerod were pressing a remote control programmed for Mommy.
She stepped once more onto the cold painted concrete floor, but before she reached the used crib that she’d bought at a yard sale, she tripped over the house shoes she’d pulled off when she got into bed. She stumbled backward against the bedside stand. The corner of the stand dug hard into the inside of her right calf, and she cried out. She grabbed the side of the crib for support.
Jerod’s cries grew louder and more insistent.
“Stop it!” she snapped. “Just stop it!” She bent over and rubbed her calf, then reached down and picked the newborn up into her arms. Feed him. Then she could get back to sleep for another couple of hours before she had to repeat the routine all over again.
She sat with him on the side of the bed and fumbled with her dirty pajama top. Everything was dirty. She barely had enough diapers for tomorrow, and she hadn’t done laundry in three weeks. How could she? Before she had Jerod, the doctor had told her to stay in bed so she wouldn’t go into premature labor. Now there was nobody to help her. Marla would have called a church for help, but every time she thought about calling someone, shame kept her from following through.
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