by R L Dunn
"Her mouth and lips are red; she's drooling, and her nose is pouring. Her pulse is in the fifties. Possible she ingested something poisonous."
"What do you mean ingested something? Did someone give her something?" A bead of sweat formed on Martin’s upper lip.
"I don't know, Martin."
Two police officers ran up the stairs with a defibrillator and oxygen. "Silverton PD," Shaun Murray announced. "Marty, what happened? This is Elvis Donner."
"We found her this way. Where's the ambulance?" Martin's voice was strained.
"Lieutenant, my name is Ken Clarke; I'm a paramedic. I need you and your partner to go downstairs and find anything she ate or drank in the last day and bag it up. I think she was poisoned. Be careful and wear gloves."
Martin washed her blood off his hands and grabbed his phone. Pete Walter answered on the first ring. "Pete." Martin gulped, "Pete, it's Elizabeth. She's unconscious."
"Did you call an ambulance?"
"Yeah, Jockey is here and Hoist."
Pete was firm. "Put Jockey on."
"She’s unresponsive. There’s a one-inch lac above her left brow. I also palpated a firm dip in her occiput, no crepitus. She lost bowel and bladder. Both fluids bloody. Pupils are dilated; her mouth is red. She's drooling. She's hypotensive and heart rate is in the fifties. Possible heart block. She is dropping beats. No radial or pedal pulses. Skin, hot and dry. I'm waiting on the ambulance. All I have is O2 and a pocket mask. Josh is assisting her breathing."
"Ambulance is here." Shaun walked back into the bathroom.
"The ER will be waiting." Pete hung up.
"I need a small c-collar and a longboard," Kenny barked orders at the two EMTs. The young female pursed her lips, moving closer to the patient.
Shaun Murray enforced Kenny's order. "Do what the man says. I don't care what your protocol is. I'll take responsibility." She headed to get the equipment, then they moved Elizabeth into the ambulance.
Kenny spoke to the two EMTs, "Listen, I'm a paramedic on the national registry. I'll talk to your medical director if I have to. I need access to your medic kit and drug closet."
Emerson shifted the vehicle into gear, and the ambulance lurched forward. "Fifteen-minute ETA."
The female EMT gave Kenny access to the necessary equipment. "Martin, listen to me. Find the atropine." Kenny initiated an IV, and Elizabeth started to froth at the mouth. "Clear her airway," he ordered the EMT. His demeanor was calm and focused.
"Got it." Martin held up a purple box.
"Push two doses." Kenny hooked up the monitor, flattening his expression. "I need to secure her airway and then pace her. She's not responding to the atropine." He aimed the tube between her vocal cords and into her trachea. "Got it." Pink froth filled the tube. The male EMT was setting up the pacer. Kenny smiled a thank you. "You assist a lot?"
He helped him place the pads on Elizabeth's chest "I'm one of Dr. Reed’s fourth-year med students. Two shifts a week pay the bills. You're maxed, but she's capturing only a few beats. The rate picked up a little. NG tubes are in the blue bag. They just got them approved."
Kenny asked the med student, "Can you set up a dopamine drip?" Kenny measured the stomach tube and slid it through her right nostril into her belly. A brown, bloody liquid filled the canister. Her heart slowed more, and without warning, Elizabeth seized. With another drug, he quelled the seizure. "Martin, how much atropine is left?"
"Two more boxes." Martin opened the seal. Everything seemed to be happening in slow motion.
"Push them.”
The ambulance stopped, and they wheeled Elizabeth into the trauma room. Patrick Hedges, Louella Miranda, and Pete Walter stood waiting, along with a complete resuscitation team, including Elizabeth's senior fellows. Martin leaned against the wall for support.
Patrick took a step back as Kenny aired out his report. Dr. Miranda stood at the foot of the bed and called out orders. The team in the room performed their assigned tasks. "Dr. Perry, page cardiology to the bedside now. Dr. Caine, insert that central line. Decontaminate her skin." Elizabeth's heart rate hovered in the upper forties. "We need that pacer now."
The clock ticked down minutes. "Keith, where's cardiology?" Patrick took over, patience gone. Martin blinked faster, as if trying to figure things out.
"The fellow is in the cafeteria." Keith twitched.
His tone deepened. "You told him our patient was critical?" The frightened intern nodded. "Get that son of a bitch on the phone now. Bring me a kit." The speaker connected. "This is Dr. Hedges; with whom am I speaking?” He gritted his teeth.
“Dr. Morton.”
“How long have you been a fellow?”
“July first.”
“Today is July fourteenth.”
“Dr. Hedges, I’ve been up for thirty hours. I needed a cup of coffee to fight back the fatigue. I’ll be there as soon as I’m done.”
“Tired, you needed a cup of coffee." He crooked a finger at Josh. "Here's how this is going to play out, and you can tell me what you choose. You can carry yourself and your coffee to the emergency room in the next thirty seconds, or I can send a persuasive Navy SEAL to find you, carry you here, and when you finish my consult, I will tie you to a stretcher and give you a coffee enema." As the line disconnected, the room let out a collective breath.
"I'm not waiting. Let's do this." A nurse set up for the procedure.
In silence, the Chase medical team took over, crowding out the residents. Pete stood ready to assist while Kenny breathed for her. Patrick gowned, scrubbed his hands, and gloved. A nurse applied the disinfectant three separate times to Elizabeth's neck. Louella held the sonogram wand on her chest for Patrick to use as a guide to insert the wire through her right jugular vein into her heart. The only sounds were the ping of the monitor, the squeeze of air into Elizabeth’s lungs, and the breathing of those in the room, though even that was depressed.
"Set to eighty and two volts." Pete turned the dials. The pings became more regular as the device captured her heart. Patrick gave a firm nod, then secured all connections and sutured the wires in place. All heads turned to the panting man in the doorway, Josh's hand firm on the man's shoulder. "Dr. Morton, I presume?"
Doctor Howard Morton approached Elizabeth's bedside. "Dr. Hedges?"
"This is Dr. Elizabeth Reed. She is suffering from refractory high degree heart block due to what we believe is an unknown toxin." The patronizing expression on Dr. Morton's face provoked a growling sound from Patrick.
"Can I examine the placement please?" Morton's tone was mocking.
Patrick placed a firm hand on the fellow's crotch. "I will not ask who influenced your practice of medicine until today, but when the emergency room calls to ask for your assistance for a critical patient, you move. I just placed a pacer wire, thanks to your tardiness, in through her right internal jugular. If you do anything to disrupt it, I will perform an adult circumcision."
The fine sweat on Morton's brow confirmed he got the message.
Steven Keys ran into radiology. "I couldn't believe the page. How is she?"
"I think she was poisoned and seized, causing her to fall and strike her head." Patrick ran down the other possibilities he was considering and the interventions performed since Elizabeth was found.
The technician interrupted, "Full body scan, Doc?"
"Yes," Steven and Patrick responded in unison.
The radiologist sat beside the technician running the scan. "Here we go. The occipital deformity is an old depressed skull fracture. She has a leaking fusiform aneurysm."
"Page Hoyt, stat," Steven choked out.
"Moving down." Images entered and exited the screen as the camera moved down her body. "The good news is her C-spine is fine. She's got pulmonary edema and considerable swelling of her GI tract, liver, and kidneys. I will do a hard read, but load the frames into the system for neurosurgery now," the radiologist instructed her technician.
"The brain bleed goes first. We are pulling straws here
if this is a poison?" Patrick rubbed the back of his neck.
"I'll start high dose antibiotics and steroids." Louella left to write orders.
"I think we can try activated charcoal and antacids," Patrick threw out his thoughts. "Bathe her again."
Sterling Hoyt, a neurosurgeon, walked into radiology. "Let me view the films first, and then we will talk. He tapped the screen. "Damn, she's had a previous fracture. No choices here. I have an OR on hold. Steven, do you want to scrub in?"
"Yes, and, Sterling, this is Pat Hedges. He's a visiting trauma surgeon."
"Pleasure to meet you. I'll have my fellow double-check her clotting factors. And then we are a go. I prefer to do this with informed consent. Do we have someone? Next of kin?"
"Her father is former Governor Talbot Reed. I'll make the call." Pete's shoulders slumped.
Patrick and Steven stepped into the corridor. "Martin, speak to me, what's going on with the two of you?"
"Elizabeth and I, we have a history. She was my first, and if I have my way, she'll be my last. I love her."
"She’s suffering from an aneurysm—the ballooning of a blood vessel inside her brain. The fall aggravated an old injury. It’s leaking. Why she fell is a mystery."
"Zach is overseeing our forensics people at her house. Kenny had the police collect anything obvious." Martin forced his shoulders back.
"Pete is notifying her next of kin." Steven looked down.
"Oh, this sucks. Her mom died about six months ago, and her dad...their relationship is complicated."
"Complicated?" Patrick sounded uncertain.
"They are estranged. She hasn't spoken to him since January."
They stepped back as Elizabeth was wheeled into the trauma room. Martin’s face showed despair as he grasped her stiff fingers.
Patrick said, “According to the hospital records, he's listed as next of kin."
As Elizabeth was being tended to, Governor Talbot Reed was on his way to the church where an early Sunday service was being dedicated to Viola Dufour. Julian sat in a back corner recording the comings and goings. The minister stood at the podium. "Friends, we have gathered here on our Sunday Sabbath to praise God and to witness our faith."
The service proceeded with prayers, psalms, and blessings. Julian noted a group of teen men and women accompanied by their parents. The kids all wore the same red, white, and blue jackets with their gymnastics' center name embroidered on the left chest. No one else appeared to stand out.
"Today, as we praise God, we will remember one of our own lost to us. Our sister, Viola," the minister prayed.
Hal Dufour spoke about his only child, "Viola was my world. I never met a more loving person in my life. Viola made me a more caring person. I don't know what I will do without her. I loved her so much."
Julian swallowed down the bile. Hal’s tone reflected what he thought a man would say about a wife, not a child. It bothered him that the speech didn't indicate a shared loss with Viola's mother.
Viola's mother rose with the support of a dark-haired woman sitting beside her, but Julian couldn't get a clear look at the woman's face. Another man sitting with them helped walk her to the pulpit. Cecile Moody Dufour spoke about a happy and loving child. She shared stories from home, school and her fondness and dedication to gymnastics. Grief-stricken, she lashed out at the "doctor whose carelessness took away my sweet Viola." She wished her “baby girl” peace. Julian again found it strange when Talbot Reed rather than her husband helped her to her seat.
After Cecile concluded her remarks, the minister offered more prayers, then ended with a final dismissal. Julian noted the time of the funeral and the restaurant where the reception was due to be held on Monday. He was preparing to pull away when Governor Reed ran out and climbed into his town car. The surveillance team broadcast the governor's sudden departure.
"Damn." Julian's Bluetooth buzzed. "Mon frère, I was about to call you. Talbot Reed just hit the exit for the hospital. We’re on top of him."
"Let him come. I'm in the ER with Elizabeth. She's...she's sick. He's her father. She's..."
"Martin, breathe. I'm coming. Ian just landed. Hold on."
"Where is Elizabeth Reed?" the imperious voice of Talbot Reed reverberated through the halls.
"Sir, we cannot release information about patients," the receptionist in the ER tried to explain.
"Young woman, you people called me. Do you know who I am? I am Governor Talbot Reed, and Elizabeth Reed is my only child," he roared.
Martin approached. "She's in the trauma room."
"Well, look at what the cat dragged in. Marty Bailey. Here you are. Shouldn’t you be with your brother, not near Elizabeth? What is it, twenty years and still sniffing around my daughter?"
Martin counted to ten in his head, refusing to take Talbot's bait. "Governor, Elizabeth is very ill. Please, for her sake, do what's right for her. As far as being apart for twenty years, I believe you bear that responsibility." Martin sounded ice-cold.
"Governor Reed, I'm Pete Walter. We spoke on the phone. Please come this way," he intervened before the argument intensified.
"Yes. But first, I don't want Martin Bailey anywhere near her. Do you understand?"
"Yes, sir." Pete reached as if he were going to grasp Martin's shoulder before dropping his hand.
Talbot Reed looked at the clipboard in his hands. "Where do I sign?" After he signed, he made eye contact with Pete. “She’s a DNR. I don’t want her to become a lab rat.”
"Here, sir. Do you have any questions?"
When the governor said no, Steven unlocked the stretcher and wheeled Elizabeth toward surgery.
While Talbot moved to the waiting room, Patrick rushed Martin toward the pre-op area. "You were never here."
The stretcher with Elizabeth entered, and Patrick held up his hand. "I'm here. I'll be here when you wake up." Martin kissed her bandaged brow. "I love you. Today and always."
"I promise I'll call you." Patrick headed to scrub.
Sterling Hoyt stood in front of the light box looking at the CT scan one more time. "Ladies and gentlemen, are we ready? We’re performing a coiling of a parietal aneurysm." The circulating nurse depressed a button, and the room filled with the sounds of light jazz.
Warren Chen checked the anesthesia and monitors. "She's as ready as possible. Her BP is in the toilet with support. You need to stop whatever is causing this."
Scrub nurse Gina Monroe stared down at Elizabeth with a sad sigh. "Patient Elizabeth Reed, positioned, field-prepped and draped." Elizabeth was on her back, her right groin exposed and cleaned for the insertion of the catheter.
"That depressed blood pressure may save her brain. Who's second assist if we need to switch to an open procedure?" Hoyt took up his position on her right side.
"I will." Patrick moved across the table.
"Scalpel." Hoyt made a small incision into Elizabeth's groin and inserted the catheter. "Loading microcatheter and the first coil. The aneurysm developed around the old site. She had to be in agony."
"She never mentioned a headache to me. Patrick?" Steven asked.
"No, and she denied she hit her head when Satanta slapped her," Patrick explained the interaction with the meth dealer.
"Do you think she'll recover?" Steven's voice wavered.
"I hope. The lowered blood pressure and minimal swelling may make all the difference. The brain remains a mystery, and we still have no clue as to what's happening systemically. She was a brilliant surgeon." Hoyt inserted the next coil.
"Is a brilliant surgeon," Steven countered.
"We must be realistic—look where the bleed occurred. As a surgeon, any loss of the ability to process visual signals or sensory information, and in particular touch, would destroy her ability to do her job." The room grew quiet at Hoyt's sobering words. "Load a stent, please. This is large."
Two hours later, after inserting a stent and nineteen coils, Hoyt repeated the angiogram. He backed out the catheter, and Patrick applied pr
essure on her groin. "Favor, gentlemen, I told my daughter I would make her softball game. Would you mind finishing?"
“No issue." Patrick stitched a femoral line in place. He changed gloves to stitch her brow.
Steven gawked. "Hell, if I could stitch like that, plastic surgery, here I come. Great money. Monday through Friday, no weekends, no holidays."
"I can thank my mom. My siblings and I were forced to take homemaking classes."
"Where did you go to school?"
"First, I was an Air Force Combat Controller, then University of Colorado undergrad and medical school on the GI bill." Patrick ran his finger over the wound.
"Did you see combat?" The room was hanging on every word.
"Yeah, three tours in Afghanistan."
"Where were you before here? You got put on staff fast."
"Chase Medical allows me to be a bit of a vagabond. I was brought in for Austin Bailey. And now, Beth."
"Who would want to hurt her?" Steven’s eyes misted above his mask.
"You care for her." Patrick's curiosity conjoined with his investigative need.
"I do—as a sister. Hope this isn't TMI, but you’re more my type."
Patrick's eyes crinkled. "Not TMI at all. I..."
"The rumors are true, then? Her and Austin Bailey’s brother?" a nurse asked.
Hospitals were notorious gossip mills. Patrick went for the simple truth, "Martin and Beth are old friends. Steven, what brought you out here?"
"You mean, I don't strike you as an Iowa boy? I went to school at Baylor, where I met my husband. He's a neonatologist here—Chris Colgate. He's an Iowa boy; his folks left him a cattle ranch one town over in Silver Tree—an interesting dichotomy."
Ian Chase commandeered a conference room to speak with Martin. Julian pulled the door closed behind them. "I need the whole story."
"I met and loved Elizabeth since high school. We reconnected and talked it through. None of our feelings changed. I refuse to let Talbot Reed keep her from me again." Sadness turned to rage, and he slammed his fist into the table when he detailed their history.