Sacred Trust

by Hannah Alexander

  Carol nodded and grabbed the phone.

  “Rita,” Lukas continued, “do we have more nurses coming?”

  “Yes, the floor says they can spare one.”

  “Just one? This is a disaster code. They’ll have to spare more than that. Lauren, is the needle decompression ready?”

  “Yes.”

  “Okay, I’ll be setting up in trauma one. Let me know if you need anything. Everyone glove up and get your goggles and trauma gowns on. Rita, will you see to it that any help that arrives receives trauma gear?”

  “Yes, Dr. Bower.”

  “Have we received any calls from our backup docs yet?”

  “Not yet.”

  Lukas frowned. What was going on here? Didn’t the Knolls docs respond to emergencies? “Call them again, please.”

  Dr. Mercy Richmond stifled a yawn as she walked through the quiet second-floor corridor of Knoll’s Community Hospital—quiet, because it was 6:45 p.m. Monday evening and census was down. All the other doctors had done their rounds and gone home. With census down, staff was down.

  There was only one more patient to see tonight. Mom.

  Just as Mercy stepped to the nurses’ station, she heard her name paged over the speaker.

  “Lucky you,” Zelda, the floor charge nurse, teased. “It’s what you get for your dedication. Probably someone wants you to cover their night call again.” She punched the switchboard number and handed Mercy the phone.

  “This is Dr. Richmond. May I help you?” She knew by the code paged that she would directly receive her incoming call.

  “Yes, Mercy, this is Robert.”

  Mercy frowned. “Hi, Robert. Is everything okay? Is Mom—”

  “Other than the fact that your mother is as stubborn as you are, she’s not too bad right now. She actually showed up for her appointment today.”

  Dr. Robert Simeon, an internal medicine specialist, had been the one to do Mom’s physical this morning. Mom had insisted that was the earliest she could take the time to go in. She’d just wanted to put it off.

  “It’s a miracle,” Mercy said. “I’ve nagged her for two weeks.”

  “So that’s why she was in such a bad mood.”

  “How bad?”

  “Nothing serious. She wasn’t happy when the treadmill stress test turned up a problem, and tried to say it was an artifact in the machine. Then she reminded us rather forcefully that she’s not senile yet, and not to go running to you with a report.”

  Mercy sighed. “What’s the report?”

  “Her cholesterol is 163, blood pressure 120 over 70, fasting blood sugar is 87. Ivy’s in good shape for sixty-six.”

  “Mom’s in great shape for thirty- six. Why is she having chest pain?”

  “I would take a stab at rate-related left bundle branch block.”

  “Rate related? But she nearly passed out at the cemetery just getting out of the car. She hadn’t been running a marathon.”

  “She was burying her mother. That would account for an increased rate, don’t you think?”

  “But a near faint? I don’t think a bundle branch block would account for that.”

  “Of course it could, especially if it brought on a vasovagal. She’s been having this for a while, and it’s sure to stress her when she feels it coming on. I’m sending her to a cardiologist against her wishes, and who knows whether she’ll keep the appointment or not. I finally had to warn her that if I didn’t see that she got excellent care, you’d turn me into a leather coat. I think I appealed to her maternal instincts.”

  “So she agreed?”

  “She tried to laugh it off, but I think that’s what convinced her in the end.” There was a pause. “Mercy, you do realize she’s still planning to go on her June hiking trip to Colorado, don’t you?”

  “Oh, no, she’s not.”

  “That’s what I told her.” He chuckled. “I don’t want to be around when you two clash.”

  “No, you don’t. We had plenty of practice when I was growing up.”

  “Who won?”

  Mercy grimaced. “Mom, usually. She can outtalk an Ozark auctioneer.”

  “Why don’t you drop by later and we can discuss—”

  “Code red in the emergency department,” came an urgent voice over the speaker just down the hallway. “Code red. All available personnel report stat.”

  “I’ve already started cooking, so don’t tell me no,” Robert continued. There was a pause. “Mercy?”

  “Huh?” Code red was the disaster code.

  “Dinner? My place in about an hour? We can discuss it then.”

  “Yeah, sure. Sorry, Robert, there’s an alert. Gotta go.” She watched the charge nurse send an aide and another RN from the floor, then hung up and rushed toward the elevator. This couldn’t be a drill, could it? Nothing had been approved through the QA team. Mercy would know. She was on it. This had to be the real thing—disaster code.

  Lukas stood in the middle of the room, surveying the “patients” being carried in from the ambulance. His first glimpse of bloodred mulage paint on Buck Oppenheimer, a supposed accident victim with tension pneumothorax, had given it away. This was a drill. Relief mingled with a little disappointment—not that he wanted anyone to be hurt. His adrenaline did a quick nose dive. He approached Buck’s litter. The big fireman-EMT with short hair and big ears was covered in fake blood and had a note taped to his arm. He pretended to be unconscious, but Lukas could see his eyes open slightly a couple of times—and that gave him the idea for a little harmless fun.

  Lauren’s triage was right. Buck’s injury was the worst. Lukas stopped at a utensil shelf just long enough to pick up a couple of things he needed. As he chose his pieces, another group entered the E.R. with one young woman holding a camcorder, and an older woman giving orders. Lukas recognized her as Dorothy Wild, QA nurse and drill coordinator.

  Before they could approach Lukas, he turned and started Buck’s way. Buck started gasping for breath. Good acting, but how long could he carry it?

  “Nurse,” Lukas said, turning to Lauren with a slight smile. “Would you please hand me a fourteen-gauge needle?”

  Her eyes widened, and she started to make an obvious protest, but Lukas winked and widened his smile.

  She raised a brow and eyed him skeptically, but did as he requested.

  “Thank you, Lauren.” He took the syringe and lowered it from Buck’s sight, removed the stainless-steel needle, and replaced the plastic cover.

  Buck’s eyes weren’t shut quite so tightly now, and he’d forgotten that he was a patient in a serious struggle for breath.

  Seconds later, Lukas held the syringe up again, raised it above Buck’s chest, and started down with it.

  Buck stopped breathing. His eyes bugged open, and his thick, muscular arms that were unsecured to the backboard flew up. “Wait!” He tried to scoot away but was held fast by the backboard and c-collar. “Hold it! No needles! I’m with the drill, Doc!” He held out his arm. “See? Fake blood. Mulage paint. This is all just a disaster drill, not the real thing!”

  Lukas frowned to keep from laughing.

  Buck took some deep breaths. “Does this sound like a tension pneumothorax? I’m fine. I’m just taking part in the drill. Please, no needles. I hate needles.”

  Lukas raised the syringe and flicked the flimsy catheter tubing that jutted from the end of it. “Does this look like a needle?” He grinned wickedly. “I’m not going to waste all that steel on a healthy ox like you.”

  Buck exhaled a sigh of relief and gradually returned the grin, which made his ears stick out even farther from his head. “Oh, boy, Doc, you almost had me there.”

  “How’d they keep word from leaking out about this one?” Lukas asked. “Usually everyone knows about a drill before it happens.”

  Buck shrugged. “You got me. Can I get up now? Wanna undo those straps so I can—”

  “Hold it.” Lukas took the description sheet that had been taped to Buck’s arm. “You’re stil
l hurt, remember? In fact, you’re supposed to be unconscious, responsive only to pain.” He gestured toward the observation team. “Over here. We have emergency chest decompression. This would be the first patient in the triage.” He continued to describe his plan of treatment. “We would fly this one to at least a level-two trauma center,” Lukas said, finishing with Buck as he unfastened the securing straps. “According to triage,” he said, stepping toward the next patient, “this one is the patient I would treat next. I would be ready to intubate if necessary. He is showing signs of Cushing’s reflex, elevated blood pressure and low heart rate caused by increased intracranial pressure. I would order a cross table c-spine, a one-view chest, a CT—”

  “Excuse me, Dr. Bower.” Lauren stepped in front of the camcorder operator and held up her hand. “I’m sorry to interrupt, but we have a patient in room five who—”

  “Lauren, don’t interrupt,” Dorothy Wild snapped. The stocky, deep-voiced woman with salt-and-pepper hair stepped between Lauren and Lukas. “You’ve done your triage. We’re recording Dr. Bower now.”

  “I’m sorry, but this is a real patient,” Lauren said.

  “They can wait a few minutes while we finish this.”

  “No, Dorothy,” Lukas said, “I’m sorry, but real patients don’t wait for drills.” He turned to follow Lauren. “What seems—”

  Dorothy stepped in front of him. “You can at least find out if it’s critical before you put all these people on hold.”

  Lukas frowned at Dorothy as he stepped around her. “Don’t worry, Lauren would not have come to get me otherwise. She’s a good nurse.”

  Dorothy gestured to the camcorder operator and followed Lukas into the trauma room. “Fine, this is for PR. Let’s give them some good PR.”

  Lukas turned to stand in the doorway. “I’m sorry, but it’s a violation of federal regulations to film a patient without his written consent. Our patients are our first priority, Mrs. Wild.”

  Dorothy moved to push past him. “Fine, we’ll obtain consent later, but we’re getting this on film for—”

  Lukas fought his irritation as he blocked her way once more. “No, you’re not.”

  Mercy heard the sirens as soon as the ancient, incredibly slow elevator opened its doors for her on the first floor. She should know by now to take the stairs. The disaster code announcement had rattled her.

  She raced toward the emergency room as the ambulance entrance doors flew open and admitted a stretcher with Rod, a paramedic, and Mike, an EMT, in attendance.

  “Got another head,” Rod called toward the E.R. entrance. He glanced at Mercy. “Hi, Doc. Decide to join the fun?”

  Beverly, the RN, came out to the hallway, obviously to triage. She caught sight of Mercy. “Oh, thank goodness, Doctor. We need you if this thing’s going to fly. We’re double covered except for Dr. Bower. He’s on for a twenty-four, and we can’t get a response from any other docs.”

  “Why not?” Mercy glanced once more—this time suspiciously—at the head wound on the stretcher. There was a typed note attached to the shirt of the seemingly unconscious patient.

  A drill? This whole thing was a drill! What was going on here? No one had warned her.

  In disgust, Mercy turned to lead the way into the emergency room. A small group of observers stood staring toward exam room five, their attention on Dr. Bower, who stood nose to nose with the drill coordinator, Dorothy Wild.

  “No footage.” His voice was firm but not raised. “This is a real patient.”

  “Dr. Bower, part of the reason for this drill is to improve public rela—”

  “Not with this patient.” Bower moved to block the camera’s view of the man lying on the cot. “We’ve received no permission to tape, and he has indicated that he wants his privacy. Kindly step from the room.”

  Mercy stepped forward and nodded at Dorothy, who was retreating from the room, face flushed, eyes narrowed, chin set. Bower was obviously not counting on a long career with Knolls Community Hospital.

  “Dr. Mercy.” The stocky, grim-faced woman spoke sharply, then took a deep breath and rearranged her expression, as if concentrating on her favorite relaxation technique. “Maybe you can help us. We need Dr. Bower in this drill, and he is not being cooperative. If another doctor were to take the patient he is with now, and no one else chooses this time to come barging in with an emergency, we might get something accomplished.”

  Mercy stared at her. Who on earth had ever decided that Dorothy Wild would be a good PR representative for this hospital? “I’m sorry you’re having so much trouble, Dorothy.” She tried to keep the sarcasm from her voice. “I wasn’t even aware of a drill scheduled for tonight. Is this a test of some kind specifically planned by our administrator for Dr. Bower alone?”

  “Well…no…not exactly, but he is our first full-time emergency room doctor, and—”

  “Who ordered it?”

  “Excuse me?”

  “You’re the drill coordinator, not the whole committee,” Mercy said. “Who ordered the drill? Why wasn’t it sanctioned by the rest of us first?”

  Dorothy’s mouth opened slightly.

  “Did Dr. George have something to do with this?” Mercy asked.

  Dorothy’s suddenly sheepish expression gave Mercy her answer.

  “Thank you. I’ll discuss this with Dr. Bower.” She left Dorothy standing in the middle of the room with her camcorder and entered exam room five, where Lukas Bower and Beverly were bent over a supine male figure on the bed.

  “Dr. Bower?” Mercy said tentatively. “I heard the code and just happened to be in the building. Is there something I can do to help?”

  “Sure,” he said without looking up. “It would be great if you would help with the drill. I’ll be out when I finish here.”

  “Well…since you’re the doc in the limelight, according to Dorothy, I thought maybe I could take this patient for you and you could go back to playing doctor for the film crew.”

  He glanced up briefly from his perusal of the man’s pupils. “Thank you for the offer, Dr. Richmond, but the crew will just have to wait. I’m the doc on duty, and this is my patient, my responsibility.”

  “I understand. But you must understand that the PR team is merely trying to learn how best to serve real patients better. It’s what drills are all about, and they are a vital function of this hospital.”

  “Thank you for your input, Dr. Richmond, but I’ll take this patient first.”

  Scowling, Mercy retreated from the room. None of this should have happened tonight. “Dorothy,” she called as she approached the central desk, “I might as well help with the drill while I’m here. Lauren, do you have a patient for me?”

  “Wait a minute, Dr. Mercy.” Dorothy held up her hand. “We’re on hold until Dr. Bower comes back. I was hoping you could help out with his patient so he could join us more quickly.”

  “Sorry, he’s the doc in charge, and he chooses not to release to an off-duty doctor. I don’t blame him. So what about the drill? What do you have?”

  Dorothy frowned. “Thank you, Dr. Mercy, but I have a specific request to let Dr. Bower do this exercise alone.”

  “A request by Dr. George, no doubt.”

  Dorothy shrugged and turned back to the desk. Mercy had been dismissed.

  Chapter Nine

  “Does Jarvis George suddenly think he’s God?” Mercy muttered as she stalked into the first call room she came to. She had never known her father’s old partner to pull a stunt like this. Sure, he was opinionated and cranky, but his interests had always been with his patients and this hospital…before. Lately Jarvis had been behaving differently. In fact, only these past few days he’d been reprimanding E.R. staff for little things they did while under the direction of Dr. Bower.

  Jarvis seemed to resent Lukas more as time went on. Beverly had complained that she was afraid to work with Dr. Bower anymore because Jarvis had grilled her two days ago about the younger doc’s judgment, as if she had something to do
with the medical decision. The problem was, the staff also seemed uncomfortable working with Jarvis. In Beverly’s opinion, Jarvis didn’t have the quality of medical judgment he used to have.

  Mercy entered the call room and closed the door behind her. She immediately spied a doctor’s traditional black bag—which she knew belonged to Dr. Bower—and a bomber jacket tossed over the chair back. Rumpled bedclothes told her he had already tried to get some sleep to keep alert on this twenty-four-hour shift.

  She didn’t leave. He was busy with a patient, and she wanted to make a private call.

  She punched Jarvis’s office number on her cell and waited. No answer. She hadn’t expected one. She disconnected and dialed his home number, which had not changed in twenty-five years.

  He did not answer.

  She refused to disconnect. He was there, and she knew he was just being his new, obnoxious self.

  On the fifteenth ring, he picked up and said testily, “Yes, what is it?”

  “Jarvis, this is Mercy. Why don’t you come and join our disaster drill party?”

  “No.” His voice was cold.

  “Then would you at least call the coordinator and withdraw your order about Dr. Bower completing the drill himself? I’d like to help out.”

  There was a pause. “Why? You don’t…owe him anything.”

  Mercy frowned at the sound of his voice. She must have awakened him. “He has a real patient, that’s why. Besides, a drill is to test the mettle of a whole team, not just one person. These things are expensive and time consuming for all concerned. And disaster drills are supposed to come through the quality assurance committee. This one didn’t.”

  “Don’t start with me…about protocol, Dr. Richmond.” He sounded more than sleepy. He sounded drunk.

  “Protocol is important. The emergency room is not a dictatorship, and you don’t call all the shots. Why are you giving this new doc such a hard time? Give it up, Jarvis.”

  Silence.