“What do you think about drugs to suppress his appetite?” Mercy asked.
“If he had his stomach stapled, we wouldn’t have to worry about drugs.” Lukas shook his head. “Unfortunately, I don’t think either of us can afford an expense like that, and he sure can’t.”
“No, but he’s moving in the right direction.”
The phone rang. Carol answered, then glanced at Lukas. “Yes, Mrs. Pinkley, he’s right here.” There was a pause, and she frowned. “Yes, I’ll tell him.” She hung up the phone. “Dr. Bower, Mrs. Pinkley wants to see you in her office before you leave.”
Lukas groaned. “So much for sleep.”
After Lukas left, Mercy changed into her scrubs and walked back out to find Lauren McCaffrey deep in conversation with Carol. They fell silent for just a moment when Mercy joined them, which surprised her, because the female staff usually spoke more freely with her than they did with the male doctors.
Lauren hesitated, then said, “Dr. Mercy, how do you feel about Dr. Bower?”
Mercy shot her a suspicious glance. Lauren had seen her pick up Lukas the other day when they went to visit Clarence, and Mercy had seen the disappointment clearly on the woman’s face. “Oh, no, don’t you start, too. Josie’s bad enough.”
Lauren blushed, though she continued to watch Mercy’s expression with more than casual interest. “I meant, professionally.”
“Oh. Of course. I think Dr. Bower is a dedicated physician. I’ve heard a lot of good things about him from staff. How do you feel about him?”
The nurse and the secretary glanced at each other again.
“I like working with him,” Carol volunteered. “He doesn’t mind helping the nurses out when they’re busy, and he makes sure we understand his orders.”
“I hear the patients like him, too,” Mercy said.
“We think Dr. Bower is going to lose his job,” Lauren said despondently.
“Why would you think that?” Mercy exclaimed.
“Because of Dr. George,” Lauren said.
“Do you think anyone’s going to listen to him, knowing how he feels about Dr. Bower?”
Lauren raised a delicate blond eyebrow at her. “Every time I have a shift with Dr. Bower, Dr. George comes to me with the charts for that shift and nitpicks everything everyone did. He even blames me for following all of Dr. Bower’s orders.”
Mercy scowled. How unprofessional! “Do you think Dr. Bower uses poor medical judgment?”
“No, but Dr. George has clout, and he could get at Dr. Bower indirectly. He could get me fired if he wanted to.”
“How?”
“He’s friends with Fern Davis, the director of nursing. She can dismiss me for any reason she wants. One of the nurses on the floor got fired last week without any explanation. She thinks it’s because she wouldn’t go to work for Dr. George in his office practice.”
Mercy rolled her eyes. Jarvis was becoming more and more obnoxious.
Lauren hesitated, bit her lip and grimaced. “I’ve had a couple of patients come in and when they found out the doctor on duty was Dr. Bower, they refused to be treated by him.”
Mercy felt her irritation build. “Did they explain why?”
“No, but they were Dr. George’s patients. I think Dr. Bower is being stabbed in the back, and I don’t like it.”
Right then the door opened, and a man walked in. His left hand was clumsily wrapped, and blood seeped through the bandage.
“Time to get to work,” Mercy said.
Lauren leaned toward her. “I hope Mrs. Pinkley didn’t call Dr. Bower up to fire—” She broke off, shaking her head. “Sorry, I’m not trying to spread rumors.”
The third floor of Knolls Community Hospital did not look like a hospital. With its plush carpeting and decorated walls, it could have passed for a high-dollar attorney’s office. It was the administration floor. In the three and a half weeks Lukas had been at Knolls, he’d had two occasions to visit there, and the atmosphere made him feel uncomfortable. The clerks, secretaries and department directors stared at him when he walked by. No one smiled.
Mrs. Pinkley’s secretary, Charlotte, seemed to be the only one who knew how to move her lips, and the smile barely touched her eyes. “She’s waiting for you, Dr. Bower,” she said, studying him carefully.
For a moment he considered hunting for a mirror to see if he had blood on his face or if his hair was sticking up, but in uncomfortable situations he liked the old adage “Never let ’em see you sweat.” He thanked her, straightened his shoulders and opened the door in front of him. It was a closet. He turned back around to see her pointing toward a second, wider door.
Without another word he walked through the door into an even plusher office decorated in tones of pale green, pink and taupe.
Mrs. Pinkley remained seated behind her broad desk and watched him enter. She must be nearing seventy. She had white hair that was cut short and feathered straight back. No nonsense. Intimidating, yet still, somehow, feminine. Lukas had liked her immediately upon meeting her for his first interview.
“Thank you for coming so quickly, Dr. Bower,” she said in her deep, gravelly voice. She sounded like a smoker, but everyone knew she was not.
She did not offer a handshake, which was good because their hands probably wouldn’t have reached each other across the broad expanse of the desk. She didn’t smile, either. “I realize I’m cutting into your sleep time, so I’ll do away with formalities and try to keep this meeting short. Please be seated.”
Lukas had already done so.
She indicated a stack of file folders on her desk. “These are charts on some of the patients you’ve treated since you came to work for us.” She pulled up the reading glasses from a chain around her neck and cradled them on her nose. She picked up a chart, opened it and read a sticky note that had been attached to the inside cover. “One of my least favorite jobs is handling patient complaints. I don’t get as many of them as I did before we added improvements to the hospital three years ago. Census is up, and we’re doing well.” She patted the stack. “These are on you, Dr. Bower.” She paused and looked at him over the top of her glasses.
He stared back at her. “They’re patient complaints?”
“Specific patients, yes. One of them is Ruby Taylor. She complains every time she’s in the hospital. It doesn’t matter to her that if not for your quick action, she could be dead now. I also have a complaint that you did not follow proper transfer procedures when you sent her to Springfield.”
“I tried.”
“I know. I read the file. I’m ignoring the complaint.” She picked up a sheet of paper. “Two of the complaints I received by telephone don’t match charts because the patients never even checked in. These two women were very displeased that you chastised them for Medicaid abuse and forced them to buy their head lice shampoo without a script.” She looked again over her glasses. “Let me point out that I have not worded the complaint with the colorful jargon they used.” There was a hint of a smile that disappeared quickly. “Another report is from Dwayne Little.” She stopped and settled back in luxurious leather.
“I’m not surprised,” Lukas said.
“Nor I, but this one could turn into a great deal of trouble before his father finishes with us. Bailey Little is not a man with whom you would want to tangle.”
Lukas liked the “us” bit. In KC it had been him against the hospital, from the administrator on down. “I hear Mr. Little’s father is president of the hospital board.”
Mrs. Pinkley held Lukas’s gaze. “Too bad you weren’t aware of that before you chased him out of the E.R.”
“I was.” Lukas took a deep breath and let it out slowly. It was happening again. “I warned you before I started that I wasn’t very good at hospital politics.”
“Yes, you did. That was one of the many qualities that attracted me to you as an excellent candidate for your position. I don’t like drug pushers, be they working through legal or illegal channels. People
who abuse drugs need help, not more drugs from political doctors. I despise Medicaid abuse, Medicare abuse, insurance abuse of any kind. We have a problem on our hands, however, because Dwayne Little’s daddy is threatening to sue. What’s worse, he’s threatening to report us on a possible COBRA violation on this thing if I don’t fire you.”
Lukas sucked in his breath.
Mrs. Pinkley nodded. “If somebody investigates the report, it could be touchy for this hospital. Most people take Bailey Little seriously, and he has a lot of support in high places, even into state and federal offices.”
Lukas suddenly felt defeated and very tired. “Maybe you should fire me. Or maybe I should quit.”
Estelle gave an impatient sigh. “I didn’t ask you up here to fire you. I called for you because I am going to need your help to fight this thing. Why wasn’t an AMA form signed before Dwayne left?”
“He got mad and stormed out before we had a chance to get one, but I filled one out afterward and signed it and left it for the nurse to sign and file. Beverly and I were both witnesses that he refused the shot of Toradol I offered, and the shots of morphine with Narcan. He nearly knocked Beverly down on his way out.”
“We will need Beverly to sign a statement to that effect, but as of now there is no AMA form with the file.”
Lukas shook his head. “Then I don’t know what happened to it. I don’t think Beverly would forget something like…” But Beverly had been acting strangely the past few days.
“We’ll talk to Beverly about it. If we get the right answers from her, I believe we can beat this. I’m more worried about public opinion at this point. I have to answer to the taxpayers of Knolls community.” She leaned forward again and indicated the stack of files. “Dr. Bower, these complaints all come from the patients of one physician. They’re mostly about tests and medications that they considered to be too expensive or unnecessary. Nitpicking. Would you care to venture a guess as to who their physician is?”
“Dr. George.”
“You have a great deal of insight,” she said drily. “Unfortunately, Dr. George still wields power here at the hospital and, therefore, in this town. Do me a favor for the time being and try really, really hard to placate him.” She frowned. “Believe it or not, he’s not usually this hard to get along with. I don’t know what’s bothering him right now.”
“He may still be upset about the disaster drill and the Ruby Taylor case.”
Mrs. Pinkley nodded. “The needlestick report couldn’t have been popular with him, either, even though it was the right thing for you to do. He never did follow protocol on that.”
“I think he needs to. The other day he was obviously suffering from a bad headache, and his hand seemed to be bothering him. He grew very defensive when I asked him about it.”
“I bet he did.” She sighed. “All these things have been ill-timed events, but not enough to trigger the backlash we’re getting. These people are out of line. I just want you to be forewarned.” She stepped around her desk and offered him a hand.
He stood and took it gently. “Thank you, Mrs. Pinkley.” She had a firm grip, showing no signs of the arthritis he knew she had. “I’ll try to show more restraint in the future.”
“I appreciate it. This could be a learning experience for both of us.” She released his hand and stepped back behind her desk.
“Tell me something, Dr. Bower,” she said before he reached the door.
He stopped and turned back around.
“How did it feel to chase a drug seeker out of our emergency department?”
He grinned at her. “It felt great.”
Her smile was genuine as he turned around and walked out the door.
Chapter Nineteen
Mercy had just finished a twenty-one-suture closure in the E.R. when Lauren came into the exam room. “Dr. Mercy, you’re not going to believe this one. There’s a hysterical woman on the line who says her brother is having a heart attack, but he weighs too much for an ambulance.”
Mercy knew before she asked. “What’s the name?”
“Their name’s Knight.”
Mercy snapped off her gloves. “Is she still on the line?”
“Yes. She insisted she had to talk to you.”
“Okay, I’m coming.” She turned to the young man on the exam table. “Mark, I’ll be back as soon as I can.”
She ran to the telephone and picked up the receiver. Before she could even put it to her ear, she heard sobbing. “Darlene? This is Dr. Mercy. What’s wrong?”
There was a deep, trembling breath; then Darlene’s words came out in a rush. “It’s Clarence, Dr. Mercy. He’s really sick and I can’t get him to wake up, and I don’t know what’s happened. He just knocked over a glass, and—”
“Darlene, slow down. Take a deep breath. Are you saying Clarence is not conscious now?”
“I…I don’t know. He wasn’t just before I came to call you. He’s breathing, but he won’t open his eyes or say anything.”
“Okay. I want you to put the receiver down and go in and rub your knuckles really hard against the bony center of his chest. See if there’s a reaction, and then come back and tell me.”
“But can’t we just call Dr. Bower to come out? I tried to get his home phone number to call him, but it’s not listed, but I know he’d come—”
“Darlene, we’re wasting precious time!” Mercy spoke sharply. “We can get Clarence here, but I need your help. Go check him.”
She heard a clatter as the receiver hit the counter, then turned to the secretary. “Carol, call an ALS ambulance, ask for a double team, and also request first responders. Get them on the line for me and have them hold. Tell them their patient weighs at least five hundred pounds.”
Carol’s eyes widened. “Five hundred—”
“Probably a lot more. Just do it. And check to see if Dr. Bower is still in the hospital. Page him.”
Darlene came back on the line. “Dr. Mercy?”
“I’m here.”
“He’s groaning. His chest hurts really bad.” Her voice shook with sobs again. “He’s dying.”
“Stop it! I need you calm, Darlene. I’m going to send an ambulance with enough people to lift Clarence. Just keep him still until they get there, and don’t leave him. He needs you there with him. Are you okay?”
There was a pause. “I’m bleeding quite a bit.”
“Bleeding?”
“I cut my foot on the glass he broke when he had the attack.”
“Okay. Get a thick washcloth and fold it into a big square. Place it directly over the cut, then tie a towel around it was tightly as you can. That’ll hold you until help gets there.”
“I’ll be okay. I’m worried about Clarence.”
“You can’t do him any good if you pass out from blood loss. I want you to come in with the ambulance. We’ll take a look at you when you get here. Okay?”
Darlene took a deep breath. “Okay. I can do it.”
“Good. I’ll see you soon. Hang in there, Darlene.”
She disconnected and punched the second line. “Hello, this is Dr. Mercy.”
“This is Connie, the paramedic. Where’s the patient?”
Mercy gave her the address. “I want you to double team and call the first responders.”
“Right. Carol told us.”
“Get a heavy-duty Stryker cot. The patient’s name is Clarence Knight. His sister will meet you, and she has a glass cut on her foot. Hurry. He could be having an MI.” She hung up and rushed back to finish her present patient and prepare for Clarence’s arrival. Darlene would need stitches. It would sure be nice if Lukas were here.
She was writing Mark a script for pain when she glanced up to find Lukas walking in and looking around the E.R. as if expecting at least more than one patient after being paged.
“Lukas, thank goodness! I may need your help. It’s Clarence.”
“What happened? Is he okay? He called?”
“Darlene called. Sounds like he’
s in trouble, could be his heart. They’re bringing him in, and Darlene, too. I know you wanted to get some sleep, but—”
“Not now.” He sighed. “We were afraid this would happen. What’s wrong with Darlene?” he asked, setting his bag down.
“She cut her foot. I don’t know how bad it is.”
“Okay, you’re in charge, you call the shots,” Lukas said. “If you want, I’ll check the cardiac room and make sure everything is ready.”
“Yes, please.”
Mercy had just finished releasing her only patient when the ambulance radio spoke to her from the central desk. “Knolls Community Hospital, this is Knolls 830 requesting medical control.” It was Connie’s voice.
Mercy punched the button. “This is medical control. Go ahead.”
“Medical control, we have reached the Knight residence. The patient is alert and oriented, complaining of severe chest pain rated at a nine. Requesting permission to give sublingual nitroglycerin per protocol.”
“Is IV established at this time?”
“Negative. Attempts have been unsuccessful at this point.”
“Do you have a current set of vitals on this patient?”
“Heart rate 120, respiration 22 and labored, oxygen saturation 93 percent on nonrebreather mask.”
“What is his BP?”
Connie’s voice sounded sheepish. “Unable to determine blood pressure at this time. We were able to auscultate a radial pulse.”
Mercy shook her head. “Permission for sublingual nitroglycerin denied until IV access is obtained. I suggest you attempt an external jugular route. Keep us advised of any change in the patient’s condition. What is your ETA?”
“About fifteen minutes. Full patient report will be given prior to arrival.” There was a pause. “Request change to private channel.”
Mercy switched the button.
“Doc, are you there?” Connie asked.
“I’m here.”
“Dr. Mercy, we’re doing the best we can, but this guy’s big. I’ve never had anything like it before.”
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