Sacred Trust

by Hannah Alexander

  “Sampson?” came a man’s voice. “Sampson, what in the—” There was a gasp. “Goldy, it’s a…a little girl!”

  “Please,” Tedi whispered between gasps. “Help me.”

  The dog nudged her again with his nose.

  “Okay, boy, we see her. We see her,” the man said, gently turning Tedi to her side.

  A bright light shone in her eyes.

  “Hey, little’un, what happened?” the man asked. “You’re swollen up like a toad.”

  “Honey, listen to her,” the woman said. Soft hands touched Tedi’s face and gently explored down her neck. “She’s not breathing right. I think she’s in trouble. She’s swollen. Honey, I think she’s been—”

  “Yep, stung by a bee. Having a reaction.”

  “We’ve got to get her to the emergency room fast!”

  “Here, take the light,” the man said. “I’ll carry her.” Big, gentle hands turned Tedi from her side to her back, then lifted her up on strong arms.

  “Be careful, honey,” the woman said. “Make sure she can keep breathing.”

  “I’ve got her. You drive. If they try to pull you over this time, we’ll make ’em escort us on in.”

  The dog whined.

  “Yes, Sampson,” the woman said as the couple made their way through the darkness with Tedi. “Good boy. Good! We’ve got her now. I’ve got a steak for you when we come back. Hope you didn’t scare this little gal half to death.”

  Lukas dried his hands and gave a silent sigh of relief. With mother and baby safely tucked away in obstetrics, peace once more reigned in the E.R. Despite all lack of prenatal care, the baby appeared healthy. Tia, with her continued denial, showed signs of mental instability. Maybe social services could help. Lukas shook his head.

  “Whew!” Claudia walked back into the department. “Still doing fine up there. That Tia’s a handful, isn’t she? What’d I tell you about the full moon?”

  “Would you look around you?” Lukas said. “We don’t have anyone in right now. Come on, Claudia, one difficult patient cites a virgin birth and you blame the moon.”

  “Night’s not over, Dr. Bower. Ever been in the eye of a hurricane?”

  “Never, and I doubt you have, either, or you wouldn’t be comparing it to this. I think I’m going to go back and try for some slee—”

  The E.R. doors flew open and an elderly couple rushed in. The man carried a little girl in his arms. The girl’s mouth worked silently as she fought for breath, her lack of oxygen apparent. Dirt smudged her face and arms, and straw clung to her clothing. It didn’t hide her swollen features or panicking eyes.

  “Help us!” the man called. “She’s barely breathing!”

  Lukas rushed forward and took the gasping child. “Rita, get me another nurse down here now.” He carried the girl into exam room one and put a nonrebreather mask over her face. A quick assessment showed a markedly elevated heart rate and deep, rapid respirations with little air movement. Her cool, moist skin revealed no evidence of cyanosis yet. She looked slightly familiar to him, but he didn’t have time to try to place her.

  Claudia joined him, followed by the elderly couple.

  “She might’ve been stung,” the man said. “We’re beekeepers, and we’ve seen this kind of thing before. Our dog found her in front of our barn. She was barely breathing then.”

  “Anaphylactic shock,” Lukas told Claudia. “Get me an amp of IV epi so I can do a sublingual injection, and get an IV started. I also need the intubation equipment.” He turned to the couple. “How much does she weigh?”

  “I can only guess,” the man said. “Maybe eighty-five pounds. About as much as one of my well-packed hay bales.”

  “That sounds good to me.” He took the syringe and injected under the swollen tongue. “Claudia, as soon as you have the IV, I want you to give her a half milligram of epi and 50 of Benadryl.”

  “Sure will.” The nurse quickly removed the child’s clothing from the waist up.

  “Will she be all right?” the woman asked. “We thought about calling an ambulance, but thought we’d get her here faster.”

  “We’ll be doing our best,” Lukas said, reaching for the intubation kit. “Would you please go to the waiting room? We’ll let you know how she’s doing as soon as we can.”

  “Sure, Doc,” the man said. “Come on, darlin’. We’ve done all we can for now.”

  “Oh, no, we haven’t,” the woman said as they walked out. “We can pray.”

  Rita passed them at the doorway. “I’m sorry, Dr. Bower, but when I told the supervisor upstairs what you wanted, she said she couldn’t spare an extra nurse right now. She’ll send one down when she can. Wouldn’t you know it would be Rachel Simmons tonight.” She caught sight of the patient, and her eyes widened. “Dr. Bower, that’s Tedi. It’s Dr. Mercy’s little girl.”

  “Then call Dr. Mercy, but first get another nurse down here. Stat.” Surely Rachel Simmons wouldn’t refuse a stat order. He turned back to Claudia. “Good, you got the IV started. Push the epi, then the Benadryl. After that she needs 250 of Solu-Medrol, IV push.” If he could intubate, he could buy some time.

  He opened the kit and pulled out a pediatric straight blade. He attached it to the laryngoscope handle and checked the light. It worked. He grabbed a 5.0 endotracheal tube and did a quick check of the cuff. It inflated. Good. He lubricated the tube and positioned Tedi’s head for intubation. She didn’t fight him. That could mean she was getting worse or that the Benadryl was beginning to work. Lukas wished he knew. He needed assistance, but Claudia couldn’t help him while she pushed drugs.

  “She’s turning blue,” he said. “We’ve got to have another nurse.” He called over his shoulder. “Rita, are we getting help?”

  “No,” she called back. “Rachel said she’s too busy to send anyone yet.”

  “I gave a stat order!”

  “I told her that.”

  “Sorry, Doctor,” Claudia said, “but if you’ll just give me a little more time, I can—”

  “We don’t have any more time.” Lukas opened Tedi’s mouth and inserted the laryngoscope blade. The light revealed what he had feared—a hypopharynx so swollen he could barely see the vocal cords. He slid the ET tube down to them. Too tight. He pulled it out and grabbed the 3.0 tube. This time he used a stylette to force it. Nothing.

  “It won’t work,” he said. “We’ll have to do a cricothyroidotomy.” They had to cut. “We need help.”

  “I want to talk to Tedi,” Theo demanded.

  Mercy sat holding the phone, not sure she’d heard correctly. “Is this some kind of practical joke?”

  “Look, just let me talk to her. I know she’s there.”

  Mercy held the telephone receiver out from her ear. The man had lost his mind at last. She knew the booze would get him someday. “What are you talking about?” she asked, keeping her voice quiet and in control.

  Silence.

  “Theodore Zimmerman, where is my daughter?” Still calm, but he would know she meant business.

  “Uh…sorry, Mercy. I must have dialed the wrong number. She’s spending the night with some friends, and—”

  “What number were you trying to dial?” This time she couldn’t control her voice so well. “What’s going on? Why don’t you know where Tedi is?”

  “Like I said, I dialed the wrong number,” he snapped. “Stop jumping to conclusions. Why do you have to be so defensive—”

  “What’s the number?”

  Again, silence.

  “Who’s she staying with?” Mercy was finding it increasingly easy to mistrust every single word that came from Theo’s mouth. Something was wrong with Tedi, and he was making a bad attempt at covering. “What’s the name?”

  The line went dead.

  Mercy’s grip tightened on the receiver until she felt sure it would implode with the pressure. These things were cheap….

  She hung up the phone and paced the room to control herself. Take deep breaths, in through the nose,
out through the mouth. “I’ve got to get Tedi back,” she muttered.

  The phone shrilled again.

  She crossed the room and jerked up the receiver. “Okay, try your story on me. And it had better be a good one.”

  Silence.

  “Don’t pull this with me again, you—”

  “Dr. Mercy?” It wasn’t Theo. It sounded like…

  “Rita?”

  “Yes, Dr. Mercy. Would you please come down to the emergency room immediately?”

  In the ensuing pause, Mercy overhead the distant sound of the hospital speakers. “Code blue, E.R. Code blue, E.R.” It was a man’s voice. It sounded almost like Lukas.

  “Sure, Rita,” Mercy said. “Sounds like you’re busy. If you need help I’ll come down. Just give me ten minutes.”

  “Dr. Mercy, you don’t understand. It’s Tedi.”

  Mercy went cold. “The code? I heard a code.”

  “Doctor, it’s Tedi.”

  Tedi had stopped breathing. She lay unconscious on the exam table.

  “Claudia, bag her.” Lukas prepped her neck with an alcohol swab, then turned and pulled on sterile gloves as the code team assembled in the room.

  Rachel Simmons, the team leader, came bustling in last, scowling. “What’s going on?”

  Lukas ignored her. “Randy, get another IV line for us. Rachel, get me some vitals. Millie, get her on a monitor.”

  Rachel hesitated, staring at the patient. “You mean you haven’t even gotten her vitals yet?’ She placed her stethoscope over Tedi’s chest. “Who called the code? This patient is not coding.”

  “She’s not breathing and she’s unconscious,” Claudia snapped, still bagging Tedi. “Dr. Bower told you to get vitals.” Her voice grew louder and sharper. “That was an order!”

  Lukas extended Tedi’s neck and identified his landmarks, palpating the throat. There. The cricothyroid membrane. He reached for the scalpel and prepared to incise.

  “BP’s 50 by palp,” Rachel said. “I can’t get the diastolic.”

  Lukas nodded, hoping no one noticed the sheen of perspiration on his upper lip, his quickened breathing. He never liked invasive procedures, but it went with the job, and he knew his strengths and limitations. He also knew who was in control. Lord! Help! I can’t do this alone.

  He lowered the scalpel and placed the point of the blade against the tender flesh of Tedi’s neck. He drew a fine line of red, an initial surface cut. The body jerked in reaction to the pain. She gasped. Aha! She was still unconscious, but the drug was working to reverse the anaphylactic shock.

  Lukas pulled the scalpel back and checked her throat with the stethoscope.

  “We have some promising air movement here,” he said with relief. “Claudia, assist her breathing.” He listened to the lungs. Good. He checked her heart. It sounded stronger and not as fast as before. The cyanosis was disappearing. Thank You, Lord! Thank You! “What’s her BP now, Rachel?” Tedi may still need dopamine.

  He turned to find Rita standing at the threshold. “Let’s make sure we have a bed open in ICU,” he told the secretary. “Have you called her family yet?”

  “Yes. Dr. Mercy is on her way. She should be here any minute.”

  “Good. Tell that nice couple in the waiting room that she’s doing better.” He turned to Rachel. “Do you have her pressure yet?”

  “Yes, it’s 82 over 53.”

  Okay, it was slowly coming up. The child’s color looked better. If she kept improving she would be okay. For the first time he had opportunity for a more thorough assessment, and he frowned at some bruising on her shoulders. He checked it more closely. The marks were faded, slightly yellow in color, so they were fairly old. They couldn’t have anything to do with her present condition. He would ask her about them later.

  Chapter Twenty-Two

  Mercy raced down the hospital hallway and into the emergency room without slowing down. “Where’s Tedi?” she called as she continued past Rita.

  “In here, Mercy,” Lukas called from the open doorway of trauma room one. “It’s okay. She’s doing better.”

  The code team stepped away from the bed as Mercy rushed into the room and to Tedi’s side. “I heard you call a code over the phone, Lukas. What’s going on?”

  “Anaphylactic shock,” Lukas said. “Apparently from a bee sting. The beekeepers brought her in. She’s getting air much better now.”

  Mercy bent over her still-unconscious daughter. “May I use your stethoscope?”

  Lukas handed it to her.

  “What happened?” Mercy asked as she listened to Tedi’s chest. She glimpsed the tiny line of drying blood on her daughter’s throat. “You started a cric?”

  “She stopped breathing. I couldn’t intubate her.”

  “Is that why you called the code?”

  Rachel Simmons stepped up to the bed. “Funny you should ask, Dr. Richmond. I wondered the same thing, since your daughter’s heart never stopped. You’re on the QA team; maybe you can explain to Dr. Bower what constitutes a code and what constitutes a violation of protocol.”

  Mercy straightened slowly and stared at Rachel in amazement. This nurse had always shown a decided lack of compassion for patients on the floor, but Mercy wasn’t sure, at first, that she’d heard the woman correctly.

  “Am I to understand that you’re complaining because my daughter wasn’t actually dead when Dr. Bower called the code?” Mercy’s voice froze the air around them.

  “Of course not. That’s not what I mean.”

  For another moment Mercy didn’t trust herself to speak. She continued to hold Rachel’s gaze until Rachel looked away. She knew the woman had some grave personal problems and that it affected her work and her interpersonal relationships. No one wanted to work her shift. Mercy had often been irritated by her attitude, and sometimes she felt sorry for her. But this was inexcusable.

  Claudia stepped up to the bed, glaring at Rachel. “Excuse me, Nurse, but weren’t you the one who refused to send anyone down for us when we called upstairs for help?”

  “We were busy. You’re not the only department in this hospital.”

  “When it comes to little girls fighting for breath, we are!” Claudia snapped.

  “I don’t know if Dr. George will feel the same way,” Rachel said, backing out of the room. She turned to leave.

  “Come back here, Nurse,” Lukas called before she could step out the door.

  Her back stiffened. She stopped, but did not turn to look at Lukas.

  “As Claudia has stated,” he said, “were you not the one who refused my stat order to come to the trauma room tonight?”

  She turned around and glanced at him with narrowed eyes, but didn’t reply.

  “In fact, I requested help twice and you refused twice,” Lukas continued. “Your insubordination endangered this child’s life. I had no choice but to call a code. If you have reason to doubt my professional opinion or skills, tell it to administration, and they can take whatever actions they feel are warranted. In the meantime you are to obey my orders when I am on duty. Is that understood?”

  Rachel raised an eyebrow and stared at him coldly.

  “If it is not,” Lukas insisted, “I will request your immediate termination. Is that clear?”

  She held his gaze for a moment longer, then looked away. “Very.”

  “Thank you. I am going to write you up for this, and if it happens again, I will request your dismissal from this hospital.”

  Rachel’s face flushed bright red. “Dr. George may not agree to that, either.”

  Mercy stepped over to stand beside Lukas. “Rachel, the cessation of breathing constitutes a respiratory code. It is a protocol not subject to interpretation. You may go back to the floor…for the time being. I haven’t decided yet what I’m going to do about this, but I, too, can request your termination.”

  They waited until the nurse had left the room.

  “Wow.” Claudia breathed at last, looking at Lukas with awe and respect. �
��I didn’t know you had it in you.”

  Lukas grimaced. “Unfortunately, my temper surfaces from time to time.” He turned to Mercy. “I’m impressed. You really can keep your cool when you want.”

  “Really? I hadn’t noticed. Thank you for your support, Dr. Bower. It’s very comforting.” She bent back over her daughter, whose eyes had begun to open.

  The rest of the code team left the room, except for Claudia, who took Tedi’s blood pressure once more.

  “I’d’ve fired her on the spot,” Claudia muttered as she smoothed Tedi’s hair back and swiped at a smudge of dirt on the child’s cheek. “She shouldn’t have a license to nurse. She’s rough on everyone. There’s a bad morale problem on the floor because of her.”

  Mercy looked in dismay at the dirt covering her daughter’s body. “Claudia, would you hand me some of those moist towelettes behind you? Where has this child been, a barn lot?”

  “Exactly,” Lukas said. “Don’t ask me what she was doing there.”

  Tedi blinked and squinted. “Mom?” Her raspy voice barely reached them.

  Mercy leaned closer. “Yes, honey?”

  Tedi’s eyes opened wider. “You’re here?”

  Mercy kissed her daughter’s cheek. “Yes, Tedi, I’m right here. How do you feel?”

  “Mom, I was so scared.” Tears formed in Tedi’s eyes and dripped down the sides of her face, forming dirty streaks that disappeared into her hairline. “I thought I was going to die. It was dark in the barn, and this big dog kept trying to get in.” Her hoarse voice cracked.

  “Try not to talk right now,” Mercy soothed.

  “But I have to, Mom. It was so awful. First Julie came and gave Dad some wine, then they started talking about marriage, then she told him I said you supported us, and I had to leave because I…because I was scared. But I didn’t want—”

  “Tedi, honey, slow down.” Mercy cleared some of the grime from her daughter’s face.

  “Mom, I swelled all up, and my lips got thick, and I couldn’t breathe, and at first I couldn’t find my way out of the barn. I thought that dog was going to eat me when I fell out of the doorway, but he didn’t, and then some people came.”