No response.
“The Whites were sick,” said a lady from across the aisle. “They’re trying to sleep it off. They’re almost deaf, so you’ll have to speak up.”
“Taylor?” Karah Lee called over her shoulder as she reached down to check the lady’s pulse. It felt slow, weak, irregular. She rubbed her knuckles against the patient’s chest bone—the best way to waken someone in a hurry.
No response.
Taylor leaned over her. “Unconscious?”
“Unresponsive.” Karah Lee repeated the sternal rub on the man’s chest. Barely a flutter of eyelashes. She took her penlight out of her coat pocket and opened Mr. White’s mouth.
“Oh, Taylor,” she murmured.
“The mucus membranes are cherry red,” he said. “We need to get everyone off this bus now. This looks like carbon monoxide poisoning.”
Karah Lee reached down to pick up Mrs. White. “Get her husband, would you?” she asked Taylor. “They need a hyperbaric chamber.”
“Cox South in Springfield?” he asked.
She nodded and led the way down the aisle. “Everybody off the bus immediately,” she said, raising her voice to be heard above the chatter. “We’ll treat you at the clinic across the street. Follow us, please, everyone.”
Chapter Thirteen
Taylor listened to Jill’s voice drift down the hallway as he settled Mr. White on the bed in exam room three, making sure his oxygen mask fit securely and the flow was at its highest setting. Jill was making arrangements for an airlift for the Whites to the nearest hyperbaric chamber, and Taylor only hoped they would hold out long enough for the chopper to arrive.
The treatment for most of the patients would be the same, though not as drastic as with the Whites. They all needed oxygen. Especially for the elderly, this kind of episode could prove disastrous because of their decreased ability to break down the components of carbon monoxide.
Blaze had rounded up all the oxygen in the clinic, and with Taylor’s small canister they had eight. Not nearly enough to treat all twenty-three passengers, but the pharmacist, Nathan Trask, had been contacted via his cell phone, and was on his way back to the pharmacy from a supply run to Springfield. He would bring a couple of extra canisters as soon as possible.
Several of the passengers had shown marked improvement simply by escaping the tainted atmosphere of the bus, and so Taylor could only hope—and at this point, pray—that they had enough oxygen for those who truly needed it.
The prayer might work, but he wouldn’t count on it. He seldom prayed lately. He doubted God would listen to him, much less answer. However, in a case like this, when Taylor wasn’t praying for himself but for the lives of others, maybe those Great Ears would be open.
“Ouch!” came a guttural cry from exam room one.
“Sorry, Mr. Walker,” came Karah Lee’s voice. “Had to get the IV started. Your heart’s showing some irritability, so we wanted to be prepared. Is the oxygen helping any?”
Taylor raised the bed rails around Mr. White, then rushed back into Mrs. White’s room next door and rechecked the cardiac monitor he had placed on her—using his own from the truck. The improvement was negligible. They both needed to be on ventilators, but that would have to wait until the helicopters landed. In the meantime someone would have to ventilate them manually, which meant he needed to intubate them—place a tube down each windpipe to help them breathe. He wasn’t familiar with the setup here. He needed help.
He went down the hallway to the first exam room, where Karah Lee stood checking the heart monitor connected to their patient with chest pain. She looked up when he entered, and he could see the concern in her expression. He glanced at the monitor and saw the reason for that concern. Heart irritability was an understatement.
“I need to intubate both Mr. and Mrs. White,” he said.
She nodded. “Jill, where are you?” she called, her strong voice carrying well over the beeps of monitors and chatter of a packed waiting room.
“I’m on the phone,” came the reply.
“Are we getting an airlift?”
“Hold on, will you?” There were quick instructions, then the sound of a telephone receiver being placed in its cradle. “Air Care will be here in fifteen minutes,” Jill called.
Karah Lee frowned at Taylor. “Fifteen minutes?”
“Count your blessings,” Taylor said. “That’s good time for here. Don’t worry, we can do this. I’m not very familiar with the setup since they changed things around a couple of months ago, but I won’t have trouble intubating if I have some assistance. After that, we’ll need a couple of people to squeeze the ambu bags until Air Care arrives.”
Karah Lee’s gaze caught on the monitor screen. “Get Blaze.” She raised her voice again. “Jill! Call for another helicopter, and then call Dane Gideon. I think he’s at the general store. Have him come over for a few minutes and help us. Blaze? We need you back here.” She turned back to Taylor. “I’ll do one of the intubations, you do the other.”
Blaze came lunging into the room. “Got something for me? Casey’s taking care of the patients in the waiting room. The ones on oxygen seem to be doing better. The driver’s arranging for another bus.”
“Who’s Casey?” Karah Lee asked.
“You know, the kid.”
Karah Lee glanced at Taylor and shrugged.
“Come with me,” Taylor said, nudging Blaze by the arm. “I need help intubating Mrs. White. Have you ever done an intubation before?”
“Sure have.”
“Good.”
“Just never on humans.”
Karah Lee was reassessing Mr. Walker’s heart condition when she overheard snippets of conversation through the open door to the waiting room.
“…not sure you’d call it breathing problems, maybe just a little tired. Don’t worry about me…Casey, you okay?”
“Where’d that Dr. Blaze go? He’s awfully young to be a doctor…”
Karah Lee grinned. Blaze would love that.
“…those things are making my nose sore. Think it’ll rub a blister?…”
“No, just leave it in there, Flo…A headache’s worse than a blister.”
“…Casey, you oughta be a doc, too, someday. You’ve got a nice bedside manner, for a young boy….”
“…calling another bus for us? Before we can take any pictures? But I bought this camera just for this trip.”
Karah Lee glanced down at her patient again, then at the monitor. It didn’t look much better. “Mr. Walker, are you still having chest pain?” she asked.
He nodded and grimaced, rubbing at the moisture on his wrinkled forehead with his right hand. “Some. Not like my headache, though.”
“What about your upset stomach?”
“Not as bad.”
“And on a scale of one to ten, what would you rate your chest pain now?”
The man grimaced again, his pale lips pursing as he appeared to consider the question from all angles. “About a four.”
“You’re not allergic to anything? Morphine?”
“Morphine?” He frowned up at her. “Why?”
“I don’t mean to alarm you, but your EKG shows your heart’s acting up a little more.”
“What does that mean?”
“You could be having a heart attack. We have a helicopter flying in for you, and they’ll take you to Springfield.”
“But I felt fine this morning. I thought this was all just carbon monoxide poisoning. Why do you have to fly me to Springfield?”
There was a collective gasp from the other room. “Casey! Quick, catch him!” somebody called out.
“I’ve got him,” came Taylor’s voice. “You just sit there and relax. It’ll be okay.”
Karah Lee hesitated, then returned her attention to her patient. “They have a hyperbaric oxygen chamber, which will do more than anything to get your carbon monoxide levels down and prevent further damage to your heart. Don’t worry, the morphine will help—”
“Doctor.” Taylor stepped into the doorway, carrying the one teenage passenger in his arms. The boy’s hat was knocked sideways and his glasses were askew on his face. “We need to get this one into a bed. He was helping one of the ladies with her nasal cannula and just pitched forward. We barely caught him in time to keep his face from hitting the floor.”
Karah Lee once more checked the monitor, then squeezed Mr. Walker’s hand. “I’m sorry, but we’re very short-handed. I’ll let Jill start you on the medication, then I’ll be back in to check on you.” She joined Taylor and directed him to exam room four, then gave Jill instructions to start morphine on Mr. Walker.
“What dose?” Jill asked.
Karah Lee called the numbers over her shoulder as she followed Taylor down the hallway to the exam room at the end of the hallway. As Taylor settled the young man on the bed, Karah Lee studied her new, young patient more closely.
“Do you know if he’s traveling with one of the other passengers?” she asked.
“He told me he’s traveling alone.”
“Okay, I’ll take care of him. You go back out and triage. As soon as Nathan arrives with oxygen, bring a canister back here.”
Taylor left, and the patient shifted on the bed. “No,” he said softly.
Karah Lee leaned over him. “Is your name Casey?”
His eyes fluttered open and he stared at her a minute, as if trying to focus. He nodded almost imperceptibly.
“You’re obviously having a bad reaction to the carbon monoxide,” Karah Lee said. “Just like the other passengers. We’re going to get you some treatment as soon as possible. You’ll need oxygen.”
“No.” His voice trembled as he struggled to raise himself on his elbows.
Karah Lee gently eased him back. “Just relax for a few minutes, okay? Just because you’re young and strong doesn’t mean you’re immune to the poison that got your fellow passengers on the bus.”
Casey took a deep breath and shrugged Karah Lee’s hand from his shoulder. “I don’t need any oxygen.” He had a surprisingly soft voice. His hat slid from his head to reveal short, deep brown hair and a red, irritated scalp. He reached up to straighten the glasses. “Don’t take it away from anybody, okay?”
Karah Lee studied the lines of his face, the slender neck, the delicate, sharply pointed chin. “We won’t be taking it from anyone else, we’ll be bringing you a new canister as soon as it arrives.”
“I don’t need it.” He closed his eyes again.
“Casey?” called an old man from the end of the hallway. “You okay back there, boy?”
Blaze stepped to the entrance and set a well-filled denim backpack inside the door. “They said this was yours, Casey. What happened to you?”
“He says he’s fine,” Karah Lee said dryly.
“Doesn’t look fine.”
“Get back in the other room, I’ll take care of him. Oh, and don’t let Nathan get away when he gets here. He’s an EMT. He can help us keep an eye on the other patients.”
Blaze saluted and rushed back down the hallway.
Casey moaned and pressed his hands against his lower abdomen.
Karah Lee leaned over him, watching his response carefully. This was an odd presentation of carbon monoxide poisoning. “You want to tell me what’s going on with you?” she asked. “You’re obviously having some belly pain. Do you have a headache? Trouble breathing?”
He shook his head, then seemed to reconsider and nodded. “Some trouble breathing.” He hefted himself up onto his elbows again and dragged his gaze toward the door. “You want to shut that?”
Karah Lee closed the door and took her stethoscope from around her neck. “Okay, let’s check you out. How bad is the pain on a scale—”
He raised his hand as he sat up. Without warning, he grabbed his shirt and pulled it over his head to reveal an elastic bandage wrapped several times around his chest. While Karah Lee watched, he unfastened the bandage and unwound it.
“With something like that impeding your movement, no wonder you’re having trouble breathing,” she said.
The bandage fell away, and Karah Lee stifled a gasp.
This was no boy.
She reached quickly for a gown and wrapped it around the young woman’s very feminine, very bare upper body. “Lie back down, please, you’re white as the bed linens. You want to tell me what’s going on?”
“Cramps.” As Casey dropped the pretense, her voice softened further, cracking with pain as her eyes squeezed shut.
“Okay, I’m going to listen to your chest,” Karah Lee said as she pressed the bell of her stethoscope against the white skin of Casey’s chest. Breathing was irregular, heart rate fast. A quick check revealed low blood pressure. When Karah Lee pressed Casey’s finger, she noted a slow capillary refill. Then she noticed the very strong smell of blood. She glanced down, and saw a stain slowly spreading across the white sheet on the bed.
“Casey,” she said softly. “There are obviously quite a few things going on here that I know nothing about. This is more than simple cramps, and you’re losing too much blood for this to be just a period. Is it possible you’re pregnant?”
The young woman opened her eyes again, and tears filmed them as she held Karah Lee’s gaze. “I’ve been taking the Pill.”
“Have you missed any doses?”
Casey glanced away. “Only a few days a couple of months ago.”
“That’s all it takes. How old are you?” Karah Lee asked.
Casey hesitated, swallowed. “Old enough, obviously.” The casual sarcasm wasn’t consistent with her expression.
“Obviously,” Karah Lee said. “For some girls, eleven is old enough, but I would be forced to handle their medical care differently than I would that of a grown woman. How old are you?”
Casey glanced toward the door. “Eighteen. You can’t write a medical chart on me or anything like that.”
“So there’s some reason you’re masquerading as a—”
“Keep it down, will you?” The young woman’s blue gaze was shot through with discernible fear. “Don’t you doctors have some code or something that says you can’t spill information about your patients?”
With a sigh of frustration, Karah Lee pulled the stirrups out at the end of the exam bed. “If you’re talking about doctor-patient confidentiality, that’s right. I won’t go blabbing about what you tell me. Okay? Satisfied?”
“No matter what?”
“I’m required by law to report the case if you or someone else is in danger because of what you tell me. Now, we need to get those jeans off and check you out, and then I’ll need to take a urine test and draw some blood for—”
“No.” Casey pulled the gown around her shoulders and struggled to sit up. “I’m the one who’ll be in danger if anybody finds out about me. You can’t even tell…” Her voice faded, and she fell back onto the pillow.
“Convinced?” Karah Lee asked softly. “We need to get some fluid back into your system or you’ll become even more dehydrated. I also need to examine you and see what’s going on.” It could be a ruptured ectopic pregnancy, which might be deadly if allowed to continue untreated.
Casey closed her eyes as Karah Lee pulled out equipment to establish a large bore IV. She needed to check on her other critical patients, but she didn’t want to leave this young woman alone.
“I’m going to call my nurse back here to draw some blood, Casey.”
The eyes flipped open. “Nobody else in this room, or I’ll leave this clinic, if I have to crawl out of here.”
“Okay, look, I’ll draw the blood myself as I establish an IV site, but you’ll feel a lot better with some fluid in you. I’ll also need a urine sample.”
“Just tell me where, and you’ll have enough samples for the whole busload. Is that door locked?”
“No one’s going to come in, but, Casey, I can’t run the lab equipment and help those people out there. I’ll at least need to have my nurse help.”
Casey f
rowned, focusing closely on Karah Lee, as if trying to glean some hint of subterfuge. “Promise?”
“I promise.”
“Don’t tell that ranger.”
“Only if your life is further threatened. I’m not going to hurt you, okay?”
Casey glanced around the room, then looked back up at Karah Lee, again with that careful scrutiny. “What will you have to do to me?”
“It depends on what I find wrong, but I’ll need to give you a pelvic exam at any rate, to see for sure where the blood is coming from.”
“You mean I’ll have to do the stirrup thing?”
“Yes.”
At last, Casey relented. “Okay, but no one else in the room, okay?”
“Okay.”
“And can I do the urine test first? I really gotta pee.”
Chapter Fourteen
Taylor removed a nasal cannula from eighty-year-old Mrs. Jessup’s face. “You’re doing better,” he said. “I’m sorry we can’t top off your supply right now, but all the other canisters are in use.”
She smiled up at him flirtatiously. “I don’t think I’m going to need it, Ranger. You’ve got my blood pumping just fine.”
“Oh, cut it out, Flo,” muttered the elderly man at the end of the room. “The poor guy’s got his hands full already without your threats.”
“That’s okay, Fred, let her flirt.” Taylor straightened, holding the used equipment, grinning at his recovered patient. “It isn’t like I have women flocking around me all the time. I’m enjoying this.” He knelt next to another lady and checked her pulse. She, too, was doing better.
With everyone else taking care of patients in the treatment rooms, Taylor had been on his own in the waiting room except for the few moments Nathan Trask had joined him. At the moment, the pharmacist was tracking down more oxygen at the fire station.
“Can’t get over the delayed reaction with Casey,” Fred said. “You should’ve seen him on that bus, what with the rest of us all whining because we felt so awful. He was passing out aspirin and sodas from the cooler in front just like he worked on that bus. Never heard a complaint from him.”
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