by Jeff High
PRAISE FOR
MORE THINGS in HEAVEN and EARTH
“Told through the eyes of Dr. Luke Bradford, a newly minted MD, the story of the little town of Watervalley, Tennessee, and its inhabitants comes vividly to life. Jeff High’s medical background gives him that cutting edge in the technical details of his tale and his love of his native Tennessee and the human race shines from every page. Dr. Fingal Flahertie O’Reilly is delighted to welcome Luke, a transatlantic colleague to be fiercely proud of.”
—Patrick Taylor, MD, New York Times bestselling author of the Irish Country novels
“The best of small-town Americana and the eccentrics who live there are brought to life in More Things in Heaven and Earth. This story warmed me, made me laugh, and then kept a smile on my face. It’s delightful, compassionate, humorous, tightly woven. If you’re looking for a feel-good read, spend an afternoon with Jeff High’s novel.”
—Charles Martin, New York Times bestselling author of Unwritten and When Crickets Cry
“A well-spun story of the mystery and microcosm that is small-town America. Jeff High skillfully captures the healing places, the hurting places, and the places where we so often find out who we are truly meant to be.”
—Lisa Wingate, national bestselling author of Tending Roses and The Prayer Box
New American Library
Published by the Penguin Group
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First published by New American Library,
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Copyright © Jeff High, 2013
All rights reserved. No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.
REGISTERED TRADEMARK—MARCA REGISTRADA
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA:
High, Jeff, 1957–
More things in heaven and earth: a novel of Watervalley/Jeff High.
p. cm.
ISBN 978-1-101-61836-3
1. Physicians—Fiction. 2. Small cities—Fiction.
3. City and town life—Fiction. 4. Tennessee—Fiction.
5. Domestic fiction. I. Title.
PS3608.I368M67 2013
813'.6—dc23 2013018662
PUBLISHER’S NOTE
This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental.
The publisher does not have any control over and does not assume any responsibility for author or third-party Web sites or their content.
Contents
Praise
Title page
Copyright page
Dedication
Epigraph
PRELUDE
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
CHAPTER 18
CHAPTER 19
CHAPTER 20
CHAPTER 21
CHAPTER 22
CHAPTER 23
CHAPTER 24
CHAPTER 25
CHAPTER 26
CHAPTER 27
CHAPTER 28
CHAPTER 29
CHAPTER 30
CHAPTER 31
CHAPTER 32
CHAPTER 33
CHAPTER 34
POSTLUDE
About the Author
Readers Guide
Excerpt from EACH SHINING HOUR
For Page Chamberlain and William Pollard,
the men who helped me learn.
And for Dawn,
the one who helped me understand.
All service ranks the same with God—
With God, whose puppets, best and worst,
Are we; there is no last or first.
—Pippa Passes by Robert Browning
PRELUDE
A drop of water.
Carried up from the vast ocean a world away and pulled by chance wind across earth and sky. In time it is released from the swell of a thunderhead and plummets through the open air, landing on the high hills. It finds a leaf, then a rock, then a blade of grass. It passes through the forest floor, then down below into the infinite web of roots and loam. Falling through layers of limestone and minerals, it is cleansed from the impurities of the world behind. Now pristine, it finds bedrock and pools in long-undisturbed caverns.
But time and pressure pull it downward toward the valley. It permeates the rock and surfaces again from a small spring. At first, part of an unhurried rivulet, then a toppling brook, then a wide, shimmering stream. It leaps over smooth stones and shallow falls until reaching the clear lake at the heart of Watervalley. Now its journey will end for a season, having found the way here through time and space and earth by the chaos of forces that were unforeseen and random.
Or were they?
CHAPTER 1
The Clinic
Watervalley, Tennessee
In medical jargon it’s called a Code Blue.
It’s a nice way of making hospital staff aware—and without panicking everybody else—that someone’s in cardiac arrest and preparing to catch the angel bus. During my residency at Vanderbilt I had run dozens of them.
Even still, trying to revive someone whose heart has just flatlined puts a real cog in your day. It’s always borderline chaos. You practice for it, plan for it, but it never happens the way it should. I hate a Code Blue.
To make matters worse, a Code Blue always involves a strange, spontaneous assumption of roles. It’s confusing. Who grabs the crash cart? Who starts an IV? Who pulls the drugs? Who does compressions? Who charges the paddles? You’re in a crowded, disorganized room with frenzied voices, frantic activity, rapid commands flying everywhere. And all the while some poor soul’s life is in the balance. So in the back of your head is this scared whisper nagging at you, reminding you that you will make the difference between some guy staying alive and an awkward conversation with the family about how “it was just his time.” Yeah, I really hate a Code Blue.
Weeks earlier, when I had been at Vanderbilt, a trained team of professionals had always been on hand to respond quickly to someone coding. But now that I was the new and only doctor in Watervalley, things were different. Here a Code Blue has to be carried out by unrehearsed clinic staff and panicked bystanders. It’s pretty much a guaranteed disaster.
And one final thing. Regardless of where and when it happens, regardless of the disorder and fluster, there are three cardinal rules to follow when you’re “coding” a patient: Always keep your cool. Know when to call it. And never—and I mean never—ever let the family be present while you’re trying to revive the guy.
But this is Watervalley, and things like a Code Blue happen differently. They don’t follow the normal order. Here they happen randomly, almost comically. And sometimes, b
eyond all reason, they happen miraculously.
Because on that July afternoon during my first week at the Watervalley Clinic, when Sawyer Wilson went into cardiac arrest in the waiting room, I didn’t break just one of the rules—I broke all three. In hindsight, thank God I did.
It was nothing that med school could have ever prepared me for.
Sawyer Wilson, or “Hoot” as he was known, had come to town in the middle of his workday because his ten-year-old daughter, Wendy, had an earache. A single parent and a third-generation dairy farmer, Hoot had an expansive, mischievous humor, a perpetual smile, and was a good three hundred pounds. Ducking as he came through the clinic entrance, he was wearing overalls tucked into knee-high rubber boots and smelled of silage. In Watervalley, for dairy farmers like Hoot, coming to town held no requirement to change from his work clothes, much less wash or shave.
Holding Wendy’s hand, he checked in with the receptionist, and after broadcasting a buoyant “Afternoon, everybody!” he plopped down in a corner chair and fell fast asleep. It was July hot outside and the air-conditioning had made him drowsy.
At least, that’s what everyone thought.
The first sign of a problem came when Wendy walked up to Nancy Orman, the receptionist, and announced in a small voice, “Mrs. Orman, something’s not right with Daddy.”
Nancy leaned over the counter and glanced at Hoot sleeping dreamily in the corner. She responded with an impish laugh. “Sweetie, I don’t want to hurt your feelings, but we’ve all known that for years.”
“No, you don’t understand. I don’t think he’s breathing.”
This got Nancy’s attention. After a minute of shaking Hoot and fussing at him to “cut it out,” she realized that something was drastically wrong. She burst into the exam room where I was taking a patient’s history.
“Dr. Bradford, I need you to come to the waiting room immediately.”
Her panicked tone told me more than the words themselves. I grabbed my stethoscope and followed.
A quick assessment told the ugly story. Hoot was in V-fib, ventricular fibrillation. His heart was quivering, not beating. In a matter of minutes he would be dead. The clock was ticking.
“Nancy, call the EMTs over at the fire station. We’re going to need them.” I turned to the staff nurse. “Mary Jo, get the defibrillator off the crash cart. It’s in exam room one.”
Mary Jo didn’t move. Her words seemed to ooze out one by one, thick with her dawdling Southern drawl. “Don’t you want the whole cart?”
I responded firmly, calmly. “Mary Jo, if we have to run a full code on him, I don’t want to do it on the waiting room floor. Go!”
She frowned and shuffled away.
“Cindy, go find the gurney and get it out here. We may need to move him to an exam room quickly.” The frail little lab tech gave me a panicked nod and headed off. Meanwhile, I sent Camilla, the phlebotomist, to get the oxygen tank and bagging mask.
I enlisted some men from the waiting room to help me ease all three hundred–plus pounds of Hoot onto the floor, where once again I listened to his breathing, or lack thereof. One whiff and I shuddered. His gaping jaw emanated a toxic smell that could take the bark off a tree. I did a finger sweep, pulling out a large plug of chewing tobacco. My day just couldn’t get better.
Cupping my hands over his mouth, I gave him two hard rescue blows, filling his lungs, and began doing chest compressions, hard and fast. Unbelievably, three more rounds of rescue blows and compressions ticked by and no one had returned. It was a damnable eternity.
“Where’s the defibrillator?” I half yelled. People crowded silently around me, staring with anxious faces.
Mary Jo finally returned with it. She pulled up Hoot’s T-shirt only to discover a chest hairier than a sheepdog. The shock pads would never find skin to stick to.
“Mary Jo, get the pediatric pads and put them on him first.”
Again she argued. “Why? He’s way too big for those!”
I was practically bouncing up and down doing compressions on Hoot’s massive chest. I didn’t need a debate. “Mary Jo, get out the pediatric pads and put them on him now!”
She reluctantly tore open the foil package and placed the two small pads on Hoot’s upper right and lower left chest.
“Now rip them off.”
Mary Jo gaped at me, confused.
“Go ahead—rip them off quickly.”
She complied. It worked as a spontaneous wax job, leaving a clear surface for the adult pads.
It was time for another round of mouth-to-mouth. Two blows into the poor man’s noxious oral cavity almost asphyxiated me. I looked up to see the arrival of the oxygen tank and had the fleeting notion that I might need it first.
“We had a hard time finding one that wasn’t empty,” said Camilla sheepishly.
Precious seconds were flying by. Still bouncing up and down, I snapped out instructions. “Camilla, hold the mask tightly over his mouth and nose and start bagging him.”
She complied with a vengeance, squeezing vigorously on the oxygen bag, pumping him full of air.
“Camilla, we’re not trying to inflate him like a flat tire. Just give him one slow squeeze every eight seconds.” She was wide eyed and scared to death, but nodded obediently with quick bobs of her head.
Finally, the defibrillator was ready to analyze Hoot’s heart rhythm. But when I stopped compressions to allow for the test, I noticed the valve of the oxygen tank sitting on zero. Camilla had been pumping him full of room air.
“Camilla, you need to cut the O2 tank on, wide open.” I was still calm but the aggravation was beginning to show. With quick, birdlike movements she looked back and forth between the tank and me, her face in a blank panic. I looked over to Nancy, speaking quickly.
“Nancy, turn the valve counterclockwise as far as it will go.” She nodded and turned it so hard I thought she might twist it off.
Mary Jo hit the analyze button. Above the din of the small crowd the mechanical voice of the defibrillator announced, “Shock advised.”
“Set it at two hundred fifty joules. Everybody step back!” I nodded to Mary Jo.
The shock caused Hoot’s body to jolt, almost lifting off the floor. Finally, his quivering heart was getting smacked back into rhythm. All eyes were on the defibrillator, waiting, watching. Magically, after a few sputtering waves, it began to show a sinus rhythm, a normal heart wave. Once again Ol’ Sparky had done his job. I exhaled a deep breath. Crisis over.
That is, until five beats later, when the rhythm went flatline. No quivering, no V-fib, nothing.
This was bad news—really bad news. The small voice of panic began whispering in the back of my head. For a moment I stood there, frozen in disbelief. All eyes were on me. The only solution for jump-starting a flatliner is drugs, delivered quickly and methodically in a timed sequence, and then shocking him. The voice was now screaming: Get moving, Luke—Code Blue! Code Blue!
“Camilla, keep bagging him.” I searched the room and pointed to a lanky fellow in his late thirties. “You—Did you see the way I was doing those compressions?”
He nodded.
“I want you to start doing them just like I was. Press hard—he’s a big fellow. Try to do a hundred a minute.”
I turned to Mary Jo. “We need to get him to the exam room and run a full code. Where’s our lift stretcher?”
“We don’t have one.”
“We don’t have one?” I responded incredulously. We had to get him off the floor and onto the gurney, which, I now noticed, wasn’t there.
“Where’s the gurney?” I looked down the main hallway of the clinic. Nancy was waddling toward me, her short legs moving as quickly as they could. I met her halfway.
“Cindy’s getting it. It was back in the storage room covered with the Christmas decorations. She’s cleaning it up.”
I pressed my lips sternly together, squelching back a fuming desire to scream, loudly and with gusto. “Nancy, I don’t care if it’s clea
n or not. Bring it now and bring an extra bedsheet.”
I returned to the waiting room and recruited three men and two of the heftier farm women to help lift Hoot. We got the extra bedsheet under him just as Cindy arrived with the gurney. The air was thick with confusion and tension. Hoot’s life was slipping away.
With three of us on each side, we yanked him up so hard he almost went airborne. Stepping quickly, we dished him onto the gurney in a smooth, sweeping motion that was perfectly executed—except for the small detail that no one had thought to lock the gurney’s wheels. Upon landing, Hoot scooted across the floor like a roller skate, his massive limbs dangling from all sides. I dove and caught him. We moved swiftly.
Including the staff, about ten of us crowded into the small exam room. I stood at the head, calling out orders, timing the intervals, running the protocol. The passing minutes became a surreal blur as events moved with an unbelievable rapidity.
Everything imaginable went wrong.
Camilla, who normally had a rock-steady hand, was so shaken she took forever to get an IV started. This forced me to give the first two doses of epinephrine by direct injection into his jugular, creating no small mess of blood. No one could find a blood pressure cuff big enough to fit Hoot’s arm. We pulled his boot off and put one at his ankle. I couldn’t intubate him because the battery in the laryngoscope was dead. The only atropine available was a month out of date. I used it anyway. With no way to get quick lab results, I was left desperately short of critical metabolic information. It wasn’t that the clinic’s resources were primitive; they were nonexistent.
To top it all off, the EMTs had yet to arrive because they had been far out at a friend’s farm helping to deliver a calf. Only in Watervalley.
Minutes passed. Numerous times the drug protocols sparked some sputtering waves. When that happened, we quickly shocked him, desperately trying to revive a normal rhythm. But nothing was working. Panic was seizing everyone, permeating the frantic voices of those around me. My frustration and anger mounted. Hoot Wilson was an otherwise robust, healthy man of forty-three. To my thinking, it just wasn’t his time yet. But he was about to meet his maker because remote Watervalley lacked the fundamental equipment needed to keep him alive and all of my training couldn’t make up the difference.