MAYA HOPE, a medical thriller - The Dr. Nicklaus Hart series 1

by Timothy Browne, MD

  Lizzy and Nick laughed, but at the same time shook their heads.

  “I don’t know what this world is coming to, Dr. Hart,” Lizzy said. “Lord, save us all.”

  * * *

  Nick ripped off his surgical gown, entrusting Lizzy to close the skin with staples and apply the dressing. He hurried from his operating room to the large trauma OR down the hall. He barely stopped to spray sterilizing foam in his hands.

  He was met at the door by one of the five scrub technicians holding an unfolded and opened gown. He thrust his arms into it and entered the room where the atmosphere was electric and the adrenaline palpable. It looked like chaos, but it was tightly orchestrated. Everyone knew their job and was good at it. Two surgical teams, one for the chest and one for the leg, called out orders. REO Speedwagon’s Time for Me to Fly blared from the stereo in the corner.

  A young, naked black man was stretched crucifix-style on the OR table. Blood pooled on the floor. The pungent, earthy smell of blood mixed with alcohol hit Nick’s nostrils. The young man had been drinking.

  Two anesthesiologists and their technician tended to the boy, one squeezed a bag of blood and instructed the tech to get more. The other anxiously scanned the various monitors that chattered with different chimes and alarms reminding them that they were losing the battle.

  The chest surgeon barked out orders above the rest of the bedlam. A nurse poured sticky brown, betadine antiseptic over the chest as the surgeon used the scalpel to slice between the ribs and insert spreaders. He wore gloves but no gown. There was no time. If this boy was to be saved, the bleeding had to stop. Blood gushed to the floor when the surgeon put his hand into the chest to pinch off the bleeding vessel. It was a lucky grab. The high velocity bullet transected a branch of the pulmonary artery. It was this boy’s lucky day.

  The chest surgeon beamed at Nick as he approached the table. “Am I good or am I good?”

  Nick smiled at him and shook his head. Just don’t ask his first three wives or his sons—one in rehab and the other in jail.

  He was an arrogant son-of-a-gun, but also one of the best surgeons.

  Nick looked at his sweating Chief Resident whose hand was thrust into the boy’s thigh.

  “My young Thomas, what d’ya have?”

  “The femoral artery between my fingers, sir.” He looked relieved to be addressed. “The bullet shattered the proximal femur after it tore through the artery.”

  “And your plan?” Nick asked, expecting the right answer.

  “I was about to cross clamp the artery to see if we can repair it or graft it. I was waiting to see if the chest surgeon would make it necessary.”

  Nick frowned. “Time’s a-wasting,” he said. “Never wait. Focus on what you need to do and do it.”

  They explored the wound together, extending it where necessary to examine the damage, and found the artery could be repaired.

  “What do you want to do with the bone?” He asked.

  “Wash it out and put on an external fixator,” Thomas said with as much confidence as he could.

  There were a few ways to repair it and he wanted a spectrum of correct answers. “What does the literature say?”

  Everything was a teaching moment, even at three o’clock in the morning.

  * * *

  Two hours later, a portion of lung was resected, the femoral artery repaired, a set of external pins and rods held the leg together, and fifteen units of blood were infused, twice replacing the normal amount, the young man was still alive. He had a long road to recovery, but he would live to fight another day.

  CHAPTER 3

  * * *

  Bad News

  Nick heard the gentle knock on the door behind him, but chose to ignore it.

  Gladys, an elderly woman dressed in a modest plaid dress that smelled of Dove soap, sat on the exam table fidgeting with a tissue as she told him about her sore knee.

  “I live in a second-floor apartment, and I’m struggling getting up the stairs, especially when—” she paused and looked past Nick at the door that opened.

  He turned and saw his nurse poking her head in. He scowled. Nurse Emily smiled apologetically at the patient, but did not make eye contact with him. He had been up all night, his temper was short, and he didn’t like to be disturbed. She seemed hesitant to deliver the message, but it must be important. She swallowed hard and said, “Dr. Hart, your father is here and waiting in your office.”

  She disappeared, quickly closing the door.

  Nick hated to be interrupted when he was examining a patient. It wasn’t so much for himself as it was for the patient.

  He stared at the door. He had changed out of his blood-stained scrubs from the night before, but he still wore an unshaven face and baggy eyes. The message puzzled him. Absorbing it, he turned back to Gladys and her sore knee.

  “I’m sorry, Gladys, you were telling me your knee hurts going upstairs?” he asked, trying not to look distracted.

  Nevertheless, his heart sank, and his mind raced. His father was retired but still consulted for a medical company, often traveling from their home in Montana, so Nick wasn’t surprised he was in Memphis. But why was he here at the MED? Why didn’t he call?

  Dad has never come to visit him at the office. Is it Mom?

  Gladys examined him tenderly. In her aged wisdom, she said, “Dr. Hart, you should go talk with your father. My knee will be here when you get back. Now you go on.”

  “Thank you, Gladys. I’ll be right back.”

  As he walked down the hall toward his office, he felt like a schoolboy sent to the principal’s office. When he stopped at the door to his office, he was met by a sense of dread mingled with fear.

  He loved his father, but his father cast a large shadow over his life. Nick was never sure if he lived up to unspoken expectations of the man and the surgeon.

  He opened the door.

  His father stood slightly stooped, staring through watery eyes at a photo on the wall behind Nick’s desk. The photo featured Nick and his friend, John, sitting on a mound of rocks that marked the summit of McDonald Peak in the Mission Mountains. They were young men with sunburned faces and grinning smiles that said it was good to be alive.

  When his father heard Nick push the door closed, he stood up straight and turned to his son.

  Nick could count on three fingers the times he had seen this stoic man cry. He was stunned by the sight and paused to brace himself for whatever his father was about to say.

  Even though retired from a general surgery practice, his father still carried that confident, surgeon’s air about him. It was a strength he had always been able to summon—except now. His confidence crumbled as he faced his son.

  “Johnny’s dead. He’s…he’s been killed,” the elder Dr. Hart said through tears. He reached out to embrace Nick.

  Nothing prepared Nick for the wave of shock and grief that crashed over him. His jaw dropped. He shook his head, and when he could utter a sound, he said, “What? No! John Russell? No!”

  Then, in an effort to distance himself from his emotions, young Dr. Hart went into overdrive. It was as if he’d been called to the ER. He pushed his father away and peppered him with questions. There was not a moment to waste. Time saves lives. He needed to save John’s life.

  “Where is he? What are his vitals? What are his injuries?” Nick asked. The questions tripped off his tongue.

  His father grabbed him by the arms and pleaded with his eyes.

  Nick knew it was true. John was gone.

  “Oh, Nicklaus, I’m so, so sorry.”

  His father hugged him, and Nick came back to the moment. He still needed to do something. He tried to pull away, but his father’s still strong arms held him firm. “He’s gone, son. There’s nothing you can do.”

  Nick went slack against his father, and he let his tears fall. The two surgeons, no longer able to distance themselves from life’s trauma, commingled their pain for a moment of rare intimacy.

  Nick brok
e the embrace first. He went to his desk chair, changed his mind, and sat on the edge of the desk. His face was wet, and he was still in shock. His father stayed where he was, wiping his eyes with the back of his hand.

  Then, as if they’d remembered Harts don’t cry, father and son stood tall and breathed deeply. They were surgeons and had long ago buried their hearts; it was part of the job.

  Nick spoke first. He asked exactly what had happened to John and steeled himself to accept the answer.

  His father knew few details. He’d received the call two days ago from John’s family that John had been found dead in Guatemala, and his wife, Maggie, was unharmed. She was escorting John’s body back to their hometown of Seattle.

  “Two days ago?” Nick’s pain turned to anger. “Why didn’t you call me?”

  “Nick—” His father’s face flushed. He took a deep breath and his expression softened. “Nick, I’m so sorry about John. We did try to call you, son, but we—” he let the rest go.

  Nick slumped his shoulders and looked down at his beeper attached to his belt, remembering the pages he got from the answering service to call his parents. He sat in silent guilt.

  John was his best friend—they were closer than brothers—and his own father thought of John as another son. Their families had little in common with John’s folks working in the local wood mill, but one thing they shared was the love of their children. An extra chair always sat at the dinner tables at each home. Some nights the friends would eat at both tables, their adolescent metabolisms yearning for more food than usual after the afternoon soccer games.

  His father squeezed his shoulder. “You going to be okay.” It was a statement more than a question.

  Nick sighed through his nose and nodded.

  “Well, call your mother. She’ll want to know how you’re doing.”

  He watched his dad walk to the door, limping slightly on an arthritic hip. His father seemed to have aged in the last few minutes; his shoulders hunched, and his spine curved to the right.

  The elder Dr. Hart paused at the door and turned to look at his son. He almost spoke but closed his mouth and gave Nick a tight-lipped, half-smile. He nodded slightly, looked at the floor, and left without saying another word.

  * * *

  Nick pulled himself together. He told the office staff to cancel the rest of the day. He went to the exam room to apologize to Gladys and got an uncomfortably long hug from her. It seemed that people around him understood how to grieve better than he did; after all, it was his best friend who had died.

  He sat in his midnight blue Porsche Boxster in the parking garage, feeling the perfectly supple leather on the steering wheel. He was not an emotional man; he couldn’t succumb to emotions in his line of work. He had cried all the tears he could for one day. He was numb.

  No, he was furious. His stomach filled with surging acid of helplessness, anger and anxiety. He hated those feelings and sat very still to keep them from erupting.

  God, my back is sore.

  He pushed against the steering wheel trying to get his back to pop.

  His mind spurned his physical discomfort and returned to the death of his friend. He didn’t know what to do next, another strange sensation for him. He could try to call Maggie, but he wasn’t sure he was ready yet.

  “Go home!” he said out loud.

  What can I do? What must I do?

  He glanced at the sign painted on the cement wall of the parking garage: Reserved for N. Heart, MD. They had spelled his name wrong, but he’d always figured it was close enough for government work. He shook his head in disgust. Is this all I’ve worked for: a nice car and a parking spot?

  A rap on the car window startled him.

  The impatient intruder rapped again.

  Nick looked through the window. “Oh geez,” he said, not so silently under his breath.

  Outside his car stood the devil herself: Anita Roe. Most referred to her as Cruella de Vil, from the movie, One Hundred and One Dalmatians. Nick let his head fall back and closed his eyes, hoping she would go away.

  Anita Roe was chief administrator of the MED. She had been in the position for three years and had managed to alienate the entire medical staff. Her every decision was based on money, not what was best for the patients or the doctors or the nurses or the rest of the staff, but how it affected the bottom line.

  She did her job with no shame—lowering wages where she could, increasing staff workloads, leaving patients without a nurse for hours at a time, and overhauling the system into a shamble of a work place.

  She tapped on the glass again. Nick felt the bile in his belly readying for eruption. Without opening his window, he glared at her. She was stooped over and peered at him through the glass. A strand of gray ran through her close-cropped hair. Her frame was tall and bony thin, but somewhere along the way had gone under the knife, giving her disproportionately large breast implants and a small nose. She wore a pink knit suit and diamond earrings that he guessed cost more than a nurse’s monthly pay.

  “Dr. Hart, I need to talk with you.” She looked perturbed.

  He realized she was not going away. He relented and powered his window down. He could smell her. He thought it was strange that such an immaculately dressed woman would have such a vile odor, worse than bad breath.

  She took a step back from the car and put her hands on her hips.

  He gave her a bewildered look. “Yes?”

  “My assistant called me at lunch and told me the news of your friend…and I’m…” she began in her overripe Georgia peach accent and then uncharacteristically stumbled over her words. She even blushed slightly.

  He was surprised. Am I seeing some humanity in this woman?

  “I wanted to make sure you are going to be okay?” she asked. “I noticed you have a full day in the OR tomorrow, and I wanted to make sure you would be there.”

  Nick rolled his eyes. I guess not. I’ll bet she doesn’t even have a heart.

  “Look,” Roe continued, “I am sorry for your friend and all, and I have been meaning to talk with you anyway.” She took another step back, sensing his growing anger. She was not about to back off. “I heard you cancelled your clinic today, and I have to tell you I’m concerned about your numbers. Your elective cases are down fifteen percent the last two months.”

  Nick had not spoken a word. He gripped the steering wheel so hard that his knuckles turned white. He wanted to jump out of the car and snap her in two. At the very least, he wanted to rip her apart with his words. How dare you?

  “You are under contract, Dr. Hart,” the chief administrator said. “Because of what we are paying you, we expect that you do ten elective cases a week in addition to trauma call.”

  He couldn’t hold his tongue another second. “I operate on those patients that need it. Period,” he shouted. By the way she looked at him, he knew his face was turning bright red. “Do you want me to make up cases? Operate on people that don’t need it, just to make your quota?”

  “Well…” she seemed to stop herself from actually saying yes. “…or see more patients in your clinic to get those cases,” she said, flustered by his irate stare.

  Nick put the Boxster in reverse, and the tires squealed. His anger had reached the breaking point. He jammed it in drive, and this time the tires smoked. Anita Roe jumped two steps back.

  “Ten cases, Dr. Hart,” she yelled as he sped away, no longer sounding so much like a southern belle.

  * * *

  The alarm continued to buzz. Nick wasn’t sure which was worse, moving and making his head throb or listening to the buzzing alarm. He had a hangover larger than the six-pack of beer that had been in his fridge for months. He rarely drank that much at one time, but last night there seemed to have been more than enough reasons.

  Am I too hung over to operate today?

  He glanced at the clock on the nightstand: 5:30 a.m. He squeezed his throbbing head. The pain lingered, and he wondered if he could handle the cases scheduled that
day.

  He’d done them a hundred times. Sick or not, I can do it. A shower and a few cups of coffee, he’d be fine.

  The throbbing increased as he became more conscious. He struggled to remember what he had done after leaving the MED.

  His mind flickered like an old black-and-white movie, and he groaned. His groan elicited movement beside him, and he turned to a mass of black hair partially covered by the pillow which was held in place by two hands highlighted with bright red nail polish.

  “Not again!” he moaned.

  The young woman grabbed another pillow in a further attempt to drown out the alarm.

  Nick’s head fell hard on his pillow as it all came back. Last night in the middle of his third beer and Monday night football, Jasmine had appeared at his door with a smile and a bottle of whiskey. She, too, had heard about Dr. Hart’s friend and thought that she could help ease his pain. Jasmine worked with him in the OR, and she was one of many women who wanted to snag him for a husband.

  He shook his head and sat up. He needed a change in his life. He didn’t know how, but he needed to start now. For the first time in eight years, he reached for the phone and called the MED. He told the scheduler he was coming in but he would need to take a few days off. He put the phone back in its cradle, got out of bed, stood up, and stretched. He looked at the sleeping Jasmine.

  She can look after herself.

  He had things to do. He had to see to John’s funeral. He had to check on Maggie. He went to the bathroom to scrub the hangover out of his head.

  CHAPTER 4

  * * *

  Reunion

  Three days later, stepping off the plane into a dreary, rainy day in Seattle, Nick caught a glimpse of himself in the steel pole of the airport gift shop outside the arrival gate. He looked like one of his strung-out meth patients.

  He made a feeble attempt to push his blond waves back and rub the bags from under his eyes.