Sacred Trust (11 page)

“Sure.” She swallowed, and the smile returned. “Well, anytime you want a fishing buddy, let me know. I can show you the best spots in the county.”

After the service Lukas went home, changed into his hiking gear, and looked for the nearest forest trail. Lonely wasn't so bad. It never hurt to take things slowly.

A
t six-thirty Monday evening, two weeks after the disappointing weekend off, Lukas Bower watched with envy as the day shift prepared to leave, all except for him. He glanced at the clock and grimaced. He was stuck here for another full twelve hours, compliments of scheduling by his beloved director, Dr. Jarvis George. Lukas hated twenty-four-hour shifts. Amazingly, there were no patients in the emergency department at this time, and this was usually the evening E.R. rush hour.

Carol and Lauren chattered as they prepared to walk out together.

The ambulance radio buzzed. “Knolls Community Hospital, this is Knolls 830. Come in.”

Beverly leaned forward and pushed the button and told them to continue.

“Be advised this is a code-red response.” Beverly caught her breath and turned to glance at Lukas. It was a disaster code. The voice continued. “We are currently
leaving the scene of a head-on MVA. A large sedan with three occupants struck a minivan with two adults and three children. You will receive eight patients.”

Lukas started to call to Carol and Lauren, but he saw they had both stopped and put their purses back under the central counter.

“Looks like we're in for some overtime,” Lauren said as she edged closer to the radio.

The ambulance report continued. “We are currently inbound with two class-one patients. The first is a Caucasian male, late twenties, who was the driver of the sedan. His vitals are: BP 80 over 45, heart rate 142 and weak, respiration 52 and labored. His initial O2 sat was 68 percent. He has absent breath sounds over the left side. He is responsive only to pain. He is intubated and is being ventilated. We have two large bore IVs established, and 1000 CCs of fluid are being bolused to the patient.”

Lukas began his mental note-making as he listened.

“There is prominent bruising to his chest,” the paramedic continued. “He moans when chest is palpated. His O2 sat has increased to 87 percent. Does medical control have questions or orders at this time?”

Lukas leaned forward and pressed the Talk button. “Wish to be advised if this patient has been secured on a long spine board with full c-spine immobilization.”

“Affirmative.”

“Acknowledged. Is patient showing signs of tracheal deviation and/or jugular distension? Also, is he having muffled heart sounds?” Lukas waited for a long moment.

“Sorry, the backboard and c-collar prevent my checking tracheal deviation or venous distension. Background noise drowns out heart sounds to an extent.”

Lukas frowned. This was not a very aggressive ambulance crew. “Please continue with report on second patient.”

This evening shift was not looking good. Time to start getting ready. Lukas pushed the talk button as soon as he received the report. “Knolls 830, what is your ETA?” How much time would they have to prepare for this deluge?

“About eight minutes. Does medical control have further questions or orders?”

“Affirmative. Is second patient intubated?”

“Negative, medical control. Are unable to intubate patient at this time but are assisting patient with bag mask ventilation, rate of 20.”

Lukas frowned again. “Copy, Knolls 830. Increase respiratory rate to 24.” He cleared and signed off, then released the switch, making mental preparations. “Sorry, Lauren and Carol, we need to keep you here for a while.” He turned to the night secretary. “Rita, please call medical and surgical backup and be prepared to do a disaster code. I'll have to wait and see what the report is from the next ambulance unit.”

“Where do you want me?” Lauren asked.

“And me?” Beverly asked.

Lukas gave them instructions, then turned to the secretary. “Carol, see if we can get some additional nursing staff down here, and then make sure radiology is on standby.”

“Gotcha.”

“Beverly, also check on air flight availability. Sounds as if we'll have to fly some of them out. Request standby at this time.”

“Okay, Dr. Bower.”

“Lauren,” he called, “better make sure we have some mannitol set up in trauma two. We've probably got a head injury with a classic Cushing's reflex. Make sure there's an intubation set up in there, too, because I'll have to tube him.”

He turned to Rita. “Have you been able to reach our medical and surgical backups yet?”

She hung up the receiver she'd been holding. “No, Dr. Bower. I've beeped both of them.”

“Good. I'm sure they'll call right back. Ask them to come as soon as possible and warn them that this is a disaster code.”

Once more, the ambulance radio blared to life. “Knolls Community Hospital, this is Knolls 832. Knolls, come in please.”

Lukas pressed the talk button. “This is Knolls Community medical control speaking. Go ahead, 832.”

“Knolls, we are currently inbound to your facility with two class-two patients. Be advised, two additional ambulances will be en route to your facility, with short ETAs. One will have a class-two patient who requires extrication.”

They gave information and vitals on a female and a male, one with possible neck injury and one with possible back injury. With an ETA of approximately six minutes, he knew he had to get the nurses back to work quickly.

“Does medical control have any further questions or orders?” the paramedic asked.

“Nothing further at this time,” Lukas said. “Keep us advised of any further changes in the patients' conditions. We will expect you in about six minutes. This is medical control out.” Lukas pressed the button and turned
to find Carol standing behind him. “Call the disaster,” he said. “We need more help, and we still haven't heard about the children. See how many more helicopters we can get on standby. I don't know how many we're going to need yet.”

Carol nodded and grabbed the phone.

“Rita,” Lukas continued, “do we have more nurses coming?”

“Yes, the floor says they can spare one.”

“Just one? This is a disaster code. They'll have to spare more than that. Lauren, is the needle decompression ready?”

“Yes.”

“Okay, I'll be setting up in trauma one. Let me know if you need anything. Everyone glove up and get your goggles and trauma gowns on. Rita, will you see to it that any help that arrives receives trauma gear?”

“Yes, Dr. Bower.”

“Have we received any calls from our backup docs yet?”

“Not yet.”

Lukas frowned. What was going on here? Didn't the Knolls docs respond to emergencies? “Call them again, please.”

 

Dr. Mercy Richmond stifled a yawn as she walked through the quiet second-floor corridor of Knoll's Community Hospital—quiet, because it was 6:45 p.m. Monday evening and census was down. All the other doctors had done their rounds and gone home. With census down, staff was down.

There was only one more patient to see tonight. Mom.

Just as Mercy stepped to the nurses' station, she heard her name paged over the speaker.

“Lucky you,” Zelda, the floor charge nurse, teased. “It's what you get for your dedication. Probably someone wants you to cover their night call again.” She punched the switchboard number and handed Mercy the phone.

“This is Dr. Richmond. May I help you?” She knew by the code paged that she would directly receive her incoming call.

“Yes, Mercy, this is Robert.”

Mercy frowned. “Hi, Robert. Is everything okay? Is Mom—”

“Other than the fact that your mother is as stubborn as you are, she's not too bad right now. She actually showed up for her appointment today.”

Dr. Robert Simeon, an internal medicine specialist, had been the one to do Mom's physical this morning. Mom had insisted that was the earliest she could take the time to go in. She'd just wanted to put it off.

“It's a miracle,” Mercy said. “I've nagged her for two weeks.”

“So that's why she was in such a bad mood.”

“How bad?”

“Nothing serious. She wasn't happy when the treadmill stress test turned up a problem, and tried to say it was an artifact in the machine. Then she reminded us rather forcefully that she's not senile yet, and not to go running to you with a report.”

Mercy sighed. “What's the report?”

“Her cholesterol is 163, blood pressure 120 over 70, fasting blood sugar is 87. Ivy's in good shape for sixty-six.”

“Mom's in great shape for
thirty-
six. Why is she having chest pain?”

“I would take a stab at rate-related left bundle branch block.”

“Rate related? But she nearly passed out at the cemetery just getting out of the car. She hadn't been running a marathon.”

“She was burying her mother. That would account for an increased rate, don't you think?”

“But a near faint? I don't think a bundle branch block would account for that.”

“Of course it could, especially if it brought on a vasovagal. She's been having this for a while, and it's sure to stress her when she feels it coming on. I'm sending her to a cardiologist against her wishes, and who knows whether she'll keep the appointment or not. I finally had to warn her that if I didn't see that she got excellent care, you'd turn me into a leather coat. I think I appealed to her maternal instincts.”

“So she agreed?”

“She tried to laugh it off, but I think that's what convinced her in the end.” There was a pause. “Mercy, you do realize she's still planning to go on her June hiking trip to Colorado, don't you?”

“Oh, no, she's not.”

“That's what I told her.” He chuckled. “I don't want to be around when you two clash.”

“No, you don't. We had plenty of practice when I was growing up.”

“Who won?”

Mercy grimaced. “Mom, usually. She can outtalk an Ozark auctioneer.”

“Why don't you drop by later and we can discuss—”

“Code red in the emergency department,” came an
urgent voice over the speaker just down the hallway. “Code red. All available personnel report stat.”

“I've already started cooking, so don't tell me no,” Robert continued. There was a pause. “Mercy?”

“Huh?” Code red was the disaster code.

“Dinner? My place in about an hour? We can discuss it then.”

“Yeah, sure. Sorry, Robert, there's an alert. Gotta go.” She watched the charge nurse send an aide and another RN from the floor, then hung up and rushed toward the elevator. This couldn't be a drill, could it? Nothing had been approved through the QA team. Mercy would know. She was on it. This had to be the real thing—disaster code.

 

Lukas stood in the middle of the room, surveying the “patients” being carried in from the ambulance. His first glimpse of bloodred mulage paint on Buck Oppenheimer, a supposed accident victim with tension pneumothorax, had given it away. This was a drill. Relief mingled with a little disappointment—not that he wanted anyone to be hurt. His adrenaline did a quick nose dive. He approached Buck's litter. The big fireman-EMT with short hair and big ears was covered in fake blood and had a note taped to his arm. He pretended to be unconscious, but Lukas could see his eyes open slightly a couple of times—and that gave him the idea for a little harmless fun.

Lauren's triage was right. Buck's injury was the worst. Lukas stopped at a utensil shelf just long enough to pick up a couple of things he needed. As he chose his pieces, another group entered the E.R. with one young woman holding a camcorder, and an older woman giving orders.
Lukas recognized her as Dorothy Wild, QA nurse and drill coordinator.

Before they could approach Lukas, he turned and started Buck's way. Buck started gasping for breath. Good acting, but how long could he carry it?

“Nurse,” Lukas said, turning to Lauren with a slight smile. “Would you please hand me a fourteen-gauge needle?”

Her eyes widened, and she started to make an obvious protest, but Lukas winked and widened his smile.

She raised a brow and eyed him skeptically, but did as he requested.

“Thank you, Lauren.” He took the syringe and lowered it from Buck's sight, removed the stainless-steel needle, and replaced the plastic cover.

Buck's eyes weren't shut quite so tightly now, and he'd forgotten that he was a patient in a serious struggle for breath.

Seconds later, Lukas held the syringe up again, raised it above Buck's chest, and started down with it.

Buck stopped breathing. His eyes bugged open, and his thick, muscular arms that were unsecured to the backboard flew up. “Wait!” He tried to scoot away but was held fast by the backboard and c-collar. “Hold it! No needles! I'm with the drill, Doc!” He held out his arm. “See? Fake blood. Mulage paint. This is all just a disaster drill, not the real thing!”