Sacred Trust (4 page)

He turned and opened the heavy glass door. “Ladies, the shampoo costs less than a pack or two of your favorite brand of cigarettes.”

“But we have Medicaid cards,” the smoker called after him. “We can report you for refusing to treat us!”

He stopped midstride and slowly turned back toward them. “Feel free,” he said, keeping his voice calm. “I feel I should warn you, however, that when a card carrier tries to use the card in the E.R. for nonemergency care, she can lose her card. It's called Medicaid abuse. I think you'll find that shampoo works very well as long as you follow the directions.” He stepped inside and let the door close silently behind him.

There were other Medicaid cardholders—for instance, the little baby in exam room three—who needed treatment today, not next week, and Lukas saw to it that they received good care. Lots of Medicaids used the emergency room here because many family practitioners refused to take assignment. Those who did still limited their patients. Medicaid paid so little that a physician who took too many could go broke. The system didn't work. Many times the people who behaved with integrity got left out entirely—both the honest Medicaid recipients and the honestly compassionate physicians. Greed was the culprit on all sides. Lawmakers spent their time writing
more laws because people kept figuring out ways to take advantage of the system. It was frustrating. Lukas had to keep reminding himself not to blame the patients who sometimes misunderstood the constantly changing rules.

Lukas glanced around at the emergency department. He liked this little ten-bed setup. The exam rooms surrounded a large central station. Each room was well equipped. Five of the ten rooms had excellent cardiac equipment. There was a separate ambulance entrance and two physician call rooms.

Mrs. Estelle Pinkley, the hospital administrator, had done a remarkable job when she'd convinced the county to pay for this upgrade. Lukas had jumped at the chance to receive a dependable salary with benefits so far away from the congestion and stress and corruption of the city. Yes, he knew corruption was everywhere, but right now, with specific, damaging events so fresh in his memory, Kansas City represented everything painful.

Carol met Lukas as he entered the E.R. proper. “Dr. Bower, Mrs. Conn is getting worse. Lauren said to notify you.”

“Thanks, Carol. Please call Dr. Richmond back.”

“Lauren already did so.”

“Get ready to call a code if necessary.”

“Dr. Richmond will have a fit about that, you know.”

“Maybe she can do more about it than I was able to.”

M
ercy Richmond ran the block from her medical office to the hospital, not bothering to remove her lab coat. Mom had promised to call when the time came, but she hadn't done so. Instead, Lauren had been the one to break the news.

Shoving open the glass doors into the emergency room reception area, Mercy barely slowed her stride. “Carol, where's Grandma?”

“She was in exam room eight, but they called a code and moved her to trauma room one.”

Mercy stopped and wheeled back. “What? There's not supposed to be a code!”

Carol shook her head in sympathy. “I'm sorry. Dr. Bower called it. He had to.”

“We'll see about that.” Mercy swung back on course. First, administration had arbitrarily decided to bring in a full-time E.R. doc from Kansas City, and now this hotshot doc had decided to ignore a perfectly legal DNR request. Perhaps he'd never learned to read.

She pushed through the swinging double doors that
pretended to lend privacy to the open emergency room. A secretary manned the central station. All other hands were gathered in the trauma room, six people altogether, including Grandma's frail, still body on the bed. Others worked with quick efficiency, responding without question to the soft-spoken commands of a slender, brown-haired man in green scrubs. He knew the drill well.

“Get me a blood gas…. Push the epi now, Lauren…. Any pulse…? Continue CPR.”

Mercy stopped just inside the doorway as a nurse from upstairs pushed methodically against Grandma's chest and another bagged her.

“What's going on here?” Mercy demanded. “Doctor, what are you doing to my grandmother?”

He looked up, his blue eyes behind gray-framed spectacles holding her with gentle concern. “You must be Dr. Richmond. I'm sorry, but as per your mother's request, we are attempting resuscitation.” He turned back to the table.

“Stand clear,” he called as he prepared the paddles to send a jolt of electricity through Grandma's chest. He placed one paddle above her right breast, and the other paddle he placed to the side below her left breast.

Mercy stood in stunned horror as the frail body jerked, arms flying out, legs up. Mercy had done the same procedure herself many times during her shifts in E.R. but not on someone she loved like Grandma.

“Check pulse,” Dr. Bower said.

Lauren gently felt the carotid artery for a moment, then shook her head. “Nothing, Doctor.”

“Continue CPR. Prepare more epi, and I need lidocaine, 1.5 milligrams per kilogram. What's that blood gas?”

“Not back yet, Doctor.”

Mercy stepped toward him. “Dr. Bower, I'm her granddaughter. Stop this code.”

He was barely taller than her five feet eight inches, but his expression held calm authority. “As I said, Dr. Richmond, your mother—”

“I heard what you said, but my grandmother signed a DNR form weeks ago. Surely that has some bearing on this case.”

“You know that form does me no good. Believe me, I wish it did.” Dr. Bower's voice betrayed frustration. He lowered his voice. “Your mother showed me her papers for legal power of attorney. Her order is to resuscitate.”

“Forget that order. As a fellow physician—”

“I can't break the law, Dr. Richmond.”

“Don't abuse this patient any more than she has already been abused!”

Dr. Bower grimaced at her words, sighed and shook his head. “I'd love to comply, but I can't. If you want to sway the decision, please talk to your mother. I tried.” He turned back to the table. “Stop CPR.”

The monitor showed an irregular, sawtooth pattern. Grandma's heart was in ventricular fibrillation. Mercy hoped it would not change back.

“Where is my mother?” she asked, her voice heavy with frustration.

“She was in the private waiting room when I left her.” Dr. Bower shook his head at the monitor. “No change. We need to shock again.”

He charged the defibrillator to 360 joules. “Clear.”

Mercy stepped back and almost turned to leave, but she couldn't. A sort of morbid amazement held her there, watching the scene of horror play out before her. She
gripped the door frame. A loud pop and flash preceded the stench of burned flesh. An electrode had blown. Lauren and Dr. Bower checked for signs of life while another nurse replaced the electrode.

“No change,” Dr. Bower said.

Mercy felt sick. Mom should be here to see what her crazy order was doing to Grandma. But then, Mom, too, had suffered enough.

Again they shocked, and Mercy could not bring herself to leave. CPR resumed. The longer they worked, the more convinced she became that Grandma was already far past their so-called help. And that meant she was also past any more pain.

Dr. Bower called a halt a seeming eternity later. Mercy did not move until he pronounced the time of death.

She stepped from the doorway as the code team cleaned up the mess of scattered monitor strips and plastic wrapping that had been tossed on the floor during the code. One by one, they filed out past her, some avoiding her eyes as if ashamed of the work they had just done.

Lauren stopped and laid a tanned, slender hand on Mercy's shoulder. “I'm sorry, Dr. Mercy.” Tears filled her pretty green eyes.

“So am I, Lauren. Thanks for calling me over.”

“It was Dr. Bower's request. Your mom told us not to.”

“Figures.” Mercy was thirty-nine, and Mom had still not overcome the need to hem her in with maternal over-protectiveness. Often it rankled. It showed lack of respect for Mercy's ability to cope. For goodness' sake, she was a doctor.

Dr. Bower paused for a moment at the bedside, his hand resting gently on Grandma's arm, his head bent and eyes closed. When the last team member had left the
room, Mercy walked over to stand beside the man and gaze into Grandma's silent, scarred face.

Dr. Bower raised his head and looked at her. “I'm sorry, Dr. Richmond, I've been told she was a much loved lady.” He had a kind voice, deep and masculine, but with a gentle quality.

Mercy nodded, dry eyed. “She was.”

“I apologize for my abruptness. I could have handled the situation better.”

The sincerity in his voice disarmed her. She'd been prepared for battle when she came in here. Now she felt spent. Empty. “I wouldn't let you.” She shook her head. “I had always sworn that I would never do to another doc what patients and families have done to me, and here I led the pack—aided by my mother, of course. I know the law, Dr. Bower. It's just that she's my grandma.” Her voice caught, and her professional demeanor abandoned her for a moment. Her throat ached with tears she refused to shed. She was grateful for the man's thoughtful silence.

“My mother died of metastatic breast cancer three years ago,” he said after a few moments. “I remember the feelings of helplessness and anger. I wanted to do so much more for her, and there was nothing more to do except keep her comfortable. Had we revived your grandmother…”

“I know.”

There was another pause, then Dr. Bower asked, “Would you like me to go with you to tell your mother?”

Mercy took a final look at Grandma and turned away. “No, thank you. It'll be best coming from me.”

He hesitated. “Did you not have a chance to discuss the DNR form with your mother?”

“I tried. Mom wouldn't talk about it.”

“It's a difficult subject to discuss. I gathered that your mother was the main caregiver.”

“Yes. I tried to help more, just to keep her from exhausting herself.” Mercy shook her head. “Mom can be stubborn and self-sufficient. She's lost so much sleep lately…she hasn't been her usual, rational self—not that she's ever been a perfect example of rationality.” Why was she talking to this stranger like this? And a man, to boot.

“I know what you mean,” he said. “My father was the same way after Mom's death. Be patient with your mother. This kind of grief and exhaustion can do strange things to the mind. And it can last a lot longer than anyone expects.”

“Let me talk to Mom.” She forced a smile and looked again into those blue eyes. “It'll be easier for all of us.”

A few moments later, after taking a drink of water from the fountain and a few deep breaths to compose herself, Mercy opened the door to the private waiting room. The first thing she saw was Mom standing there in the middle of the floor, glaring in her direction.

“Where is that blasted doctor? I told them not to call you yet.” Ivy Richmond turned to pace across the room toward the thickly cushioned sofa on the far side, then back again. “It's been over an hour, and no one has seen fit to tell me anything. Do you know that man came in here and asked for permission to just let Mother die?”

“Grandma had an advance directive, Mom.”

“How can he just take it upon himself to decide who is and who isn't worthy to live? Mother couldn't have known what she was doing when she signed that form.” Tears filled Ivy's eyes. “Oh, Mother.”

Mercy's eyes grew moist, too. She'd thought they would have been drained of emotion months ago, but the
stages of grief had continued to batter them. Right now confusion ran high, and Mercy knew Mom was exhausted and weak from too many nights of sleeplessness.

Ivy jerked another tissue from the box on an end table and blew her reddened nose. “I wish they hadn't called you against my wishes.”

“It's a good thing they did.”

Ivy stiffened at those words.

“She's gone, Mom.”

Ivy's face twisted into a mask of pain. “Mother wasn't ready to die.”

Mercy closed the door behind her and took a seat on the nearby recliner, perching on the edge with her hands in her pockets. “We're the ones who weren't ready.”

Ivy turned away. “I can't believe my own daughter, the learned doctor, cannot grasp the reality of an afterlife.”

Mercy suppressed a sigh. Now was not the time to bring up that old argument again, but if Mom had found peace in her so-called God these past few years, where was that peace now?

Ivy reached up toward her chest with both hands and bent forward, as if on a sob.

“Mom…?”

Ivy shook her head.

Mercy stepped up and laid a hand on her mother's shoulder. “Mom? Are you okay?”

Slowly Ivy straightened and turned around. Her face was as gray as the clouds gathering outside, but she nodded and patted Mercy's hand.

“I'll be fine. This just brings back so many memories.”

“I know.” Mercy's father had also died a lingering, painful death five years ago. That was when Mom had suddenly started babbling about “finding Jesus.” At the
time, Mercy was sure she would get over it, but she hadn't. Where was her Jesus now?

Ivy took a deep breath and squared her shoulders. “That doctor is dangerous. He doesn't hold human life sacred. He tried to manipulate me into allowing Mother to die. He was going to go over my head to keep from doing anything for her. Did he even try to save her?”

“He called a code. I saw it.”

“How hard did he try?”

“He did everything to resuscitate her. He had already begun when I arrived.”

“And he didn't revive her at all?”

“No.”

“Is that normal for someone whose heart has just stopped?”

“It would be hard for me to say, Mom. Everyone is different. Most of the codes I get have been out for at least fifteen minutes.”

“I think he could have bought us more time. Do you know that he as much as told me he had other patients who needed him more than she did and that doing more for her would be inhumane?” Ivy put a hand to her chest again, then quickly dropped it.

Mercy held her mother's dark gaze and said nothing.

“Jarvis didn't want this new doctor here in the first place, did he?” Ivy asked. They both knew that Dr. Jarvis George, E.R. director, had been bitterly opposed to bring in a full-time physician for the E.R.

“No, and neither did I. But to be fair, I disagreed with the code, too. I even tried to stop him. He did what he felt he had to, and I can't blame him for that. Granted, he could have been a little more tactful with you, but…”

“I'll have a talk with Jarvis. Maybe he can put my
mind at ease about this guy, but if he can't, I may have to have a talk with administration.”

 

Lukas Bower could find his way around an unfamiliar hospital or a forest trail almost by instinct. Let him loose in a strange town, however, and he would be lost the moment he stepped out the door. By the time he entered the front door of the cantina—little more than a house with a small unlit sign in the front yard—where he was supposed to meet the others Wednesday night, the tiny place was nearly empty and a Hispanic waiter was clearing the tables. It still smelled wonderful, full of smoky spices and warmth.