Sacred Trust (8 page)

“Sorry, I had to ask. We're doing an X-ray.”

She shot him another startled look. “Do you have to? I don't have insurance.”

He considered it a moment. He'd like to see an X-ray, but with the other tests, it may not be necessary. “Okay, we'll put a hold on that for now, but we still may need it, depending on what the other tests show.” That could be what was bothering her.

She looked slightly relieved.

“Hello.” There was a knock at the open door, and Kaye, the respiratory tech, walked in. “Are you Darlene Knight? I've got orders to make you start feeling better, or I lose my job. Got a few minutes?”

Lukas smiled at her. “Thanks for coming so quickly, Kaye. Darlene, I'll be back after your treatment.” He braced himself to face the man with the migraine.

“Do you make a habit of abandoning your patients in this emergency room?” Mr. Little demanded as Lukas walked back in and laid the clipboard down on the counter.

“Not if we can avoid it,” Lukas said calmly. “Would you mind stepping to the bed?”

“Why?”

“If I'm going to treat you, I'm going to check you out. Please move to the bed. If you need some help, I can—”

“I don't need help,” the man snapped, then grudgingly obeyed Lukas.

Lukas checked heart, lungs, reflexes. Normal. Then he lowered the lights and checked the eyes. Bingo. They were pinpoint, no dilation. In this dimly lit room, that didn't fit.

He picked up the chart. “Mr. Little, it says here that you're allergic to Imitrex and Reglan. Those are our drugs of choice for migraine. What medications have you taken before?”

“Demerol and morphine work best.”

“But I can't in good conscience give you a narcotic without running some tests to make sure you're not in danger. I need a CT and a urine—”

“What?” Little brought his hands down from his head and glared at Lukas. “What're you trying to do to me? I just want some simple pain relief! No urine test.”

Lukas checked the time. Forty-five minutes until Camp took over. No problem with this patient; he was about to leave. Federal law had to be satisfied first, though. Lukas knew the regulations well. Unfortunately, Little probably did, too, if he was habitual.

Darlene was another problem. For some reason, Lukas wanted to finish her himself.

“Okay, Mr. Little, I'll send the nurse in with a shot for you.”

The man visibly relaxed. “It's about time.”

Lukas had Beverly take a dose of Toradol to Mr. Little in room three while Lukas looked for and found the young man's old chart at the central desk. Very interesting—eleven E.R. visits in four months, all for pain shots and pills. How many other area hospitals had records on him?

“Carol, please call the area emergency departments
and check to see if Mr. Dwayne Little has visited them recently for pain medication.”

Carol raised a brow at him. “Yes, Doctor, but you know who he is, don't you?”

“Yes. Thank you for your concern.”

Lukas returned to Darlene in room six.

She still wore her mask and the finger probe. Her O2 sat was still low, but better. Her arterial blood gas turned out to be better than Lukas had expected. He checked her breathing.

The wheezing was louder. Good. That meant more air movement. She was still working for her air, but she was holding her own.

“Well, Darlene, you're doing better, but we've got a way to go yet. You're still doing some inspiratory and expiratory wheezing. I can't send you home like this.”

Her eyes grew wide. “Please, Doctor, don't put me in the hospital. I can't stay.”

“We'll see. I want to give you a couple more treatments. How long have you been breathing this poorly?”

“Not quite a week. It didn't get really bad until yesterday. I know I should have come in sooner, but I already feel much better.”

The woman was slightly more animated than she had been a few moments ago, but not much. Lukas would guess by the circles beneath her eyes that there were other things going on he hadn't discovered yet. Stress could bring on an asthma attack, especially when exacerbated by lack of sleep.

“Dr. Bower,” came Beverly's flustered voice from the doorway. She glanced at Darlene, then back at Lukas. “The patient refuses the shot.”

Lukas excused himself with Darlene and walked with
Beverly to the central desk. “Of course he refuses the shot,” he said. “It's not a narcotic. He probably requested Demerol.”

“His usual,” Beverly muttered.

“Please make a notation on your chart that pain relief was offered and he refused it. Did he give a reason?”

“Said he'd had it before and it upset his ulcer.” She looked around and lowered her voice. “I don't think it's a good idea to mess with this guy. He could cause a lot of trouble for all of us. I told you, I can't afford to lose my job.”

“We could cause him a lot of trouble, too. It doesn't change the treatment plan. There's no record of ulcer history or medication. Time for our trump. Would you please call for Kaye to give Darlene another treatment? Then I need you to join me in room three. I need a witness.”

“For what?”

“You'll see. Carol, what did you find out?”

The secretary bit her lip and glanced toward the room where Little waited. “He's been to at least three different places several times each in the past two months.”

“Thank you. Call them back and warn them that he may be a drug seeker and he may be headed their way soon.”

While Beverly called for Kaye, Lukas filled out his part of the form he'd placed with Little's chart earlier. They went together to room three.

“Mr. Little, so sorry to hear about your ulcer. Is it still giving you trouble?”

“That's not what I'm here for,” the patient snapped.

“Sorry. You're not allergic to morphine in any way, are you?”

The man couldn't hide his surprise. “No.”

“Good. I think we can fix you right up.” Lukas couldn't resist a glance at Beverly. She gaped at him
in shock mixed with relief. He grinned. “First, Mr. Little, I have a form for you to sign.” He pulled out the sheet he'd just filled out and put it at the top of the papers on the clipboard. He placed it under Little's nose. “I need you to read this over first, of course. It states that you are aware of the nature of the drugs I am going to give you, and that you understand the effects Narcan has on you if you are an addict. It will precipitate violent withdrawal symptoms, up to and including death.”

The man's mouth flew open. “Narcan!”

“Yes. Maybe you're familiar with it? It's a narcotic antagonist. You'll still get good pain relief from the morphine, but you will not have to put up with the resulting high. I was sure you would approve.” He pushed the sheet forward. “Your signature, Mr. Little.”

The man jumped from the bed. “You're saying I'm a junkie!”

“Not at all. I'm saying that if you aren't an addict, you should have no problem with this course of pain relief. If you do have a problem, we can get you into a drug treatment prog—”

Little stomped toward the door, shouldering Beverly aside. “I'm getting out of here. You people are crazy.” He turned back and pointed a finger at Lukas. “You won't get away with this, Bower. Do you know who my father is?”

“Does your father know you're here looking for drugs?”

Little swung away and stalked out of the hospital.

“Dr. Bower!” Beverly exclaimed. “You don't listen very well.”

“He was a drug seeker. What did you want me to do?”

“He could get us both into a lot of trouble.”

“How can you get into trouble for doing your job and following the doctor's orders?”

She stared at him, shaking her head. “Those shots could have killed that man.”

Lukas nodded. “Don't worry. I've never had anyone take me up on the offer. Where do we keep the AMA forms? If he's going to refuse medical advice, we need to fill one out, and we both need to sign it.”

Beverly stared at him a moment longer. “They're at the central desk. I need to check on Darlene, so just have Carol get it out for me to sign later.”

Darlene's numbers still weren't up to acceptable levels when Lukas checked her again. She wheezed only upon expiration now—a good sign. But Lukas didn't yet feel comfortable.

“I feel so much better, Doctor,” Darlene said. Healthy pink tinged her cheeks now, and her posture was more relaxed. “Can I go home?”

“I'm sorry, Darlene, but I can't make any promises at this point. I'll cut your oxygen down and see how you do. I'll waive the X-ray. But we have to watch you awhile longer before I can decide.”

She stared at him rebelliously for a moment, as if she might check herself out against medical advice.

Lukas glanced at his watch. Thirty minutes until Camp got here. Lukas completed some charts, then returned to Darlene's room and took her off the oxygen to see how she would do on room air. Then he went to change out of his scrubs. He would be cutting it close, but he still didn't feel right leaving Darlene.

After fifteen minutes on room air, Darlene did a peak flow test. She registered 250, which was not enough for her age, weight and sex.

“I'm sorry, Darlene,” Lukas said. “We tried.”

She moved halfway off the table, her eyes wide. “Please, can you give me another treatment before you make your decision? I can't stay.”

He went into his usual spiel. “I know it's never convenient to be sick, but—”

“I'm not talking about convenience.” Her whole body radiated tension. “I have to go home. I'll be fine.”

“Is it worth risking your life? You can work out a payment plan with the hospital. Asthma can be fatal if not treated properly.”

“I'll take care of it,” she snapped.

“You weren't taking your medicine before. I don't think you realize how—”

“Please, Dr. Bower! I have a brother at home who needs me. He doesn't have anyone else to help him. I didn't even want to leave him this morning, but I just couldn't breathe anymore.”

So that was what was going on. Lukas sat down. Time to find out more. “What's wrong with your brother?”

Her warm hazel eyes shimmered with tears. Her finger worried the pulse ox probe as if she'd like to slip it off and falsify the reading. “Clarence is very sick, and he won't see a doctor.”

“Sick?”

“He's extremely obese. The last time he got on the scales, he broke them. He made a big joke of it, but that was two years ago. He's gained continually since then. He doesn't leave the house, and these past few weeks, I've had to take his meals to his room. The only place he goes is to the bathroom.”

“He won't see a doctor?”

She shook her head as tears flowed down her cheeks. Lukas set a Kleenex box beside her on the bed.

“He's given up. He's tried so hard. He was such a hard worker, so proud of his mechanic skills. He helped me buy my house, then he lost his job because of a layoff. Which meant he lost his insurance. Then he developed pneumonia, went into the hospital, and used up the last of his savings to pay the bill. He had to give up his own home and move in with me, which really hurt his pride. He went into a deep depression, and he just kept gaining weight.”

“You can't convince him to see a doctor?”

“He knows I can't pay for it. Even when I worked outside the home as a bookkeeper, I couldn't put him on my company insurance. I ended up having to quit my job and stay home and work as an indexer on computer so I could take care of him.”

“Surely he qualifies for disability.” Lukas couldn't believe his own words, but if anyone truly needed state aid, this family did.

“He wouldn't consider it.”

“But doesn't he see what he's doing to you?”

“He can't help it. He's just waiting to die. That's why I have to go home. I don't dare leave him alone for long. Please let me go. We don't…we aren't close to family.”

“Are you sleeping at night?”

“Not well.”

“You need more help. This is too much of a strain on you. Would you consider counseling?”

She pulled a single tissue from the box and dabbed at her face. She took another tissue and blew her nose. “I don't have the money.”

“There are local agencies that can help. We can make some calls for—”

“No.”

He sighed in frustration. “Darlene, sometimes we all have to ask for help. That's why those agencies are set up, for people like you, who are really struggling, trying to make an honest living for yourself and your brother. There is no shame in—”