Trauma Plan (11 page)

“You’re here. Hello!”

“Oh!” Riley peeled her hand from her chest and blinked at the sun-browned man bent low at her car window. “Um . . . hello.” She managed a shaky smile.

He smiled back and quickly pulled off a tattered cap. “I’m Bandy Biggs, building manager. Doc Travis asked me to show you around.” His blue eyes were warm. “That is, if you are Miss Riley Hale.”

“I am,” she said, not at all sure she wanted to be. “Dr. Travis isn’t here, then?”

“Ah . . .” Bandy hesitated. “Not sure if we’ll see him. But I know this place like the back of my hand. Happy to do the honors.” He opened the Honda’s door and swept an arm toward the clinic as if he were a royal page welcoming her to the castle. “Follow me.”

She did so, deciding that up close the chalky-pink paint resembled Pepto-Bismol far more than frosting. And then had serious concerns she would fall through the creaky porch. The window boxes, however, were an unexpected delight. “Tomatoes?”

“Early girls are coming right along; tryin’ my hand at heirlooms. We’ll see—lots of sun out here.” Bandy pointed farther down the porch. “And that’s cucumbers over there, some peppers, and cilantro. Corn out by my camper truck, but the armadillos have been turning things up a bit. Not sure if it will survive. The geraniums are just for pretty.” He smiled. “Figured our patients wouldn’t mind taking fresh goods home with them, and I enjoy digging in the dirt. Must be part armadillo myself.”

He opened the front door and waved her ahead.

Riley stepped across the threshold into an old parlor, greeted by the tantalizing aroma of freshly brewed coffee and what she would swear was buttery cinnamon toast. Along with the eager, warbling whine of a small dog. Her eyes widened.
Pulling a cart?
Yes. It was supporting his hindquarters. She watched as the animal’s front paws clicked across scarred hardwood flooring, the wheels of the cart brushing against a couch topped with tatted doilies. His tail gave friendly thumps on the cart.

“That’s Hobo,” Bandy explained. “Our version of a Walmart greeter. Or if anyone official asks: therapy dog. The stubborn pup was dragging those legs for months after being stomped by a steer; wouldn’t give up. Doesn’t hurt his attitude either. I think that’s a good thing for folks to see.”

“Mm.” She bent down and stroked his furry head as she surveyed the cozy room, its mauve walls boasting crayon art and several old photos of a white-haired woman serving food to long lines of people. There were a half-dozen or so mismatched chairs as well as several floor cushions. A vintage magazine rack held pamphlets and printed information sheets in both English and Spanish. A Busy Zoo Activity Center, plastic table and chairs, and a makeshift shelf of children’s books were tucked into one corner. “So this is the clinic’s waiting room?”

“Right. By the time we open this afternoon, it will be filled and there’ll be a string of needy souls leading right past the porch.”

Needy souls.
Riley stood, remembering Vesta’s neighbor’s poisonous rant.
“A steady stream of indigents, prostitutes, drug addicts, and illegal aliens. Not in my neighborhood!”

“That pass-through window leads to the receptionist,” Bandy continued, pointing. “Which is mostly me these days.” He shook his head. “Tough economy means fewer volunteers. Right now we have—” he counted on his fingers—“three retired nurses, a pediatrician who comes by for two hours on Thursdays, an Army medic who hasn’t been able to find a paying job, a dentist once a month, a retired veterinarian who draws blood . . . and one of Doc Travis’s mountain bike buddies.” He laughed at the look on Riley’s face. “Who’s an internist over in Fredericksburg.”

He led Riley through the small reception office, down a hallway that opened into three exam rooms. Once bedrooms, they were painted in Easter-egg colors of lavender, yellow, and green. Each was outfitted with an old-style, paper-covered examination table and basic medical supplies: gauze, alcohol swabs, otoscope, tongue depressors, and percussion hammers, all neatly organized on paint-layered bedroom dressers. Here, too, childish art decorated the walls. The largest of the rooms boasted a hanging quilt—and a shiny new multidrawer crash cart.

Riley’s gaze swept over the defibrillator, adjacent EKG machine, twin IV poles with bags of solution, and Ambu bag. “Do you—” she cleared her throat, surprised to feel her pulse quicken—“get many critical cases?”

“Hardly ever.” Bandy raised a calloused finger. “See this? Fastest finger to hit 911 you ever saw.” His gaze held hers for a moment. “Let me show you the mudroom we call a lab. It’s right off the kitchen, and I make the best coffee this side of the Pecos.”

Riley followed him down the short hallway past a closed door, a bathroom perhaps. Bandy gave her a quick tour of the combination supply room and laboratory and an adjacent laundry room also utilized as the medication room. Then he led her back into the sunny kitchen with frilled curtains, fruit-print wallpaper, pink- and brown-tiled counters, and speckled linoleum. Riley accepted a mug of strong black coffee laced with cinnamon and a chair at the kitchen’s chrome-and-Formica table. A khaki scrub jacket was draped over the back of the chair; its name tape read
Major Jackson Travis, MD
. Riley settled against it, wondering if she’d been wrong about the closed door in the hallway.

“So that’s the tour,” Bandy said after feeding Hobo a dog treat. “And here’s the part where I say that no matter what you might hear on the TV, we’re doing important work here. The woman who donated this property to the city—that’s her in the waiting room photos—meant it to be used for a charitable purpose. She headed the Loaves & Fishes Food Pantry downtown for forty years. A church community did some of that work out of this house after she passed. Then the building changed to a charity thrift store and finally it sat vacant because . . .” He sighed.

“Because the new housing development didn’t like ‘needy souls’ quite so close.” Riley’s heart tugged, remembering Gilbert DeSoto. “But if this woman designated the property for charitable use, how could a developer expect to turn it into high-rent condominiums?”

“Well . . .” Bandy hesitated. “I only heard it secondhand, but apparently Mr. Payton has floated the idea that the city council could be persuaded if the homeowners’ association offered to host an annual charity event. You know, one of those shindigs where rich people lock the security gates and drink champagne in honor of the poor folks, and—” Bandy’s face flushed and genuine remorse sprang to his age-lined eyes. “I’m sorry. That was plain mean-spirited.”

“I understand,” Riley said. “Really. That’s a big part of why I became a nurse. To offer help, hands on.” She glanced back toward the hallway, thinking of the pink window boxes filled with vegetables and the children’s artwork on the walls. Then, with a stab of guilt, admitted that she was also remembering what Kate had said about Riley’s proposal for the position of Alamo Grace triage nurse.
“The final decision will depend on your performance of skills.”
And that Jack Travis’s offer to let her work here at the clinic could be her only chance to practice those skills.

“I’d like to volunteer here. But . . .” Riley set her coffee cup down. “I don’t know if Dr. Travis told you; I had an injury that’s left me with some weakness in one arm. And—” She stopped as Hobo gave a short bark and wobbled toward the hallway door, his cart’s tiny wheels rolling neatly over her foot.

Bandy grinned. “I think we can work around any physical difficulties, Miss Hale.”

“Riley,” she insisted, smiling back at him. “I promise I’ll do the best I can. And if the medical cases are as straightforward and basic as you indicated—”

A barrage of honking stopped her short, followed by furious barking from the front of the house. Bandy hustled for the door and she followed him to the waiting room.

Riley’s stomach lurched. “Oh
no
.”

The front door was flung wide and a teenage girl in a glittery pink raincoat lay sprawled on the porch. She was desperately pale, her long hair matted with congealed blood, face battered, and one heavily made-up eye swollen closed. She groaned, gasped for a breath, then made a gargling noise as blood bubbled from her lips.

“Call 911!” Riley shouted, pushing past Bandy.

“On it—and I’m grabbing gloves!”

Riley dropped to her knees beside the girl, heart pounding as rescue protocols buzzed through her brain.
Airway, breathing . . .
She gingerly opened the top buttons of the raincoat—
careful, don’t move her; her neck could be broken
—exposing a small green-and-yellow tattoo of Tinker Bell just below the girl’s collarbone. Riley confirmed the shallow rise and fall of her chest beneath a thin T-shirt.

Next . . . circulation.
Riley pressed her fingers to the girl’s neck to check for a pulse, confirmed it, then jerked her gaze toward the hallway at the sound of heavy footfalls.

Jack Travis barreled toward her.

9

“She’s obtunded—brain hemorrhage, probably.” Jack frowned when the young victim gave no appreciable response to firm pressure against the thin fabric covering her breastbone. He tried again, then palpated her neck to locate the carotid.
Pulse strong but slowing.
“Beaten to a pitiful pulp and dumped on my porch.” He shifted his knees on the hard floor, glanced at Riley kneeling on the other side of their patient.

She nodded mutely, her hand on the girl’s shoulder.

“Let’s see this eye . . .” Jack touched a gloved fingertip to their patient’s grossly swollen eye and retracted the lid. “Dilated, sluggish.” The victim’s ragged breathing gurgled ominously behind the high-flow oxygen mask. “Got that portable suction ready?”

“Yes. If you’ll lift the non-rebreather mask, I’ll . . .”

He watched as Riley slid the rigid, hissing catheter into the corner of the patient’s mouth. Her gloved right hand trembled very slightly with the effort; she bit her lip and continued on. He noticed that the front of Riley’s tailored jacket was smeared with blood—and that she didn’t seem to care. He nodded. “Good, thanks. But I still don’t like the quality of that breathing. I’m going to intubate.”

“But if the assault injured her neck . . .” Her face paled, dark pupils suddenly huge against the blue of her eyes.

“I’ll put the tube in nasally,” he clarified. “You’ll find a transport cervical collar in that mobile kit. We’ll slide it on before I intubate.”

“The police are here,” Bandy announced from the porch steps. “And the medics should arrive any minute.” He sighed. “Along with a passel of neighbors, I expect.”

“No doubt.” Jack frowned, then caught Riley’s eye. “Make sure the oxygen’s on high flow. Pull out the collar, a few adult endotracheal tubes, and the Ambu bag. I want her airway protected in case she vomits. And this way, the paramedics can get on the road faster.”

Bandy hurried forward. “I’ll help you with the collar, Doc.”

“Oxygen’s cranked high,” Riley reported, her expression a fraction more confident. “I’m getting the airway supplies and switching the suction tip.”

Bandy squeezed in beside her. “Here’s the collar, Doc. Tell me what to do.”

“Great, let’s do this then,” Jack said as a blur of dark uniforms appeared in his peripheral vision.

Rob Melton crossed the porch and glanced down at the victim, his expression compassionate. “We’re checking for witnesses. Need any help?”

“No, we’ve got it. Thanks.”

Rob shook his head. “Heard that Hobo barked the alert. Quite a team you have there, Jack.”

“You bet.” Jack turned to Bandy. “Here we go, like this.” They slid the collar into place without moving their patient’s head; then Jack reached for one of the endotracheal tubes that Riley had placed neatly on the girl’s chest.

Jack paused for a moment, shook his head.
Bull rider, chaplain, and a dog pulling a cart.
He’d worked with far less help in military scenarios. But . . .

Jack’s jaw tensed as he glanced at his patient’s battered face. He wished he was wrong about her chances for a hopeful outcome. And wished just as earnestly that he could get his hands around the throat of the low-life bottom-feeder who was responsible.

* * *

“I’ve got the suction,” Riley said, whispering a silent prayer that her numb fingers would stop cramping and that she could control her shaking well enough to pass the catheter through the tube protruding from the unconscious girl’s nostril. “Just say when.”

“Now.”

Riley fed the suction catheter in, assisting her clumsy fingers with her other hand, then activated the suction and drew back, sucking bloody mucus from the airway. “I hear sirens,” she said, relief making her dizzy.
Please hurry. I don’t know how long I can do this.

“I want to hear clearer breath sounds. Bag assist her, will you?” Jack pulled the stethoscope earpieces away and raised his brows, clearly amending his question:
Can you?

“I . . .” Riley reached for the football-size resuscitation bag, difficult to squeeze under ordinary circumstances. Could she do it left-handed? She struggled and got the bag fitted to the nasal tube. Felt Jack watching her.
Help me, God.
She supported the bag with her numb and shaky fingers, spread her good left hand across its surface.