Gregg Hurwitz: Do No Harm

"Why are you pimping a nurse?" Carson asked, a competitive note finding its way into his voice. Most doctors only fired questions at med students, interns, or residents.

"Because, in general, they've been around longer and know more than arrogant med students."

Pat looked over quickly, her cheeks quivering. "I… what…?"

"Would you like to tell Carson here, and Dr. Trace, the four reasons we don't use charcoal to soak up alkali in the stomach?"

Pat managed to regain her focus, which had been David's aim in questioning her. "One, activated charcoal doesn't absorb alkali. Two, it obscures the endoscopic visual field. Three, if the patient is perfed, it would leak right into the mediastinum, and four, it's a vomit risk, and Carson and Diane already pointed out those pitfalls."

"That's right." David glanced around the small room bustling with people. A few faces still looked upset, and a lab tech was holding one of Nancy's limp hands. "We have a damn sharp team here," he said. "Don't worry, and stay focused."

A clerk leaned through the door. "Dr. Jenner's ringing through."

"Aah," David said. "Our ophthalmologist."

The telephone behind David emitted only a half ring before he grabbed it, first handing off his saline bottle to a nurse and pointing. "Keep flushing," he mouthed, pivoting to miss an IV pole a lab tech pulled around.

"Dr. Jenner, just in time. We need you down here, got a bad alkali exposure to the eyes."

"Was the skin around the eyes burnt?" Dr. Jenner's deeply textured voice was low, rolling, authoritative.

"Everything's burnt. The cornea's cloudy white."

"So the endothelium's already not functioning. Are you irrigating?"

"Saline."

"Good. Osmosis advantage."

"I can't find the Morgan lenses."

"Don't worry about it. They're outdated and overrated. Just get the eyes open and keep irrigating copiously. Once the eyes are better cleared, give her a drop of Pred Forte to stop the inflammation and a drop of Cipro for infection. I'm on my way."

Diane glanced up at David as he hung up the phone. He chewed his lower lip. "Pat, can you call GI again, ask what's taking so goddamn long on our consult?"

The radiology tech poked his head into the room, fresh back from the X-ray suite in the rear. "No free air," he said.

That was good-at least the alkali hadn't eaten through the esophagus, allowing air to escape into the body. Yet.

Diane leaned forward over Nancy's body, and she and David brushed foreheads. Her eyes jerked quickly away. "Sorry."

"How are you doing on the eyes there, Carson?" David asked.

Carson nodded. "Okay. But I think she's gonna need a corneal transplant." He leaned over, examining the other eye. "Two."

"We're going to apply some Cipro and Pred Forte drops. Can you get them ready?"

A uniformed UCLA Police Department officer strolled in; David was immediately irritated by his casual gait. The cop cleared his throat. "I have some questions I need to-"

"This patient is unconscious and can't answer questions."

"Well, I'll need to take a-"

"Not right now," David said. "Out, please. Out."

The cop shot him a good glare before retreating.

The nurses and techs continued to irrigate Nancy's flesh, lined on both sides of her body like feeding pups.

"Good, good," David said. "We're gonna keep irrigating her for hours."

Pat looked up, a little moist-eyed, and nodded. "We'll be here."

The wall phone rang, and a tech grabbed it, then held it out to David. "Dr. Woods."

David shot a latex glove into the trash bin and fisted the phone. "What took you?"

"I was in on a-"

"We have an alkali burn, some ingestion. No free air on the film."

"Ulceration of oropharynx?"

"Yes. And acute laryngeal swelling. We had to crich her."

"We like to have them swallow a little water, push the alkali down the esophagus into the stomach. Greater area, protective acids." Dr. Woods's voice was slow and droning. It reflected his personality.

"The swelling was already acute, and I didn't want to run the risk of her vomiting it back up," David said, a note of impatience creeping into his voice.

"Smart… smart. Unfortunately, there's little you can do to mitigate esophageal damage. Liquefaction necrosis happens almost instantaneously."

"Yes," David said. "I know."

"Fever? Whites are normal?"

"No. Yes."

"I'm going to need to get down there and take a look."

"In the meantime?" David waited through what seemed an eternity.

"One-fifty of Zantac IV stat to reduce the stomach acid. That should prevent stress bleeding and ulcerations as well."

"We'll see you shortly."

"Okay. Very we-"

David set the phone down on the cradle and relayed the order. He glanced at the monitor, admired the healthy baseline rhythm. Blood pressure 160 over 100. Respiratory rate at eighteen. Pulse 120. Oxygen saturation 99 percent.

He pulled a deep breath into his lungs and exhaled loudly. It took a conscious effort to relax his muscles and let his shoulders sink. Diane leaned forward over Nancy's face, continuing to irrigate her eyes. A wisp of hair arced across her cheek, finding the corner of her mouth.

An intern skidded on the floor, accidentally sliding past the door. She hooked the frame with a hand as she leaned in. "Golf cart versus Buick. Two forty-three-year-old males with penetrating head wounds. ETA two minutes. We're prepping Procedure Two."

David shot his other latex glove at the trash bin and headed for the door.

"You let me the fuck back there or I'll mop the floor with that ratty head of yours."

The police officer's gloved hand was inches from Carson's nose, pointing, as David approached them. Carson stepped back and glanced at the floor. He did not look pleased at the prospect of his prize locks being used to clean the tile of Hallway Two.

"Excuse me, officer," David said, pulling Carson farther back with a hand on his shoulder. "I'm Dr. Spier, chief of the ER Division. What can we-"

"You'd better step back," the officer said, the words coming in a low hiss through his teeth. Though he was cleanly shaven, incipient stubble dotted his face. It was only a little after 10 A.M., David thought. That's a lot of testosterone.

The cop's shoulders were broad, made broader by the dark, dark blue LAPD uniform that stood out in the stark white hall like a stroke of paint. His hair was neatly groomed, flicked to one side in a clean part. Though he looked younger than thirty, the hard flat sheen of his eyes bore witness that they'd already seen much beyond the purview of civilian eyes. His eyebrows, sharp strokes above his supraorbital arch, lent his face a sharp, focused cast.

David glanced quickly behind him for a white security uniform, but saw only pink and blue scrubs. He wasn't sure how helpful a security officer would have been in the face of a belligerent cop anyway.

David spread his arms slightly, his hands splayed, palms out. "You seem agitated," he said. "I'm sorry."

The cop took a deep breath and David eyed the name tag above the pocket line on his right breast. Jenkins. Nancy's brother?

David looked up and caught Jenkins's hard stare. "I'm sorry," he repeated.

"Listen, Doctor, I need to know right now where my sister is."

Seventeen years in the ER had left David not unfamiliar with how to deal with hard-ass LAPD cops. He forced a curt smile. "Nancy's in Trauma Twelve. I'll be happy to take you back to see her once I check on her, make sure a visitor won't interfere with the doctors and nurses who are still treating her. I'm sure you don't want to do anything to endanger her."

Jenkins's nostrils flared slightly. David debated asking him to step out through the swinging doors to Admit but decided not to fight that battle.