Michael Palmer: Oath of Office

Poor goddamn Meacham.

What in the hell happened out there?

John Meacham was tightly wound, but not this tightly wound. In fact, he had a better-than-decent recovery program, and had mellowed considerably. Word was bound to get out that he had been attending Alcoholics Anonymous meetings for four years, and a few hundred alcoholics and drug addicts in need of the program would decide that they were better off going it on their own.

Any excuse in a storm.

Meacham was one of the first docs Lou had been assigned after he went to work part-time as the assistant to the director of Physician Wellness. A father of three, and a history buff, the internist was a lifelong Virginian, working in D.C. at the time. He played bluegrass on several instruments and could take his motorcycle apart and put it back together. The only two drawbacks in his life were his temper and alcohol. The day he exploded at one of his patients for continuing to smoke following a coronary, Meacham admitted to Lou that he had a ferocious hangover after drinking the night before. The result of his outburst was a report by his patient to the board, a six-month suspension, and a referral to the PWO.

Lou ordered an immediate psych evaluation and sent Meacham away for a month of rehab and anger management. As soon as he was discharged home, Lou signed him to a legally binding monitoring agreement-random urine testing twice weekly, regular psychological therapy, frequent face-to-face sessions with Lou, and involvement with AA.

What could go wrong?

Much to his chagrin and that of his dentist, Sid Moskowitz, Lou was a teeth clencher and grinder. Moskowitz had been pushing forever for some kind of mouth guard, but even in the ring, Lou could barely handle an appliance jamming up against his gag centers like two stalks of rubber celery. He could kick the grinding habit, he insisted, even as Moskowitz was totaling up the cost of the crowns he would soon be installing. He could kick the habit just as he had kicked the drugs.

But not today.

With the wipers slapping steadily, Lou turned into the crowded physician parking lot of DeLand Regional. Four cruisers, strobes flashing, were parked near the ER entrance. Twenty-five yards away was a phalanx of sound trucks. Lou estimated that the glass-and-redbrick three-story hospital had a capacity of somewhere between 150 and 200 beds. It had a decent reputation from what little he knew, although he had no firsthand experience with the place.

Before he made it to the elevator and up to the second-floor ICU, Lou’s credentials were checked three times. There were two uniformed cops-a woman and a man-posted outside the unit, and another man, a broad-shouldered African American in plainclothes, whom Lou guessed might regularly rehearse his air of authority in front of a mirror.

“No one’s allowed in there,” the man said, performing a heavy-lidded inspection of the new arrival.

“I’m a doctor.”

“So’s the guy in there who just killed seven people.”

“Nice comeback. How about if I said I was a close friend of his?”

“ID?”

Lou passed over his driver’s license and wallet-sized medical license. “Neither of these say I’m a close friend of his. I left that one at home.”

“I can be a wise-ass because I’m in charge,” the detective said. “You can’t, because you’re not. And the head nurse left word that no one is to be let in until she says so. They’re going after the bullet in your close friend’s head.”

“They’re what!”

Incredulous that they were going after the bullet in the ICU and not the operating room, Lou stared across at the man, who looked perfectly serious. Not possible , Lou was thinking. Even in the most ragtag level-two trauma center imaginable, no one would be fishing for a bullet while inside the ICU. Generally, what remained of the slug were fragments, and more often than not, the brain trauma caused by trying to remove them wasn’t worth the benefits. But no matter what, any procedure, whether an exploration or a decompression maneuver to reduce swelling, would be performed in the operating room.

“Going after the bullet,” Lou said. “Of course. Just like they do all the time in the movies. Usually, that’s when I snatch up my popcorn and leave.”

“Too gross?”

“Too absurd.”

The remark appeared to have sailed over the cop’s head. “What kind of doc are you, anyway?” he asked.

“Emergency. I work at Eisenhower Memorial in the city. Who’s going after the bullet?”

“I have no idea. I don’t live around here. I’m state police. We were called in to take over for the locals.”

Lou was about to grill the man for information when the glass doors to the unit glided apart and a trim, olive-complexioned woman in scrubs emerged. Tension was etched across her face. It took only a second for Lou to recognize her.

“Sara!”

Sara Turnbull and he went way back-almost to the beginning of Lou’s residency, when he was razor sharp, thrilled to be having his dreams come true, and enthusiastic as the Energizer Bunny-back to before his father’s financial implosion, and Lou’s subsequent moonlighting jobs, and the extra shifts, and the utter exhaustion; back to before the unstoppable downward spiral and the amphetamines, and the visits from the drug-enforcement people.

“God, am I glad to see you,” Turnbull said. “When they called from downstairs to say you were on the way up, I nearly jumped through the phone. They’re killing him in there, Lou. I don’t care what he’s done, it’s not our job to judge.”

“Okay if I go in there, Officer?”

“Sorry to give you a hard time,” the cop said. “It looks like you have a boxer’s knuckle, there. I’m not used to seeing doctors with boxer’s knuckles.”

“I work in a really tough ER,” Lou replied.

Sara Turnbull was a crackerjack nurse-as smart and intuitive as she was compassionate. There was a time when Lou could have added passionate to her list of attributes, but those times were long past. The last he had heard from her was a get-well card forwarded to him in rehab.

“How long have you been working here?” Lou asked as they joined the crowd milling in the gleaming ICU.

“Just four months. My husband’s a nurse on med/surg. We have a one-year-old son. It’s not Eisenhower, but it’s a decent-enough place-at least it was. This is a mess, Lou. An absolute mess. I’m charge nurse today, and I can’t follow some of the things that are happening.”

“Like someone blindly jamming a hemostat into a patient’s brain, fishing for a bullet?”

“Exactly. That’s Dr. Prichap. As far as I know, he’s a decent-enough neurosurgeon, but I’ve never seen anyone do that.”

“It may be a while before you see anyone do it again,” Lou said. “What else?”

“Dr. Meacham is going downhill fast, but no one seems all that alarmed. Do you know him?”

“For a few years. We’ve actually gotten to know one another pretty well. This came right out of the blue. I can’t believe he did it.”

“He’s over there in three. Dr. Schwartz, the intensivist, has been in and out, but mostly it’s been Dr. Prichap. It looks as if things have quieted down now. Prichap may have given up hunting for the bullet.”

“I hope so,” Lou said, almost to himself.

Lou followed Sara into the cubicle, which was crowded to near overflowing with nurses, radiology, lab, and respiratory techs, what appeared to be a resident, and a short, copper-skinned man-probably from India. ANTHAR S. PRICHAP, M.D. was stitched in blue over the breast pocket of his lab coat. Although he wore scrubs beneath his white coat, it appeared that he had performed surgery just as he was. Next to Prichap was a tray with bloody sponges and instruments piled on it.