Michael Palmer - Flashback

Zack eased the woman onto her back. Her seizure was continuing, though her movements were becoming less violent. Again he checked for pulses, first at her neck, then in each groin. There were none. He delivered a sharp, two-fisted blow to the center of her chest and began rhythmic cardiac compressions as Frank arrived with his medical bag. "Judge, please fold something up and put it beneath her neck, then lay that chair over and put her feet up on it if you can. That's it. Frank, there are some syringes with needles already attached in the bottom of the bag. I need two. Also, there's a little leather pouch with vials of medicines in it. I'll need Valium and adrenaline. That one may say 'epinephrine' on it. Mom, did you get the ambulance? Good. How long?"

"Five minutes at the most."

"Frank, can you do CPR?"

"I took the course twice."

"Good. Take over here, please, while I get some medicine into her to stop her seizing. Don't bother trying mouth-to-mouth until she stops.

Just pump. You're doing fine. Every one's doing fine." Zack placed his fingertips over the femoral artery. "A little harder, Frank, please," he said. "Time, Lisette?"

"Just over a minute."

Without bothering with a tourniquet, Zack injected Valium and adrenaline into a vein in the crook of Annie Doucette's arm. In seconds, her seizure stopped. Frank continued pumping as Zack hunched over the woman and administered half a dozen mouth-to-mouth breaths. Moments later, Annie took one on her own. "Hold it, Frank, please, " Zack said as he searched, once again, for a cartoid artery pulse. This time he felt one-slow and faint, but definite. He checked in her groin. Both femoral artery pulses were paldable.

I. N Again, the woman took a breath, then another. Come on, Annie, his mind urged. Do it again. Just one more. Just one more. He slipped a blood pressure cuff around her arm and then worked his stethoscope into place with one hand while he returned his other to the side of the woman's neck. "I hear a pressure, " he announced softly. "It ain't much, but for right now, it's enough."

Annie's breathing was still shallow, but much more regular. Softly, but steadily, she began to moan. Her lips were dusky, but the terrible mottling of her skin had lessened. At that moment, they heard the whoop of the ambulance, and seconds later, strobelike golden lights appeared in the living room window. Zack looked up at his older brother, who knelt across the woman from him. For an instant, he flashed on two young boys kneeling opposite one another in a dusty, vacant lot, shooting marbles. For ten seconds, twenty, neither man moved or spoke. Then Frank reached over and took his hand. "Welcome to Sterling, " he said. THE AMBULANCE WAS one of several well equipped vans owned by Ultramed-Davis and operated by the Sterling Fire Department. Zack sat beside Annie in the back, watching the monitor screen as the vehicle jounced down the narrow mountainside road toward the hospital. A young but impressively efficient paramedic knelt next to him, calling out a blood pressure reading every fifteen or twenty seconds. Sterling, New Hampshire, was small in many ways, but Zack could see Ultramed's influence in the emergency team's response. This was big city medicine in the finest sense of the term. Annie was still unconscious, although her breathing seemed less labored and her blood pressure was inching upward. "Eighty over sixty, " the paramedic said. "It's getting a little easier to hear."

Zack nodded and adjusted the IV which the young man had inserted flawlessly, and even more rapidly than he himself could have done. Frank had stayed behind to tend to the family and contact a cardiologist. They would meet later at the hospital. Zachary felt tense, but he was also charged and exhilarated. When it all came together, when it all worked right, there was no comparable feeling. Come, Watson, Come! The game is afoot. Zack loved the quote, and often wondered if Arthur Conan Doyle, a physician, had transferred the energy of his experience with medical emergencies to his detective hero. After a brief stretch on the highway, the ambulance slowed and turned into the long, circular driveway leading uphill to the hospital. A large, spotlighted sign at the base of the drive announced, ULTRAMEDDAVIS REGIONAL HOSPITAL–COMMUNITY AND CORPORATE AMERICA WORKING TOGETHER FOR THE BETTERMENT OF ALL. Zack smiled to himself and wondered if he was the only one amused by the hubris of the pronouncement. The Betterment of All. Ultramed Hospitals Corporation and Davis Regional Hospital could certainly never be accused of setting their sights too low. Still, although he had a few lingering concerns about working for a component of what some had labeled the medical-industrial complex, his conversations with Frank and the Judge, and his investigations of the hospital and its parent company, had provided no cause to doubt the proclamation, however audacious.

Ultramed-Davis, now a modern, two-hundred-bed facility, had a proud history dating back to the turn of the century, when the Quebecbased Sisters of Charity placed ten beds in a large donated house and named it, in French, Hopital St. Georges. Over the decades that followed, brick wings were added, until, ultimately, the old house was completely replaced. The hospital's capacity grew to fifty patients, and eventually, to eighty. In 1927, the St. Georges School of Nursing was established, and before its closing in the early seventies, produced more than 350 nurses. In mid-1971, the ownership and administrative control of St. Georges was transferred from the Sisters of Charity to a community based, nonprofit corporation headed by Clayton Iverson, already a Clarion County circuit judge, and was renamed after Reverend Louis Davis, the pastor who had donated the initial structure to the town. Over the years that followed, a succession of inadequate administrators, most of them using Davis Regional as a stepping-stone to bigger and better places, made a succession of unfortunate decisions, opting too often for projects and personnel additions that looked progressive but could not support themselves financially. Gradually, but inexorably, community support for the facility dwindled, and benefactors became scarce. Older physicians began retiring earlier than they had planned, and a lack of financial inducements kept young recruits from taking their places. Bankruptcy and closure became more than theoretical possibilities. It was then, with the wolves howling at the hospital door, that the Ultramed Corporation appeared on the scene. A subsidiary of widely diversified RIATA International, Ultramed assailed the hospital board with slide shows, brochures, stock reports, pasteboard graphs, and more financial information on the facility than even the most diligent trustee possessed. Suspicious of outsiders and wary of losing control of an enterprise that had, for most of a century, been at the very heart of their community, a majority of the board opposed the sale, favoring instead another bond issue and one more stab at doing things right. Clayton Iverson, citing what he called "the bloodred writing on the wall, " knew the community had no sensible alternative but to sell.

By his own spirited account, he worked his way through the trustees one by one, cajoling, arguing, calling in markers. In the end, Zack had been told proudly, the vote was unanimous. Unanimous, that was, save one Only Guy Beaulieu remained opposed, though out of respect for the Judge he declined to vote at all. Never one to relinquish power with a hook, the Judge extracted two concessions from the corporation in exchange for the sale of the hospital, a provisional four-year period after which the board of trustees could repurchase the facility, including all improvements, for the original six-million-dollar price, and the serious consideration of his son for the position of administrator. As near as Zack could tell from his father's account, following an exhaustive series of interviews, Ultramed had selected Frank over dozens of applicants-most with extensive hospital experience. That decision, for whatever reasons it was made, had proved brilliant. Orchestrated by Frank, and aided by time-tested business practices and public relations techniques, the turnabout in the hospital was immediate and impressive.