Michael Palmer: Fatal

"Hey," Matt said, "you handle the mining, I'll handle the doctoring."

"If you say so. People round these parts speak real highly of you, Doc. I been thinkin' lately of gettin' me a doctor, and you're the one I 'uz gonna call."

"Do that," Matt said, dreading what an X ray of the man's chest might reveal.

He numbed the margins of the huge wound with I percent Xylocaine, prepped the area with Betadine, clamped a set of sterile drapes around it, and carefully lifted the flap back in place. There was going to be a scar. There always was when skin had to be sutured. The question was whether to do a meticulous, microscopic closure with tiny sutures that might pull out if tested by Mickey's going back to work too soon, or a quicker job using thicker suture material, guaranteed to hold under almost any circumstance.

"What's the deal with your qualifying to collect disability?" Matt asked.

"We get full salary so long's we have sick time available. Then it's a month waitin' period before the disability kicks in. With a doctor's note sayin' the problem is work-related, we start collectin' disability immediately with no loss of sick time. But I'm — "

"Shhhhhhh."

Matt selected dissolving sutures for a careful, layered closure, and fine, 6–0 nylon for the actual skin. Then he donned magnifying goggles and a new pair of gloves. Mickey's lined, weathered face showed every day of three decades in the mine. But there was no way he was going to leave the ER with anything but the thinnest of scars from this one.

"You're out for two weeks," Matt said. "I'll give you the note. In fact, make that three weeks. And if you have any kind of a headache, any kind at all, we'll tack on a few weeks more."

Twenty minutes later, he was halfway done with a closure that would have satisfied a movie star, when Laura Williams, breathless, called to him from the doorway.

"Matt, Dr. Easterly needs you right away in the crash suite. You'll have to finish in here later."

Matt placed some saline-soaked gauze over Shannon's wound and set the sterile drapes aside. Then he stepped back from the table, flexing some of the tightness from his neck.

"Mickey, you hear that?" he asked.

"Don't worry about me. Who's he got to see, miss?"

"A man named Darryl Teague," Laura replied. "Some sort of heavy equipment fell over on him."

"Let 'im die!" Mickey Shannon snapped.

Considering that every bed in the ER was occupied and most of those patients were being attended to, there was quite a crowd working in room 10. One glance at the overhead monitor told Matt why. Heart rate 140. Blood pressure 80/40. Oxygen saturation only 89 percent. Jon Lee, the nurse working beside the gurney, caught Matt's eye and made a brief thumbs-down sign. It seemed as if Mickey Shannon's and Robby Fenton's prayers were being answered. Somewhere beyond the wall of technicians, nurses, and GP Judy Easterly, Darryl Teague was on the verge of checking out.

"What's up?"

Startled, Judy Easterly swung around, then came over to him. Not the most energized or enthusiastic of doctors under any circumstance, she was currently in her seventh or eighth month of pregnancy, and looked as if she would have chosen to be anyplace in the world at that moment other than where she was.

"This is the guy who caused all this," she whispered.

"I know," Matt whispered back. "Is he bleeding somewhere?"

Easterly thrust out her gravid belly and arched her back, trying to relieve some tightness somewhere.

"Not that I can tell," she replied, still whispering. "He drove some piece of heavy equipment over two guys. No one knows why. One of them's dead. The other's up in the OR right now, and I don't think he's going to make it. After he did that, he knocked down some supports and the roof collapsed. He was trapped beneath a load of rock. The rescue guys said his BP was all right on the way in. I think the triage nurse assigned him to me because he looked pretty good when he got here."

"Not anymore. Obvious fractures?"

In addition to the usual sources of hidden blood loss — the chest and abdominal cavities — a fractured leg, or even an arm in some cases, could cause enough bleeding into muscle to throw a victim into shock.

"None," Easterly said. "He's moving all extremities. Joe Terry was just hanging around waiting for the OR to be ready for his case, so I had him put an arterial line in."

"Nicely done."

Matt meant the compliment, although it was also obvious that except for the arterial line, Easterly hadn't been nearly aggressive enough with a man this hurt. At the moment she seemed close to tears.

"You know," she said, "if I had known I was going to end up with this sort of crunch in the very guy responsible for the disaster, I would have stayed home."

"Listen, Judy, why don't you go ahead home right now," Matt said. "You've got things under reasonable control here, and it looks as if you and the kid could use some rest."

Easterly started to protest, then suddenly thanked him.

"Bloods are off for the usual labs plus six units," she said rapidly. "I ordered a portable of his chest and abdomen. I really appreciate this."

"Just name your kid after me," Matt said.

"Matthewina," Easterly said. "I think she'd like that. Hey, thanks. Good luck."

Before Matt could even respond, she was gone. It was just as well. She clearly had other things on her mind and was already hovering between not-much-help and downright dangerous. He glanced again at the monitor and moved into Easterly's spot at the bedside, across from Jon Lee. Then he stopped short, staring down in disbelief at the man whose insane rage had just killed one and possibly two co-workers. Darryl Teague's face was covered with fleshy lumps, at least twenty of them, some pea-sized, but some quite a bit larger, and one, just in front of his left ear, approximating a walnut. Almost certainly they were neurofibromas — bundles of nerve tissue mixed with spindly fibrous cells. Cause: unknown. Cure: none known. Darryl Teague was well on his way to becoming an Elephant Man.

Even more startling to Matt was that Teague was the second case of such a condition he had seen in the past four or five months.

"Laura, Dr. Hal Sawyer is part of our disaster team. Could you please call him in the lab and ask if he can come over as soon as possible."

"You've got it."

Matt quickly turned his attention to the miner. Teague was conscious and still breathing on his own, but his skin was mottled and his lips were a grayish purple.

"Jon, anything ordered for his pressure?"

"Nothing yet, Doctor." Lee's tone made it quite clear that he was grateful for the change in medical command.

"Hang some dopamine, standard drip. Run it wide open until we see what happens. Get a catheter in him and keep his volume up."

Laura Williams returned. "Dr. Sawyer will be over shortly," she said.

Matt peered up at the EKG monitor. The size of the beats on the tracing appeared much smaller than normal. He filed the information away for the moment and began an efficient exam. Teague's heart sounds were muffled and distant. There was tenderness in the center of his sternum — enough tenderness to cause the semi-comatose man to cry out when the spot was pressed. His belly was soft and not the least bit tender. His lungs were clear. Legs, arms, unremarkable. Skull and scalp also normal, except that there were a dozen or more neurofibromas hidden beneath Teague's long, strawlike, dirty blond hair.

In short, there was no evidence for bleeding anywhere. So why was Teague in shock?

The likely answer at the moment centered around trauma to the miner's breastbone, and beneath it, his heart.

"Laura, where's Dr. Crook?" he asked.

"On his way in. Turns out his beeper was accidentally shut off, and his phone wasn't working. The Sandersonville police went out to his place and woke him up."