Michael Palmer - The Last Surgeon

“Pulse one ten. Pressure ninety over sixty.”

From the beginning of his medical training, Nick constantly had to suppress the urge to jump in and get to work when a patient was bleeding. As it was, unless there were obvious indications, he still could not bring himself to allow an injured person to continue bleeding while he took maximum, time-consuming precautions against AIDS, such as donning a gown, an extra pair of gloves, and plastic full-face shield.

“Mike, don’t be frightened. I’m going to glove and then I need to examine you, and quickly.”

“Where am I?” Campbell rasped.

Nick and Junie exchanged concerned glances.

“You came to the Helping Hands medical van,” Junie said. “I’m Junie and this is Dr. Nick Garrity. We’re here to help you.”

“Is this the hospital?”

“This is the mobile medical van.”

Campbell looked wildly about.

“No hospital.”

“We’re on your side,” Nick said, as Junie gingerly pulled off the man’s shirt. “Anything we do will be to keep you alive.”

Nick could tell immediately that there was no way this wound could be properly evaluated outside of an ER, and possibly an OR. The chest cavity could easily hold a lethal amount of blood if the blade had gone through the chest wall. A lobe or an entire lung could have collapsed. He was relieved to see that Campbell’s trachea was midline-an excellent sign that for the moment at least, the lung was still inflated. His nail beds were fairly pink, another good sign.

“Systolic pressure is still ninety,” Junie said, as if reading Nick’s mind. “He’s having a few extra beats.”

“Hang in there, Mike,” Nick said. “We’ll explain everything in just a minute.”

“No hospital,” Campbell said again, his speech marginally thicker than it was before.

Nick carefully listened with his stethoscope. There were breath sounds out to the chest wall in all fields. He forced himself to take a step back. The knife wound could be nothing, or mortal. He knew that guessing at this point was a shortcut to disaster, but his clinical sense told him the wound was shallow. If so, the man’s low blood pressure, confusion, dilated pupils, and irregular heartbeat were out of proportion to the severity of his injury. Something else was going on.

“Junie, could you get his record?” he asked, continuing his exam.

There was no question that Campbell needed transportation to the hospital, and quickly. The trick would be getting him to agree. Nick checked his blood pressure again. Eighty-five. Maybe there was more internal bleeding than he thought. Without asking, he slipped an oxygen cannula into Campbell’s nostrils and turned the flow up to six liters. The man made no attempt to resist. Nick was preparing to start an IV when Junie opened Campbell’s chart and pointed to a section.

Known heroin and benzo addict… History of multiple overdoses, especially meth… On probation. Terrified of going back to prison.

“That explains why Mike is so reluctant to let us take him to the ER,” Junie said. “Is that right, Mike?”

Nick could feel the tension in the man’s body.

“Mike, I need to put an IV in your arm to give you fluid and medicine. Your blood pressure is really low.”

Campbell’s expression was that of a caged animal.

In seconds, Nick had inserted a two-inch IV catheter into a vein at Campbell’s wrist.

“Extra wrap?” Junie asked.

Nick nodded. As usual, she was ahead of the game.

“Draw up one of Narcan and point three of flumazenil. Then hang a liter of saline and run it wide open,” he said.

Junie unlocked the small crash cart and began drawing up the meds. At that instant, Campbell slid off the examining table and began turning frantically from one side to the other. Nick shelved his plan to anesthetize and probe the knife wound and instead tried to help the addict back onto the table. The exam could wait until the antidotes for the narcotics and Valium overdose were in.

However, before anything more could be done, Campbell bolted.

Mike Campbell, wide-eyed and beyond reason, bellowed and thrashed at invisible enemies as he charged from the examining room toward the front of the RV. Eddie Thompson, a hundred pounds heavier than the addict, rose to block his path, and was thrown aside like a child, stumbling against the table and down to the floor, sending coffee spraying from the mugs of the other two students.

Janus Fielding, moving with surprising quickness, reactively filled the spot vacated by Thompson, leaving Phillip MacCandliss exposed to the brunt of Campbell’s onslaught. The claims evaluator, caught in the passenger-side stairwell, was slammed backward against the door with enough force to snap the latch and fling it open. Helpless, he disappeared into the pelting rain, landing on his back in the mire of Jasper Yeo’s Dependable Used Autos sales lot. Campbell, naked from the waist up, stepped off the bottom stair and onto MacCandliss’s belly, falling heavily next to him in the mud. Then he scrambled to his feet and lurched off toward the busy five-way intersection.

By the time Nick had taken the antidotes for overdoses of narcotics and Valium from Junie, Campbell was out of the van. Thank God she had taken the precaution of a bulky wrap around the IV, Nick thought. Thank that same God they had found a vein at the man’s wrist-one of the best spots to protect a line. If he could catch Campbell, there was a good chance that Junie’s maneuver might end up saving the man’s life.

Eddie Thompson was awkwardly trying to return to his feet when Nick sprinted past. Two more strides and he was at the stairwell. Beyond the doorway, MacCandliss had managed to get unsteadily to one knee. Focused on Campbell, Nick leaped off the bottom step like a hurdler.

The scene ahead of Nick unfolded in slow motion. Campbell, still moving forward in a bizarre, uneven gait, was stumbling from side to side like a prizefighter about to go down for the count.

But he did not go down.

Instead, he stepped off the curb and into traffic. Nick, closing the gap between them rapidly, saw the bus that was barreling through the rain toward Campbell from the right. His instantaneous estimation told him that his patient was better than even money to be dead in a matter of seconds. But his mind’s eye had locked on to something else as well-Sarah, coming from the OR, moving unaware across the path of a careening pickup truck, whose driver had no intention of stopping. The image of her being slammed in the midsection by the pickup froze him at the curb for what seemed an eternity.

Suddenly, he broke free of the paralyzing image. With no real plan, fully expecting to be killed, he charged into the street. Campbell was just about in the location between the headlights where Sarah had been when she was hit, but there was still a gap between the man and the massive bumper of the bus.

As he dashed across the road, Nick glanced to his right enough to see that the driver had spotted them and begun to react. She instinctively pulled the wheel to her left, just as Nick launched himself at Campbell, catching the half-naked addict by the waist. The two men pitched face-forward onto the rain-soaked tarmac and slid ahead half a dozen feet, past the speeding bus and into the next lane of traffic.

Brakes and tires screeching, the bus rose up on the driver’s side wheels as it skidded sideways. For several terrible seconds, it hovered motionless, the front and rear wheels on the right side well off the road, its full length now at a right angle from the direction in which it had been headed.

Nick’s chin snapped against the pavement and instantly split open. Dazed, he still managed to hold on to the two syringes. The SUV that had been following behind the bus spun out, with its passenger side wheels also lifting off the road. It smacked against the rear end of the bus. The impact kept both vehicles upright, and sent them skidding away from the two prone figures.