Hannah Alexander - Sacred Trust

Lukas glanced around at the emergency department. He liked this little ten-bed setup. The exam rooms surrounded a large central station. Each room was well equipped. Five of the ten rooms had excellent cardiac equipment. There was a separate ambulance entrance and two physician call rooms.

Mrs. Estelle Pinkley, the hospital administrator, had done a remarkable job when she’d convinced the county to pay for this upgrade. Lukas had jumped at the chance to receive a dependable salary with benefits so far away from the congestion and stress and corruption of the city. Yes, he knew corruption was everywhere, but right now, with specific, damaging events so fresh in his memory, Kansas City represented everything painful.

Carol met Lukas as he entered the E.R. proper. “Dr. Bower, Mrs. Conn is getting worse. Lauren said to notify you.”

“Thanks, Carol. Please call Dr. Richmond back.”

“Lauren already did so.”

“Get ready to call a code if necessary.”

“Dr. Richmond will have a fit about that, you know.”

“Maybe she can do more about it than I was able to.”

M ercy Richmond ran the block from her medical office to the hospital, not bothering to remove her lab coat. Mom had promised to call when the time came, but she hadn’t done so. Instead, Lauren had been the one to break the news.

Shoving open the glass doors into the emergency room reception area, Mercy barely slowed her stride. “Carol, where’s Grandma?”

“She was in exam room eight, but they called a code and moved her to trauma room one.”

Mercy stopped and wheeled back. “What? There’s not supposed to be a code!”

Carol shook her head in sympathy. “I’m sorry. Dr. Bower called it. He had to.”

“We’ll see about that.” Mercy swung back on course. First, administration had arbitrarily decided to bring in a full-time E.R. doc from Kansas City, and now this hotshot doc had decided to ignore a perfectly legal DNR request. Perhaps he’d never learned to read.

She pushed through the swinging double doors that pretended to lend privacy to the open emergency room. A secretary manned the central station. All other hands were gathered in the trauma room, six people altogether, including Grandma’s frail, still body on the bed. Others worked with quick efficiency, responding without question to the soft-spoken commands of a slender, brown-haired man in green scrubs. He knew the drill well.

“Get me a blood gas…. Push the epi now, Lauren…. Any pulse…? Continue CPR.”

Mercy stopped just inside the doorway as a nurse from upstairs pushed methodically against Grandma’s chest and another bagged her.

“What’s going on here?” Mercy demanded. “Doctor, what are you doing to my grandmother?”

He looked up, his blue eyes behind gray-framed spectacles holding her with gentle concern. “You must be Dr. Richmond. I’m sorry, but as per your mother’s request, we are attempting resuscitation.” He turned back to the table.

“Stand clear,” he called as he prepared the paddles to send a jolt of electricity through Grandma’s chest. He placed one paddle above her right breast, and the other paddle he placed to the side below her left breast.

Mercy stood in stunned horror as the frail body jerked, arms flying out, legs up. Mercy had done the same procedure herself many times during her shifts in E.R. but not on someone she loved like Grandma.

“Check pulse,” Dr. Bower said.

Lauren gently felt the carotid artery for a moment, then shook her head. “Nothing, Doctor.”

“Continue CPR. Prepare more epi, and I need lidocaine, 1.5 milligrams per kilogram. What’s that blood gas?”

“Not back yet, Doctor.”

Mercy stepped toward him. “Dr. Bower, I’m her granddaughter. Stop this code.”

He was barely taller than her five feet eight inches, but his expression held calm authority. “As I said, Dr. Richmond, your mother—”

“I heard what you said, but my grandmother signed a DNR form weeks ago. Surely that has some bearing on this case.”

“You know that form does me no good. Believe me, I wish it did.” Dr. Bower’s voice betrayed frustration. He lowered his voice. “Your mother showed me her papers for legal power of attorney. Her order is to resuscitate.”

“Forget that order. As a fellow physician—”

“I can’t break the law, Dr. Richmond.”

“Don’t abuse this patient any more than she has already been abused!”

Dr. Bower grimaced at her words, sighed and shook his head. “I’d love to comply, but I can’t. If you want to sway the decision, please talk to your mother. I tried.” He turned back to the table. “Stop CPR.”

The monitor showed an irregular, sawtooth pattern. Grandma’s heart was in ventricular fibrillation. Mercy hoped it would not change back.

“Where is my mother?” she asked, her voice heavy with frustration.

“She was in the private waiting room when I left her.” Dr. Bower shook his head at the monitor. “No change. We need to shock again.”

He charged the defibrillator to 360 joules. “Clear.”

Mercy stepped back and almost turned to leave, but she couldn’t. A sort of morbid amazement held her there, watching the scene of horror play out before her. She gripped the door frame. A loud pop and flash preceded the stench of burned flesh. An electrode had blown. Lauren and Dr. Bower checked for signs of life while another nurse replaced the electrode.

“No change,” Dr. Bower said.

Mercy felt sick. Mom should be here to see what her crazy order was doing to Grandma. But then, Mom, too, had suffered enough.

Again they shocked, and Mercy could not bring herself to leave. CPR resumed. The longer they worked, the more convinced she became that Grandma was already far past their so-called help. And that meant she was also past any more pain.

Dr. Bower called a halt a seeming eternity later. Mercy did not move until he pronounced the time of death.

She stepped from the doorway as the code team cleaned up the mess of scattered monitor strips and plastic wrapping that had been tossed on the floor during the code. One by one, they filed out past her, some avoiding her eyes as if ashamed of the work they had just done.

Lauren stopped and laid a tanned, slender hand on Mercy’s shoulder. “I’m sorry, Dr. Mercy.” Tears filled her pretty green eyes.

“So am I, Lauren. Thanks for calling me over.”

“It was Dr. Bower’s request. Your mom told us not to.”

“Figures.” Mercy was thirty-nine, and Mom had still not overcome the need to hem her in with maternal over-protectiveness. Often it rankled. It showed lack of respect for Mercy’s ability to cope. For goodness’ sake, she was a doctor.

Dr. Bower paused for a moment at the bedside, his hand resting gently on Grandma’s arm, his head bent and eyes closed. When the last team member had left the room, Mercy walked over to stand beside the man and gaze into Grandma’s silent, scarred face.

Dr. Bower raised his head and looked at her. “I’m sorry, Dr. Richmond, I’ve been told she was a much loved lady.” He had a kind voice, deep and masculine, but with a gentle quality.

Mercy nodded, dry eyed. “She was.”

“I apologize for my abruptness. I could have handled the situation better.”

The sincerity in his voice disarmed her. She’d been prepared for battle when she came in here. Now she felt spent. Empty. “I wouldn’t let you.” She shook her head. “I had always sworn that I would never do to another doc what patients and families have done to me, and here I led the pack—aided by my mother, of course. I know the law, Dr. Bower. It’s just that she’s my grandma.” Her voice caught, and her professional demeanor abandoned her for a moment. Her throat ached with tears she refused to shed. She was grateful for the man’s thoughtful silence.