Hannah Alexander - Silent Pledge

“Is he responsive?” Lukas hadn’t heard an ambulance report, and he’d only walked back here a couple of minutes ago.

“Just a minute and I’ll ask.”

“Never mind. I’ll be right there. Have Tex paged over the speakers.” Lukas hung up and returned to the E.R. to the overhead blare of Carmen’s voice. He walked into the cardiac room to find Quinn Carnes and Sandra Davis—the paramedic and emergency tech—transferring a seemingly unconscious elderly man from a gurney to the exam cot. The patient was fully immobilized, arms and all, to a long spine board, with head blocks, C-collar, the works. He had a hundred percent nonrebreather mask over his face. But no IV. No ET tube, so his airway was not protected.

“Hey there, Doc,” Quinn said, walking over to the desk in the exam room and tossing his paperwork down. He reached up in a habitual gesture and scratched at the thick, wavy brown-gray hair that grew to his shirt collar. “Got you a gomer here.”

Lukas flinched. He hated that term. Gomer meant “Get Out of My E.R.” and was used by burned-out, unprofessional personnel who felt the patient wasn’t worth their trouble.

“His wife found him down and unresponsive and dialed nine-one-one,” Quinn continued. “Looks like a stroke. Finger-stick glucose was one-oh-seven on scene. The wife’s on the way in her own car, but no long-playing record here.”

Lukas cringed as he stepped over to the side of the bed, and he saw Sandra glare at her partner with obvious disgust. Although Quinn was probably in his midforties, he apparently had only been on an ambulance crew for a couple of years. Lukas believed he never should have been allowed to work with patients in the first place, but there were probably few contenders for the job in a town like Herald. Lukas knew the man was presently working as many hours as possible with the ambulance service and bugging hospital personnel to give him some shifts in the E.R. If Lukas had anything to say about it, that wasn’t going to happen.

“What’s the gentleman’s name? ” Lukas asked, unable to keep irritation from his voice.

“Mr. Wayne Powell,” Sandra replied for Quinn. Her voice was hesitant, soft, as it had been the other time Lukas had seen her in here. “His poor wife was almost hysterical when she called.”

Lukas leaned forward and squeezed the patient’s upper arm. “Mr. Powell?”

“Told you he’s out of it, Doc,” Quinn said over his shoulder as he sat down to do paperwork.

Lukas took the patient’s arm in a firmer grip. “Mr. Powell! Mr. Powell, can you hear me?” he called more loudly. “I’m Dr. Bower. Try to open your eyes if you can.”

No response.

Tex walked into the room, slightly breathless from her rush back down the hallway. Her large frame and broad shoulders seemed to fill the already crowded little exam room. “Can’t leave this place for two minutes without—Uh-oh, what’ve we got here?”

“I’m still trying to find out.” Lukas rubbed his knuckles hard against the man’s sternum and didn’t even get a groan. The sternal rub would rouse him if anything would. “Tex, we’ve got an unresponsive patient with an unprotected airway,” he said. “Set up for an intubation, but first let’s get the suction set up.” He couldn’t believe Quinn hadn’t intubated this patient.

Tex turned to the cabinets on the left and opened a door to pull out some equipment.

Quinn looked over at them and gave a quick chirp of irritated laughter. “Would you relax, Doc? Don’t you think I’d have done that if he needed it? He’s not throwing up or anything. His airway’s clear.”

Lukas grabbed the black box that Tex handed to him. He broke the safety lock and opened the box, pulled out the laryngoscope and endotracheal tube and snapped the blade into place. “An unobstructed airway is not the same as a protected airway. If this is a stroke patient, he’s at high risk for aspiration.”

Tex came around with the suction. “Got it, Dr. Bower.”

Lukas reached over to pull off the oxygen mask just as Mr. Powell retched. “Tex, get the suction catheter in. Quinn, Sandra, help me here.” He reached for the grips and turned the patient toward him as Sandra rushed to help. Good. The man’s body didn’t slip. They’d done a good job of securing him. Quinn ambled over to help.

“Sloppy job, Quinn,” Tex snapped above the sound of the suction. “Sloppy, sloppy. Why didn’t you intubate this guy on scene? I’d have taught you how if you needed me to. Maybe I could teach you how to do an IV, too, while I was at it, and how to hook up a monitor. And I didn’t hear your radio report. I was gone less than a minute. Trying to sneak up on us?”

“No time,’ Quinn said. “We were busy, and we were just about a mile away. There wasn’t time for little nonessentials.”

“You call lifesaving and preparation nonessentials?” Tex snapped. “If you’d spend a little more time worrying about your patients and less time whining about your bank account, you might make a good paramedic someday.”

“You try going on scene every once in a while.”

Tex returned his glare and shook her head. “I did it for five years.”

“Sure, but most of that was years ago,” he taunted. “Things have changed. You think being a med-school dropout makes you special.”

“I didn’t drop out, you stupid jerk.”

“Tex,” Lukas snapped, “keep your mind on what you’re doing.”

“Sorry, Dr. Bower.” She suctioned for a couple more seconds, then pulled the tube back. “He looks clear.”

“Good, let’s get him back over. I need an IV now, and give him Ativan, two milligrams. Sandra, take over that suction and keep it handy, just in case.” He called over to the secretary across the E.R. “Carmen, I need an EKG, CBC, electrolytes, PT and PTT—”

Carmen turned around in her chair, eyes widening in panic. “What? Slow down, I can’t get all this down.” She grabbed a pen and a pad. “Now, what was that?”

“Just do a standard cardiac workup,” Lukas said gently. “It’s taped on the wall to the right of the phone.” He turned back to Mr. Powell and tried to wake him up again. No response. He pulled out his penlight and checked the man’s pupils. They were sluggish, and the one on the left looked a little dilated. Nothing obvious.

“Call for a helicopter launch. He’s going to have to be flown to Columbia.” Lukas slipped off Mr. Powell’s shoe and, with the point of an ink pen, ran the tip up the bottom of the man’s foot. The big toe curled upward.

Positive Babinski’s. The abnormal reflex was found in stroke victims. Quinn should have intubated.

“Dr. Mercy, help me.” The feminine voice drifted to her from the dark mist, soft and indistinct. A sudden, frantic pounding reached her, and then the quiet voice again. “Help me.”

Mercy awakened suddenly with her face pressed against the hard surface of her desk. The overhead light blared down on her, and her right shoulder and arm were splayed across the back of her chair, cramped and stiff. The pounding continued to sound in her head from her dream, but as she listened all she heard were soft puffs of wind against the window and the scratch of branches from the cedar tree against the rain gutter.

She got up, stretched and walked to the darkened waiting room. All was quiet. Was she dreaming about Kendra? Were the worry and stress of the past few months finally taking their toll?

Just in case, she opened the entrance door, and freezing wind rushed in, mixed with a powdery feathering of snow. She shivered and stepped back into the warmth but didn’t close the door for a moment.

“Hello?” she called out into the cold. She felt foolish. Of course it had been a dream. “Is anybody out there?”