Solemn Oath (19 page)

“Just listen for the siren.”

 

Scrubbed, gowned and gloved, Lukas entered the delivery room to find the mother-to-be and her attendants the unwilling stars of an amateur movie production. While the husband, Jeremy, focused his camcorder from a few feet away, the OB nurse and Lauren placed the patient on a fetal monitor. She was already draped with cloths on a delivery table and had an IV in her left arm. Lukas knew Mercy's standing orders for blood work would have already been completed. An OB pack lay open on a metal tray beside the bed—cord clamps, forceps, scissors, baby towels, 4x4s, bulb syringes, tubes for drawing a cord blood
and a cord gas. There was also an anesthetic for a midline episiotomy.

“I can't do this!” the patient said with a gasp, grabbing Lauren's arm. “Please, you've got to give me something. Why isn't Dr. Mercy here? She'd give me something for the pain.”

Lauren glanced at Lukas. “Dr. Bower, she's fully dilated.”

Lukas stepped forward and quickly checked beneath the draping. She hadn't crowned yet, but she would any time. “I'm sorry, Melinda, but it's too late to give you anything now. We can't risk respiratory depression with the baby.”

The mother-in-law snorted from the reclining chair at the other side of the delivery table. “Melinda, you should've listened to me. I told you not to take the time to change your clothes after your water broke.”

“Rats!” Jeremy cried. “I forgot to change the battery before we left the house. I'll be just a second. Hold on.”

“Are you crazy?” his mother shouted. “I can't believe I raised such a…Get over here and help your wife before I take that camcorder and hit you over the—”

Melinda cried out with another contraction. Lukas checked her again and instructed the OB nurse to prepare the anesthetic for the episiotomy. He checked the monitor and was relieved to find the heart rate holding well.

The perineum stretched, and Lukas injected and cut.

“Got it!” Jeremy shouted eight inches from Lukas's right ear.

Lukas gritted his teeth, held steady and completed the procedure.

Just in time. The baby crowned. The nurses coached. The mother-in-law cried out in sympathetic agony, and Melinda moaned.

“All right!” Jeremy said. “Keep it coming! Yeah! Come on, honey, you can do it!”

Lukas watched the crowning head and gently coaxed it farther. “Okay, Melinda, good, the head's out. Now stop pushing and breathe deeply for a moment.” He cleaned the baby's pale face of the heavy coating of natural lubricant that resembled cottage cheese while the father jockeyed noisily for a better viewing position.

“Doc, can you just move to the left a little? I want to see his face.”

Lukas ignored him. “Okay, Melinda, now you can push again, but gently. We don't want—”

A loud moan, followed by a loud crash of metal came from directly behind him, where Jeremy had been avidly taping the whole scene.

Melinda groaned again in pain. Her mother-in-law cried out and jumped up from the recliner and ran behind Lukas.

“Okay, the movie producer's out of the way for a moment,” the OB nurse announced. “Too bad we didn't catch that moment on tape, Melinda. You'd have loved it. Dr. Bower, don't back up. You've got a crowd behind you. Lauren, I can take it from here if you want to check on the proud father.”

As Lukas and the other nurse helped the new mother complete the birth, Lauren called for reinforcements with c-collar and backboard for Jeremy.

Lukas reached out and caught the emerging slippery baby boy—like a football, just as he'd been taught. The tight little face scrunched and his mouth opened. No sound came out. Lukas flicked the feet with his fingers, grabbed a towel and rubbed the baby's back, and felt a flood of relief when the cry came, strong and clear. He clamped and cut the cord and turned around with the baby—just in time to catch Lauren in the new little boy's urine stream.

 

Mercy's cell beeped again as she continued to work on Darlene. Once more, it was the hospital, but she couldn't
do anything about it. She glanced at Clarence, whose puffy, bearded face betrayed his own physical pain. He had probably pulled one or two major leg muscles in his hurried trip to the neighbor to call for help.

And that neighbor had refused to allow Clarence into her house. Mercy vowed that once this whole thing was over, she would personally go to that woman's house and sock her in the mouth.

But this wasn't over, and as Clarence lay watching her with fear-filled eyes, Mercy realized that he and his sister were both getting worse. Darlene now had an irregular heart rate of 140. Her breath sounds, fast and shallow, were barely perceptible. She was failing.

Mercy reached into her bag and pulled out an ampule of Brethine, a bronchodilator that should open Darlene's bronchial tubes. Unfortunately, it could also increase the heart rate and drop the blood pressure even lower. But this was Mercy's last play. She injected the drug and hovered over the woman, waiting.

“I thought she was better until I saw her blue lips this morning,” Clarence said, his deep voice seeming to rattle the closet door against which he leaned. “She stopped wheezing yesterday. I thought that meant she was getting better, but she wasn't, was she?”

“We don't know that for sure, Clarence.” Mercy placed her stethoscope over Darlene's chest. Was that a slight wheeze she heard?

“Don't try to fool me, Doc. I should've caught it, and I didn't. I was so busy feeling sorry for myself, letting her wait on me and carry food and give me my medicine that I didn't even know she was getting worse.”

“You're not a doctor,” Mercy snapped. “Hush for a moment and let me listen.”

At the sharp sound of Mercy's voice, Darlene opened her eyes.

“Feeling pretty rough?” Mercy asked her.

Darlene nodded. She opened her mouth to try to speak, but Mercy placed a finger over her lips. “I've given you a drug that I hope will help, and we're waiting for an ambulance.”

Another reading of blood pressure showed no change. The heart rate did not increase past 140, but Mercy heard no sounds of wheezing, which would have indicated an improvement. The drug wasn't working yet.

“Just hold on, Darlene. Keep breathing for us.”

“She's been quiet the past few days,” Clarence said, “but I knew she was worried because she was behind with her work, so I didn't think about her being sick.”

Mercy adjusted the mask over Darlene's gray face. “The ambulance will be here.”

“Take care of him,” came a breathy, whispered croak.

Mercy jerked back around to find Darlene watching her with tears in her eyes. “Hold on, Darlene.”

“I'm not going to get through this, am I?” She was struggling for breath, fighting to stay awake, and Mercy could barely hear the words.

“Yes, you are.” Mercy once more inflated the blood pressure cuff. “We'll get you to a hospital and get you on a ventilator. Just keep going a little longer, Darlene.”

Darlene reached up and touched Mercy's arm, her eyes closing once more. “Take care of my brother.”

A moment later, they heard the faint, welcome call of a siren.

L
ukas winced at the disharmony of strong baby lungs and strident grandma lungs as he pulled off his gloves. He bent down and gently moved Jeremy's mother aside so he could examine the new father. Her labor pains had ended when her own baby dropped the camcorder.

The woman scrambled as close as she could to her son's other side. “He's bleeding, Doctor. Oh, my…what if he's got a concussion? Jeremy? Jeremy! Wake up, honey. I didn't mean those things I said.”

“What happened?” Melinda demanded from the birthing cot. “Did something happen to Jeremy? What's going on?”

A two-inch-long streak of bright blood angled across Jeremy's forehead where he had connected with the corner of a metal utensil tray that had interrupted his sideways fall. Lukas checked Jeremy's airway, breathing, circulation, looked in his eyes, and nodded to himself. The man would be coming around any moment.

“We need to check him out,” Lukas told the others. “He'll need some stitches, but he fell because he fainted at the sight of his son.”

An exhausted chuckle reached him from the birthing cot. “Oh, is that all?” Melinda said weakly. “He'll be okay,
then. He gets sick at the sight of blood. I told him he couldn't take it.”

The mother's eyes widened behind her wire-framed glasses. “You're kidding! The big baby fainted?” She stared back down at her son, her expression metamorphosing from concern to disbelief to disgust. “How typical!” She shook her head and climbed to her feet with a grunt, then walked back over to the bedside. “Oh, Melinda, honey, I'm so sorry,” she said, patting her daughter-in-law's hand. “This is so humiliating.”

Jeremy opened his eyes and blinked up at Lukas, then groaned and tried to rise, but Lukas put a hand on the young man's bony left shoulder and eased him back down. “Just stay put and we'll all be safer. Someone is on the way down to take you to the emergency room so we can check you out.”

“Are they okay?” Jeremy asked.

“Your wife and baby are fine, but I'm not an electronics expert, so you'll have to get a diagnosis on your camcorder from somebody else.”

Amanda rushed through the wide delivery room door with a gurney, on which lay a c-collar and spine board. “All right! A new baby! Way to go!” She instantly saw Jeremy splayed out on the floor and lowered the adjustable gurney to make it easier to transport the patient. “Lauren, will you give me a hand? Dr. Bower, as I was on my way in here, we got a call about a bad asthma coming in by ambulance. They're about six minutes out.”

“Okay, thanks. Keep me posted.” Lukas took the c-collar from Amanda and placed it around Jeremy's neck. Together, he and Amanda logrolled the patient onto his side, strapped him onto the backboard, then transferred him onto the gurney. As Lauren and Amanda wheeled Jeremy out, Lukas grabbed another pair of gloves and turned back to his other two patients. The efficient, seasoned OB nurse had already
shown the baby to the mother and taken him over to place him beneath a radiant warmer. Melinda, the new mother, needed attention.

“Oh, and, Dr. Bower?” Amanda continued as they started to push Jeremy out of the room. “The ambulance attendant told us that Dr. Mercy is with them. She was at the scene with the patient when they arrived.”

Lukas frowned. “She's in the ambulance?”

“That's what they said.”

Immediately, Lukas knew. Darlene…. Hadn't he discussed this very thing with Mercy a few days ago?

“After all that trouble, I hope he didn't break that stupid camcorder.” Jeremy's mother once more leaned over her daughter-in-law and dabbed the young woman's forehead with a wet towel. “My boy means well, even if he is a wimp. He's just always loved his gadgets.” She glanced in the direction of her new grandson. “How's that baby doing?”

“Looking good,” the nurse assured her without looking up from her work. “Great Apgar test scores. He's got a good strong heart rate, and he's pink from head to toe.”

“Now we just have to deliver the placenta,” Lukas said as he positioned himself to complete the job.

Melinda grimaced. “Jeremy's going to be okay? Ouch, I'm cramping! Did he even get the baby on film?”

“Now, now.” The new grandmother continued to pat Melinda's face with the towel. “He's going to be fine, just like the baby. Maybe a scar on the forehead will make my son think about
you
next time you're in labor, instead of his little gadgets.”

Melinda's eyes widened at her mother-in-law. “
Next
time?”

 

Tedi found Abby sitting out by the trees on the playground, watching a last-minute game of baseball before school began for the day. Mr. Walters had been encourag
ing them to practice for the past two weeks so they would be ready to play the other sixth-grade team Thursday. Tedi dreaded it. She could beat everybody in sixth or seventh grade in a spelling bee but couldn't control a baseball with a bat or a glove, and she didn't want to learn.

She walked over and sank onto the grass beside her best friend. “Why aren't you playing, Abby? You're their star hitter.”

Abby pointed to her bandages. “I don't have my stitches out.”

“So? That didn't stop you last week.”

Abby shrugged and looked down, ignoring the game. That wasn't like her, either.

“What's wrong?” Tedi asked.

“Nothing.”

Tedi knew what it was. “They're fighting again, aren't they?”

Abby pushed her glasses up her nose and nodded.

“Sorry.”

“Yeah, I know.”

The bell rang. Tedi groaned and started to get up, when the bell rang again, and then again, in short bursts.

“All right!” the pitcher on the mound shouted. “Fire drill! We're gonna get out of class.”

Tedi groaned. “That's silly. Why are we having a fire drill before we're supposed to be in—”

Abby gasped and pointed toward the cafeteria at the east end of the long elementary school building. Gray smoke billowed from one of the open windows. “It's a real fire!”

The fire alarm continued its blast, echoing across the large grassy playground behind the building. Wide-eyed with excitement and fear, Tedi and Abby got up and joined the ballplayers at the spot by the flagpole where their class was supposed to stand. They watched kids and teachers and the principal and secretaries file out of the doors of the
building and walk toward them, just as they'd done during the drill they'd had three weeks ago.

Mr. Walters came rushing out from the west exit, herding two other kids in front of him. His slightly chubby belly jiggled over his belt, and his right hand grasped his attendance book. He directed the two kids to join Tedi and Abby and the ballplayers, and as soon as he reached them, he started roll call, just like the other teachers.

The bell continued its sharp retort. Before Mr. Walters finished calling out the list of kids' names, a siren joined the jangle of the bell. Another siren soon joined it. The flashing red lights of two blaring red trucks raced toward them down the street from the direction of the fire station.

The smell of the smoke reached Tedi as the trucks pulled into the school driveway. More trucks arrived, and men jumped out and unwound huge hoses from their trucks. They connected the hoses to the fire hydrant at the back of the school, and with two men per hose, they shot their forceful streams of water at the fire.

The smoke turned to sizzling steam as the men shouted to one another and fought the hoses. One skinny man kept running around, tripping over the hoses, until another fireman walked over to him and jerked on his arm. Together they entered the school building.

“Do you think the cooks are okay?” Abby asked.

Tedi nodded and pointed toward the school staff. The cooks all mingled with the secretaries at the far end of the group.

About the time the final wisp of smoke disappeared, Tedi saw Grandma pull her car into the front driveway and wave at them. They'd been dismissed from school for the day.

That was it? That was all the excitement they were going to have today? No screams, no explosions, no collapsing buildings? Just wisps of smoke and a few fire hoses, and it was finished?

Tedi sighed and walked toward Grandma's car. Oh well, at least nobody was hurt. Time to go home.

 

In the ambulance, Mercy's physical tension rose and fell with the sound of the siren above her and the constant
beep-beep
of Darlene's monitor. Sitting in the jump seat at the head of the cot, she squeezed the ambu bag with increasing frequency. Darlene had to struggle to take in a breath. This left Connie, the paramedic, free to keep track of the blood pressure and monitor and establish a second IV en route to the hospital. She was just as efficient inserting the second IV as she had been with the first, but Mercy noticed with concern that this time, when the needle pricked Darlene's flesh, there was no reaction, not even a flinch. And Mercy was having to use more and more force to move air through the ambu bag because of Darlene's decreased responsiveness and muscle tone. Darlene was too worn-out to breathe.

Less than four minutes from the hospital, Connie rechecked the monitor and inflated the blood pressure cuff. “Dr. Mercy, I can barely hear a pressure.” She checked for a pulse, then looked up at Mercy in alarm. “She's in shock. We've got to intubate.”

“Give her fifty milligrams of lidocaine first.”

“I've got it ready.”

Mercy watched Connie administer the drug through the IV, then she removed the bag mask and changed places to allow the paramedic to do the intubation. “You do it, Connie. It's what you're good at, and you do it often.” Mercy was too emotionally involved at this point.

Connie was smooth, very experienced, and the tube slid in quickly, but too late they saw that in spite of the medication, the tube triggered a sudden bad reaction. The monitor alarm shot through the van.

“She's in v-tach,” Connie said, checking the pulse again. “I'm not getting anything.”

Mercy pressed Darlene's throat in search of the carotid artery. Nothing. She turned toward the driver. “Bernie, call the hospital. Tell them to call Air Care. Tell them we're coming in with a code.”

 

Lukas stood in the ambulance bay as the code team continued to assemble in the E.R. He had already told the secretary to call the chopper, on Mercy's instructions. He saw Mercy and Connie bent over someone in the back of the van. He knew for sure it was Darlene Knight before they opened the double back doors and wheeled her out.

He felt sick.

He stepped forward to help them. Connie recited the patient summary to him, continuing chest compressions as she spoke.

Lukas caught sight of tears shining from Mercy's face, but he had no time to dwell on that. Darlene had crashed hard, and they would have their hands full bringing her back. And they had to bring her back. They
had
to.
Please, God.

 

Mercy continued to squeeze the bag as the code team worked over Darlene, and Lukas ordered drugs. She released her position only when Lukas placed the paddles on Darlene's chest for defibrillation. All stood back.

“Clear.”

The body arched, the monitor sang, and then a steady rhythm beeped across the room from the monitor. Mercy felt fresh hot tears—this time of relief. She ducked her head and blinked, scattering the tears over her flexing arms. This was no good! She couldn't fall apart like this. She felt a hand on her arm and looked up as Lukas gently took over the bagging for her and nudged her aside.

“We've got extra help now, and the chopper's almost here,” he said under cover of the monitor beep. “Go blow your nose.”

She went, feeling helpless, inept. After working with patients for more than ten years, she had learned to protect her emotions, to distance herself from the suffering so that she could most effectively help those who depended on her calm judgment. This one had cut deep, had shaken her more completely than her first code blue as an intern, and she hadn't even run this resuscitation effort herself.

And what about Clarence? She'd left him slumped on the front porch of his house, frantic about his sister, and grimacing in pain from pulled muscles.

She did as she was told and blew her nose and wiped her face, but she would not leave the E.R. After rechecking the progress on Darlene, she turned to watch through the plate-glass windows for a helicopter to appear in the sky. She listened for the pulsing thrusts of echoing blades that would be her first assurance that help was arriving.

Instead, she saw Buck Oppenheimer wheel into the ambulance bay in his big red pickup truck. He wasn't supposed to be doing that. What was going on?

Then she saw Clarence Knight riding shotgun, his massive bulk taking up half the cab.

Mercy ran into the E.R. proper and grabbed their sturdiest wheelchair. When she stepped out with the chair, she saw two more cars pulling up behind Buck's pickup. Altogether, five men climbed out.