Solemn Oath (21 page)

Mrs. Pinkley stepped into the thick-carpeted room wearing her usual attire of suit jacket and skirt, this time in gunmetal gray with a white blouse. She had every hair in place, and her face held no expression. She stood aside as a woman followed her into the room.

Lukas remembered his manners and stood while Estelle introduced him to Ms. Francis Fellows, a young woman who couldn't have been more than twenty-five, with short straight blond hair and wire-framed glasses. Her complexion looked as if she'd made up this morning with pale pink Liquid Paper. She shook Lukas's hand weakly and did not smile. Lukas felt as if he could inhale the tension in the room. He waited for the two women to be seated, then managed to sit down without turning the chair over.

“I'm sorry I wasn't able to meet with you earlier,” Lukas began. “We had several emergencies at one time, and I couldn't leave.”

“That's fine.” Ms. Fellows pulled a pad of forms from the wide pocket of her tailored suit jacket. “This is a preliminary meeting and shouldn't take long.” Her voice lacked inflection, as if she had memorized the lines. “Dr. Bower, I need to ask you some questions about the Dwayne Little case and your refusal to prescribe pain medication for a patient obviously in pain.”

“Dwayne Little was not obviously in pain.” Lukas kept his voice as monotone as hers. “I did not refuse to give pain medication. I offered two different medications for his alleged migraine, and he became angry and left against medical advice.”

Ms. Fellows wrote something on her pad. “We show no AMA report from anyone other than you, Dr. Bower, so you had no witnesses?”

“I had one witness, my nurse, who did not fill out a form.”

The woman looked up at him. “We will want to interview her, if possible. Would you have given Mr. Little a suitable narcotic if he had not left?”

“Objection,” Mrs. Pinkley said suddenly from her place of observation behind her desk. “That question calls for conjecture, not facts.” She smiled to temper her words, but the smile did nothing to cover the keen intelligence and insight behind Estelle's calm gaze. “You'll have to excuse me. I was an active attorney in this county for thirty-five years before I retired and took this position as hospital administrator. Sometimes I have trouble keeping my opinions to myself.”

Lukas watched as some of the already sparse color drained from young Ms. Fellows's face. He could tell she did not appreciate the intrusion, but she was going to have
to get used to it. For fifteen years Estelle Pinkley had been known as the most formidable prosecuting attorney in Knolls County, and her reputation had spread all the way to the state capital of Jefferson City. Several times she had been urged to run for the office of state senator, and as many times she had declined nomination. Estelle's roots were always solidly in Knolls, and now they were just as solidly rooted in this hospital.

Ms. Fellows turned back to Lukas, her gaze cold, her tone colder. “What I will be striving to discover during this investigation is whether or not this case falls under COBRA jurisdiction, which I believe it does. Next I will be determining whether or not Mr. Little received ethical treatment for pain. If I find—”

“Excuse me, Ms. Fellows,” Lukas interrupted, suddenly angry. “I can tell you what ethical treatment entails. First of all, it does
not
entail handing out morphine every time someone comes in off the street and demands it. I'm not a pusher. I'm a doctor. I took a solemn oath to that effect, a part of which is to employ only those recognized methods of treatment consistent with good judgment. I could not in good conscience give morphine to Dwayne Little that day.” He glanced at Estelle and caught the barest shake of her head, and he fell silent.

“If I may continue,” Ms. Fellows snapped. “If I find this case to have been inappropriately managed, we can fine you and the hospital twenty-five thousand dollars for each violation we uncover, and we can recommend that the hospital dismiss you. If this hospital does not dismiss you, we can give them six months to correct the problem, or they will lose Medicare and Medicaid funding.” Her voice went from cold to antagonistic.

“I'm sure you are aware that emergency departments are not allowed to refuse Medicare or Medicaid patients,” she continued, “and that without government funding this hospital
would go out of business. Some hospitals receive up to eighty percent of their funding from government entitlements.”

“How long will this investigation last?” Lukas asked, this time with an attempt to keep his voice well modulated.

She held his gaze with a hard stare. “As long as I see fit to continue discovery. And my discovery does not have to be limited to this one particular case. If I even sense a lack of cooperation from you or Mrs. Pinkley or anyone else in this hospital, I can and will open other files at my discretion, including confidential peer reviews. Your malpractice insurance will not cover our fines.” She stuffed her pad back into her pocket and stood up. “I'll be in touch.” Without waiting for him to play gentleman and stand, she saw herself out the door.

Lukas felt cold tingles of anger and worry make tracks up his spine. After she disappeared out the door, he slumped in his seat and stifled a groan. “Oh boy, I blew it that time. Why can't I learn to keep my mouth shut at the right time?”

“Don't get all worked up, Lukas,” Estelle warned him. “I like the old commercial that says ‘never let 'em see you sweat.' If they sense any weakness, they think they have something on you, and they'll go for the jugular.”

Lukas scowled. “She's after more than my jugular. She's already got it in a death grip.”

“Don't let her fool you. Most COBRA investigators try to be fair-minded.” The older woman's eyes narrowed thoughtfully. “This one's got another agenda. I picked up on that when she first got here. Let's just wait and see what she's up to.”

“And use me as bait? In this gal's eyes I'm guilty until proven innocent. That's not the way the justice system's supposed to work. How can they get away with this?”

“She hasn't—yet.”

“That's encouraging.”

“Oh, come on, Lukas.” She sat back in her chair and folded her hands together. “You know doctors are always
in the hot seat. You're not allowed to be human and make mistakes like the rest of the human race. Lives are at stake.”

“I don't think it's lives people are worried about as much as money,” Lukas complained, surprising himself with his own bitterness. And he realized after he said it that he meant it. “Even when we do everything right, some money seeker is going to look for a way to cry foul, and there's greed at every level. They can always find plenty of ‘expert' physicians willing to help them turn the screws on a colleague for a cut.”

Estelle nodded, unfazed by his cynicism. “Hey, this is America. We're nothing if not litigious, but keep in mind this isn't a lawsuit. If it were, your malpractice insurance would cover you, no matter what the decision about your actions.”

“Thanks for the reminder,” Lukas grumbled. “I didn't make a mistake with Dwayne Little. He was a drug seeker.” And Lukas was at the mercy of Francis Fellows, who had obviously already made her judgment.

He thought about the whopping school loans he had yet to pay off, and the house mortgage, and the bills he had willingly incurred for Clarence and Darlene. There was very little in his pockets except lint. He had a generous income, which was good, but his bank account worked like a financial sieve. If the hospital didn't pick up his malpractice insurance, he'd be living in a tent in the Mark Twain National Forest. Come to think of it, that might not be so—

“The present legislation is a reaction to fraudulent medical personnel,” Estelle said, breaking into his thoughts. “Many hospital emergency departments used to have the unethical practice of checking on a patient's ability to pay before they accepted the patient for emergency treatment. Hospitals would play ‘hot potato' with unwanted patients. COBRA is the result of government reaction to that practice. Unfortunately, human beings also operate the government, and so the corruption continues.”

“And the honest people suffer for it on both sides of the medical fence.” Lukas had to remind himself that the only perfect society would be Heaven, and his expertise would not be needed there.

Estelle nodded and stood. “Sorry, Lukas, it's a part of your education as a director.”

Lukas stood and took her outstretched hand. The meeting was over, but he didn't feel any better. He never had wanted to be the E.R. director. Now was not a good time to address that, but after this was all over, if he still had a job, and if the hospital was still a hospital and not just another moneymaker for some power-drunk HMO, he would resign from his red-tape duties and concentrate on treating patients.

A
t ten o'clock on Wednesday morning, Mercy walked down the street from her office to the hospital. She had lab reports to collect and patient rounds to do, and this short walk was the only exercise she would have for the day, except for her hops between exam rooms in the clinic. If she wasn't careful, Mom would buy her a treadmill and attach a pedometer to her waist.

To prevent this from happening, Mercy climbed the stairs to the second floor instead of taking the elevator.

She knocked at the threshold of room 232, then stepped into the room. All rooms in this sixty-bed hospital were private. It was one of the first things Estelle Pinkley had done when she became the administrator.

Clarence lay in drugged listlessness in his bed with the raised cold metal rails pressing into the flesh of his right side. The hospital gown he wore looked like a bib on his huge shoulders, and a sheet was pulled up to his waist for modesty—probably by a kindhearted nurse, since it would have been difficult for him to reach down for the sheet, even without his injuries. His eyes were closed, but at the sound of Mercy's quiet footsteps he opened them.

“Good morning, Clarence. Did you get my message earlier about Darlene?”

“Yeah.” His voice was heavy with worry. His sister was still in a coma.

“As I told you yesterday, Darlene is in the best place possible, and my secretary will be checking on her again today. They promised they would call if there was a change. How's the pain?” She retrieved the clipboard with his chart from the end rail of the bed and stepped over to his side.

“Still there.”

His voice, usually loud and rumbling, barely reached her, and she watched him worriedly as she checked the chart for vitals, medication and urine output. “You know, Clarence, your weight has gone down extensively with fluid loss since you've been in here. Are you sure you were taking the Lasix at home every day?”

He looked away and didn't answer.

She pulled a pen from her pocket and jotted a memo on the chart. “I thought Darlene was the only one I had to lecture about hoarding drugs.”

A muscle twitched at the side of his mouth. He stared out the window. “Just trying to stretch it out. I got tired of going to the bathroom every ten minutes. I figured if I just cut it down a little, that would make it easier on me and the floor. And my back.”

“Your back?” Mercy crossed her arms and leaned against the windowsill. “You mean you were having trouble with your back and you didn't tell me about it?”

He shrugged and looked at her. “And what could you do about it? You've already said it's just pulled muscles.”

“I didn't say
just
pulled muscles. Pain is a real thing, a signal that your body is not functioning properly, or that there is a threat to your health. It is not something you can ignore until it goes away.” She had to stop and remind herself not to lecture too severely. He was worried about his sister, so she softened her voice. “You don't need me to tell you what happens when you ignore your body's signals, do
you?” Clarence had been fighting all summer against the effects of type 2 diabetes and chronic heart failure—both due to his obesity.

“If you damage the muscles further, you'll be out of commission longer. And if you don't take the medication the way I've prescribed, you're going to have trouble, not just with your body, but with
me
.” She leaned forward and tapped his arm to emphasize her point.

He watched her for a moment. “How much weight did I lose?”

“Would you believe twenty-five pounds?”

He stared at her in disbelief. “In water weight?”

“Exactly. If you'd taken your medication the way I asked in the first place—” She broke off, once more biting back irritable words. She took a slow, deep breath, reminding herself of the pain and worry Clarence had suffered in the past two days. “I just wish you'd trust me a little more. Now, tell me about the pain. And this time, tell me the
truth
.”

He took a deep breath and looked once more out the window. “My back's killing me.”

“The muscle relaxers aren't helping?”

“Yeah, they help for a while, and then the pain comes back.”

“Then why didn't you tell me?”

“Because you'd just give me more drugs.”

When it came to macho stubbornness, Clarence held a master's degree. That was one reason for his condition right now. He refused to ask for help. Mercy and Lukas had been making house calls to the Knights all summer, and the only way either of them ever found out if Clarence was hurting was when Darlene whispered it to them.

“I don't want to be doped up all the time, Mercy,” he growled.

“I understand that, and I know how you hate drugs, but you're not in here for the fun of it. We need to keep those
muscles relaxed so they have time to heal. You don't want to keep reinjuring them, do you?”

“That stuff constipates me.”

“Then we'll unconstipate you. What about your leg?”

He grimaced. “It doesn't hurt unless I move it.”

“Then don't move it. Later, when you do start getting up and around, we'll set you up with some Ace bandages.”

He shifted in the bed, and the side rails rattled. “They won't let me get out of this bed to go to the john, so I don't move it much. If I'm good, how long before I can get out of here?”

“It's a moot question, Clarence, because you don't know how to be good. Remember that IV we had in your arm when we admitted you?”

His mouth opened slightly, and his eyes widened in surprise. “You wouldn't.”

“This time I'll stick the needle in myself. I'm not as gentle as Lauren.”

He looked away again, and his glower returned. “Fine. I could check out of here.”

She watched him in silence for a moment. Someone had washed his hair and bathed him, and the dark hair set off the pallor of his skin in spite of his usually florid complexion. “Clarence,” she said, then hesitated.

He turned his head back to look at her, and the bleak expression in his eyes and the knowledge of his situation saddened her. Beneath all of that, Clarence was a handsome, intelligent man who had always reminded Mercy of Tom Selleck.

“Have you called your family about Darlene?” she asked.

His eyes darkened, and his lips set in a straight line between his beard and mustache. “Don't even think about it.”

“I wouldn't do it without your consent.”

“You'll never get my consent, and if you knew my parents you'd know why. They never did anything but take,
take, take. They lived off the government all their lives and didn't even try to get jobs. They took advantage of so many people in our hometown that everybody avoided them. That's why Darlene and I left home and never went back. Why do you think I hate being on Medicaid and welfare so much?”

“I understand that, Clarence, but they don't even know—”

“They don't care! They won't care if she dies!” A sudden expression of shock on his face showed his inner reaction to his own words. Slowly, tears filled his eyes, and he looked at Mercy helplessly. “I can't believe she might die.”

“I can't, either.”

He covered his face with his right hand, and a silent sob shook the bed. Mercy pulled some facial tissues from the small box on the bedside stand and placed them in his left hand, then waited in silence. What were she and Lukas going to do about him? Clarence and Darlene had been recluses for the past two years. As far as Mercy knew, they had no friends. Their neighbors didn't even know them, and therefore distrusted them. That was evident when Clarence had gone to a neighbor to call for an ambulance.

It had taken some blunt conversation from Lukas to convince Clarence last spring that if he didn't start taking care of himself, he could die a slow and painful death and could also ruin his sister's health. Unfortunately, Darlene had turned out to be even more stubborn and independent than her big brother. And now Clarence was blaming himself. Even if Darlene did come out of her coma, who was going to take care of her and Clarence? Darlene couldn't even afford insurance for herself.

Clarence wiped his face and blew his nose, then laid his head back against the raised pillows and took a deep breath. “Sorry.”

“It's okay.”

“What'm I gonna do, Mercy? I was four when Darlene was born, but as long as I can remember, I took care of her. Up until two years ago, I always watched out for her, made sure she was okay. Then when I lost my job and my insurance, I couldn't take care of her anymore. She had to take care of me. How did I let it get this far?”

Mercy laid a hand across the broad expanse of his forearm. What was she supposed to say? “You're not alone, Clarence.”

 

A timid knock sounded at Lukas's call room door, and he looked around from his small work desk to find Beverly standing there—Beverly, the redheaded, hot-tempered nurse who had avoided him all summer.

Lukas turned in his swivel chair, unable to keep the surprise from his face.

She entered the small room without waiting for an invitation. “Dr. Bower, I've been thinking about the COBRA investigation.”

“Yes?”

She left the door open and stepped over to perch on the corner of the bed—the only other place in the room to sit. “I hope the investigator didn't give you too bad a time in that interview.”

Lukas shrugged. “It's her job.”

Beverly's thick red brows drew together in a frown. “Half the hospital staff is mad at me. Claudia flat-out told me it's my fault you're being investigated, and I know Lauren thinks so, too, although she doesn't say it.”

Lukas tried not to let himself hope.

“Lauren did say that she thinks the reason I've been avoiding you is because I feel guilty.” She looked at him, then looked away again. “Maybe she's right.” She took a deep breath and let it out “There. I've said it.”

But she hadn't actually said anything. “Beverly, what are you—”

“The thing is, Dr. Bower, that you scared me last spring. When you refused to give Dwayne Little the narcotics he wanted, I was upset.”

“I am aware of that.”

“But I've known, deep down, that it wasn't because I disapproved of your treatment plan. It was because I knew the Littles could hurt my future.”

“So Bailey did threaten you.”

Beverly nodded. “I'm sorry, Dr. Bower. I guess I hoped all summer that since Dwayne was killed in that car wreck, Bailey would drop everything. Didn't he realize it was morphine that caused the wreck?”

“I don't think he's able to accept the truth right now.”

“Bailey and truth have never gotten acquainted. I've never liked that man. He—” Beverly caught herself, shook her head and spread her hands. “And who am I to talk? I've tried to convince myself all summer that I was mad at you because your actions threatened the security of my kids. I was really just mad at myself because I didn't have the guts to stand up to Bailey the way you stood up to Dwayne.”

“As you told me, Beverly, I didn't have a family to support.”

A smile chased the heaviness from her face. “And I won't have to worry about that so much, either, in a couple of months.” A blush touched her cheeks.

“Oh? Did your ex-husband suddenly decide he could pay child support?” It was common knowledge that Beverly struggled to support herself and her two kids. She openly complained about it and didn't take offense at his question.

“Ha! That deadbeat?” The smile didn't quite leave her eyes. “Jacob Casey asked me to marry him.”

All right! “Cowboy? The confirmed bachelor, the Lone Ranger, Jake of the Jungle?”

The tenor of her rich laughter filled the small room. “In fact, he heard about the situation with Bailey—” She held
up her hands. “Don't blame me, I didn't give away patient confidentiality. Somebody else told him, but Jacob talked with me about it and told me I needed to do the right thing. Then he told me he would help me. He proposed.”

Lukas returned her enormous grin. “Congratulations. Somehow I get the impression that you accepted.”

“You'd better believe it! You know how I feel about his '66 Mustang.”

“You obviously care a great deal about him.” Lukas couldn't resist thoughts of Mercy. Would it ever be possible…?

Beverly nodded. “I think he kind of likes me, too, although we're going to have to work on communication. The next time he gets shot, or when he gets kicked or bitten or trampled by one of those exotic animals on his ranch, he'd better tell me before he tells anybody else.”

“Have you heard anything more about the guy who shot him?” Lukas asked. The last he'd heard, some idiot had released the guy on bail.

“He disappeared. Hasn't shown up at his house, and I hear it's going to be foreclosed because he didn't make his payments. They think he skipped out of the state.” The laughter in her eyes died. “Jacob is having trouble coming to terms with what happened. He's so softhearted and trusting, he expects everyone to be the same way. Violence doesn't fit in his vocabulary.” She slapped her hands on her knees. “Anyway, Dr. Bower, what I came here to tell you is that Mrs. Pinkley now has a filled-out AMA form on her desk. All it needs is your signature. It's already got mine.”