Solemn Oath (3 page)

“Judy, get a chopper on standby,” he called over his shoulder as he and Connie transferred Alma to the exam bed. “And let Lab know we've got stat blood work for them.” He turned to Lauren, who had come in behind them. “Start another IV, and draw blood for a stat trauma panel.”

Alma's pupils reacted briskly, and her breathing, though
a little fast, was even. Her eyes remained open after he checked them. She moaned again, and Lukas bent toward her. “Mrs. Collins, I'm Dr. Bower, the E.R. physician here.” Because Connie's businesslike manner could sometimes make a patient feel cut off from human support, he injected even more tenderness than usual into his own voice. “Can you hear me?”

Physical pain etched itself in the lines of the woman's face. Her eyes filled with tears. “Yes…Hurts bad…Can you help me?”

“Yes. I'm sorry, but I need to do a quick check and ask you some questions. Do you have any drug allergies?”

She attempted to shake her head.

“Please don't move your head or neck until we know how badly you're hurt. Just tell me yes or no.”

“No.” Her voice shook with the effort to control her reactions.

“Good. I know your right leg hurts. Do you have pain anywhere else?”

“My head.” Her chin quivered. “I think I hit my head.”

“Were you knocked out?”

“I think so. Arthur?” She stretched out the fingers of her right hand as if to free herself, but she was constricted by the backboard. “Where's Arthur? Is he okay?”

“I haven't checked him, but he seems to be doing okay. Do you hurt anywhere else?”

“I can't tell.” She grimaced. “My leg hurts so bad. Please!”

Lukas turned to find Lauren securing the second IV tube with tape. “Get me a pressure, and if that's okay, give Mrs. Collins 2 milligrams of morphine, slow IV push. And add 12.5 milligrams of Phenergan. I don't want to risk the morphine nauseating her.” He looked at the open tib-fib fracture just below the knee, then moved down to look at Alma's right foot. He still didn't like what he saw. It was cool to the touch, white, and when he checked for a pulse on top of the foot, he found
none. The capillary refill was very sluggish. He had to get this woman to a vascular surgeon fast if he wanted to save her leg.

Lord, guide me. Touch her through me. Give her the comfort I can't.

He stepped to the hallway and called, “Judy, launch that chopper, then order me a c-spine, chest, pelvis and right tib-fib and ankle X-rays. Have you heard from Dr. Richmond yet?”

“Yes, she'll be here shortly. She said she had to finish with a really sick patient.”

Lauren straightened from Alma's bedside. “Dr. Bower, the pressure's good. Want me to do the morphine?”

“Yes. Run the second IV at 200 cc's per hour. I want her kidneys well hydrated to prevent damage. I'll be back in a moment. I need to go check on her husband.” He called out to Claudia to help him and stepped into the next room, where the techs and Connie were transferring Arthur from cot to bed.

Arthur, too, was on a long spine board, with a c-collar and head blocks to keep him as immobile as possible. Blood had seeped through the gauze and Ace bandage the attendants had used to stop the bleeding from an obvious scalp laceration.

Claudia, chunky and motherly and expert with patients, stepped into the room behind Lukas and immediately began her assessment while Lukas talked to the attendants.

“Connie, you said there was a lot of blood loss. How much would you estimate?”

“At least a unit, maybe two,” came the paramedic's monotone again. “The first responders said he wasn't answering their questions, but when we arrived he was alert and oriented and asking about his wife. He grew very agitated when he saw her leg. His pressure was a little low, but it came up with a fluid bolus.”

Claudia turned from her assessment and nodded. “BP's 122 over 79, heart rate's 110.”

Lukas nodded. Not bad. “Okay, get me a second IV.” He stepped to the head of the bed and introduced himself to Arthur Collins.

“How's Alma?” the man asked. “My wife…she looks so bad. She's—”

“She's very worried about you,” Lukas said. “We've given her morphine to help control her pain, and we're running tests now to assess her injuries. How about you, Mr. Collins? Where do you hurt?”

The man closed his eyes for a moment, as if trying to focus for a few seconds on his own symptoms. “Call me Arthur. We're Arthur and Alma. My right shoulder and my scalp took a beating, but please take care of Alma first. Her leg looks so bad, Dr. Bower. Can you help her?”

“We're going to fly her to Springfield for vascular and orthopedic surgeons to take care of her. I've already ordered an Air Care helicopter.” Lukas took out his penlight. “I'm going to check your pupils right now.” He shone the light into the man's worried eyes. “Are you having any trouble with blurred vision?”

“No.”

“Nausea or vomiting?”

“No. When will the helicopter be here?”

Lukas turned off the light and put it in his pocket. “Shouldn't be too long, less than thirty minutes. Arthur, it's very important that I know if you're having any nausea. We have you strapped down and on your back, and that can spell trouble if you're sick. We don't want to risk letting you develop aspiration pneumonia.”

“I had a little trouble before I got here, but I'm fine now.”

Lukas studied the man's expression for a moment, trying to decide if he was just trying to divert help and attention back to his wife. “Have you eaten?”

“No, Alma and I didn't get a chance. Where are you taking her in Springfield?”

“Cox South, unless you have a preference.”

“Cox is fine. Is there room for me in that helicopter?”

“I'm sorry, Arthur, but we'll need to keep you here for a while.”

Lukas turned to Claudia and ordered blood work and X-rays. “Are the other patients here yet?”

“Yes, they came in just a couple of minutes ago. Lauren didn't want to leave Alma, so a nurse from upstairs is doing the new assessments. They don't look too bad.” She leaned toward the patient and placed a hand on his uninjured shoulder. “Mr. Collins, the people from your tour group are here, and they asked us to tell you they're holding a prayer service out in the waiting room.”

Some of the tension left Arthur's face, and he sent her a grateful half smile. “Thank you. Will you tell Alma? And, Dr. Bower, will you let her know I'm fine? She worries about me so much.”

“Apparently the feeling is mutual. I'll reassure her.” Lukas squeezed Arthur's arm, then went back into Trauma One to find the X-ray tech setting up films, and Lauren taking Alma's blood pressure again.

“She's doing better, Dr. Bower.” Lauren glanced at the clear plastic bag hanging from the IV pole. “But she's still in a lot of pain. Her blood pressure is okay, and she's responsive. The liter of fluid is almost in.”

“Cut her rate down to 50 cc's per hour—just enough to keep the IV open. That'll hold her until she gets to Springfield. Keep the second IV at 200 cc's per hour.”

The X-ray tech slid a cartridge into the Stryker bed, which was a newly purchased, state-of-the-art setup for the trauma room. “Dr. Bower, I'm ready to shoot.”

Lukas and Lauren stepped out of the room while the tech shot the films, and from the hallway they could see the
bustle and activity of a suddenly full waiting room and ambulance bay. As Claudia had said, a group of casually dressed people stood in a circle in the corner of the waiting room and held hands, heads bowed.

The EMT from the Collinses' ambulance passed by them in the broad hallway, saw Lukas and stopped. “They brought in the drunk driver who hit everybody, Dr. Bower. He's crying, talking to everybody who walks by, but nobody knows what he's saying. Sounds like he's speaking Spanish. The police are here, and they're itching to haul him in. They're really ticked.”

Lukas shook his head. “They can't have him until we've checked him out, and that'll be a few minutes. We'll need an interpreter. I'll ask Judy to call one in.” He turned to Lauren. “Repeat Alma's morphine dose, two milligrams every five minutes, and let me know if her pressure drops or if she develops depressed respirations. And tell her Arthur is okay.”

Lauren nodded. “I'll reassure her.”

The tech left the room, pushing the portable X-ray machine.

As Lauren went back in to recheck Alma, Lukas walked to the central desk. “Judy, would you please call a Spanish interpreter?”

“Did it already,” Judy said without looking up from her keyboard.

He reached into a drawer and drew out a consent form for Arthur to sign so they could transfer Alma. “Has the chopper called yet?'

Judy's fingers still didn't break stride. “No, but I should hear from them any time.”

“When they call, let them know her vitals are stable, but she has a class-one limb threat to her right lower extremity.”

No answer. The sound of the clattering keyboard stilled suddenly.

He glanced up to find the secretary staring toward the entrance, and when he looked, he saw Jacob Casey—Cowboy to most of the citizens of Knolls—come stum
bling through the glass doors, aided by an older man in bib overalls. Somewhere, Cowboy had lost his hat.

“Oh no, not again,” Judy said softly.

Lanky, weathered Cowboy was such a frequent visitor in this E.R., Lukas wondered how the forty-three-year-old man had survived his occupation. He'd been kicked, gouged, bitten and knocked senseless on that exotic animal ranch of his—he believed in personal contact with his bison, zebras, lions and whatever else he raised on his three hundred acres of reinforced paddocks. Scars on several areas of his hard-bodied frame attested to his dedication.

Today blood covered Cowboy's upper right arm and splattered his chest and back. The left arm of his long-sleeved denim shirt had been ripped off and tied over his upper right arm in a crude attempt at a pressure dressing.

Lukas pushed back from the desk and got up to help. “Cowboy, what happened this time?” He took a closer look at what appeared, surprisingly, to be a bullet wound. “Has Leonardo started bearing arms?” Everybody knew the rancher wouldn't touch a gun.

Cowboy shook his head as he allowed his helper to transfer his leaning weight to Lukas.

“The neighbor shot him,” the farmer said. “He chased Cowboy clear out of the woods into my field with a rifle. I saw it myself. Didn't take the time to call the sheriff. Guess we oughta call him now, huh, Doc?”

“No need, the police are already here doing an accident report. Would you please go tell them about this? They'll want to check it out and take your statement.”

The man nodded, then patted Cowboy on his bare good arm. “Don't you worry, Jake, I'll take care of it.”

Lukas helped Cowboy to exam room five. “How many times did the guy shoot you?”

“Once.” Cowboy grunted as Lukas lowered him to sit on the bed. “Lost some blood. The guy's crazy.”

“Is that the one who moved onto that farm next to yours, then started complaining about the smell of the animals? I heard about him.” Lukas removed his patient's shirt and then helped him lie back. “How much blood do you think you lost?”

“Maybe a pint.” Cowboy's deep voice thickened with pain as the shirt came off. “No time to measure.”

Lukas stepped out into the hallway and called for a nurse, then returned to the bedside. He made a quick check of airway, breathing and circulation, then listened to Cowboy's heart. Not bad, a little fast, but understandable under the circumstances. The left wrist had a strong pulse, and the fingers were warm and healthy.

When the relief nurse from upstairs stepped into the room, Lukas gave immediate orders for an IV and a trauma panel, then repeated his check on Cowboy, this time on the arm that had been shot. To his relief, it looked good. “Okay, Jake, I'll regret this, but give my hand a firm squeeze.” He braced himself for the man's well-known iron grip, but it didn't come.

Cowboy grimaced again, the lines of his face deepening as his color faded. “Hurts to squeeze. Is it bad?”

“Not as bad as it could have been.” Lukas pulled on a pair of sterile gloves and reached for a packet of 4x4s. He removed the makeshift bandage and saw no active bleeding. He found the entrance and exit wounds. “What did he shoot you with?”

“Looked like a .22 rifle, almost point-blank. Just up and shot me in cold blood, the same way he did—”

A young steel-faced policeman pulled back the curtain and stepped into the room. “Dr. Bower? Do you mind if we interrupt? The sooner we talk to Cowboy, the faster we'll be on the guy's trail.”

Judy came in behind the policeman. “Dr. Bower, we just got a call from the fire department. They're bringing in two more patients.”

Lukas shook his head in frustration. The day was exploding like popcorn in a microwave. Why did everything have to happen at once?