Solemn Oath (36 page)

“I saw it happen, and I was the first one to reach her. What's that disease Dr. Bower's talking about? Is Abby sick?”

“No, sweetie, she'll be okay. Von Willebrand's disease just means she has a condition that makes her bleed a lot. When she cuts herself, the flow doesn't stop as easily as it does with you or other normal kids.”

The shrill cry of an ambulance siren reached them, and Lauren glanced over her shoulder toward Lukas. “There's the man they called about, Dr. Bower. I can do the assessment. Tedi looks good, and I saw Buck just walk back into the E.R., so he can take her from here.”

A lot of things happened at the same time after that. Tedi saw the ambulance attendants wheel in a man who sounded as if he was choking. His breaths came in short, wheezing gasps, and his eyes were wide with fear. When Lauren rushed up to him, he reached out and grabbed her arm.

“Help me!” he cried hoarsely. “Help!”

She reassured him and directed the attendants into an exam room. “Dr. Bower, we need you stat. Where's Dr. Wong?”

The ambulance attendant walked alongside the patient, pushing the gurney, giving his report to Lukas. “Dialysis patient who had the flu, so he missed his dialysis.”

He jabbered some numbers to Lukas that Tedi didn't understand, and halfway through, the patient released Lauren and grabbed Lukas by the arm.

“Help me! I should've had dialysis, but I was sick and I didn't feel like…”

Right behind him came Abby's dad running through the double ambulance doors just before they closed. “I'm Jason Cuendet,” he called to the secretary as he ran up to the central desk. “Where's my daughter? They said she was here. Is she okay? What happened?”

The secretary pointed him toward Abby as she turned and greeted a small dark-haired man, also in scrubs, who stepped in from the other door. “Dr. Wong, thank goodness! Your patient is in One. She needs you now.”

 

Estelle Pinkley sat at her huge desk and stared out the large picture window of her office, kneading the painful hot joints and tips of her fingers. She didn't want to think about the stack of subpoenaed reports her secretary had just brought in and placed on her desk. She wanted to bask just for a moment in the golden-red autumn beauty of mature maple trees that graced the hospital lawn. She wanted to watch ninety-year-old Mrs. Robinson walk her elderly collie along the sidewalk across the street, as she had done
every day at this time for as long as Estelle had been hospital administrator.

On the surface, Knolls County appeared to be the perfect community, where families could escape the crowded cities and raise their kids to be responsible adults who voted, worked for an honest living and made enough money after taxes to send their own kids to college. Sadly, many people who moved here were disappointed. The county next door to theirs had the unenviable reputation of producing the most methamphetamine in the state. Knolls Community Hospital E.R. treated their share of addicts, to the point that Estelle had suggested to the long-range planning committee that they crunch the numbers for a future drug-abuse treatment center.

The telephone intercom beeped, and the muted alto of her secretary's voice came through the speaker. “Mrs. Pinkley, Mr. Little is here.”

Estelle sighed and dragged her attention from the natural outside beauty to the ugliness of the files before her. She pressed the button. “Please send him in.” She glanced at her watch. It was two-fifteen.

She closed her eyes and recalled the earnest, intelligent face of Dwayne Little fifteen years ago. During his parents' nasty, lengthy divorce, Estelle had watched helplessly as the sweet little boy metamorphosed into a morose, angry teenager, and then a manipulative, drug-seeking adult. She'd shed tears over his death certificate this spring. She'd watched his father, Bailey, attempt to destroy this hospital and two doctors in an attempt to assuage the pain of his own guilt. Bailey Little was a very guilty man.

The office door opened, and as Bailey stepped across the threshold, Estelle felt an unaccustomed thrill of fear at the sight of his steel-gray eyes set beneath a prominent brow. His features suggested the appearance of a bird of prey, and his combed-back hair, silver now, gave him an air of distinction. Refined danger.

But she would control this meeting.

He nodded coldly and took a seat across from her. “What are you hoping to gain from this summons?”

“Everything I need, Bailey, but it's going to cost both of us.” Before he could reply, she continued. “Your COBRA investigator, Ms. Fellows, has refused to acknowledge that our records are excellent, and I'm tired of her wearying presence in this hospital, requesting confidential patient files and treating our secretarial staff like criminals who are trying to hide something. So the first thing I want is for you to call off your pit bull.”

“I'm not—”

“Don't try to bluff me,” Estelle snapped, fixing him with her own stiletto glare. She took a fax transmission from the top of her stack and shoved it across the smooth surface of her desk. It drifted to a stop in front of him. “This was from the investigator's home office a week ago, informing her that the material she had produced was not sufficient for her to continue her search.” She didn't tell him that he had a snitch inside his own office, and that she knew about the faxed copies of that same confidential hospital material in his possession. “I also have data linking you to Ms. Fellows last year, when she was your client.”

“That information is confidential!”

“Of course it is. Your previous association with her worried me, and so I had my own investigator dig a little deeper.” She picked up copies of microfiched bank transactions. “Amazing what a subpoena will do. I found a few inconsistencies between her salary and her deposits. Cash deposits. Bribery is illegal, Bailey, whether you want to acknowledge that fact or not. She will lose her job as soon as I have enough evidence in my hands, because I've already spoken with her supervisor.”

Anger darkened Bailey's eyes. His physical reaction to anger had always been his biggest weakness when he'd locked horns with her in court.

“Because Ms. Fellows has been so persistent in wasting federal money,” Estelle continued, “and because you saw fit to advertise the investigation to the public, I decided it was time to do a little detective work of my own. You know how I love to research a good meaty case. Since Knolls Community Hospital is a not-for-profit enterprise, and the public supports us, how is it going to look when that same public finds out that the esteemed Bailey Little was the one who reported faulty information to COBRA about us in the first place?”

“Harvey won't print unsubstantiated rumors.”

“He'll print my open letter to the citizens of Knolls, or he'll have a lawsuit on his hands for printing yours,” Estelle snapped. “And I'll be writing the grandmother of all letters to the editor, and none of the sidestepping verbiage you used to stir up dissension against us. In that same letter, I will reveal the results of my research into RealCare, whom you advertised in your open letter as a strong, growing company with good ethical standards.” She pushed another sheet toward him. “You probably aren't interested, but their employee turnover rate is three times higher than ours here at Knolls. My investigation has shown that the majority of employees are unhappy there, with concerns ranging from poor quality of patient care to overly regimented work hours to low pay and miserable employee benefits. Even more interesting, and more frightening, is the fact that the mortality rate for their patients is twice as high as the national average.”

Bailey snorted. “What did you do, interview an ex-employee?”

“Would it surprise you to know that fifteen of our present employees, who are happy, dependable workers, came to us from RealCare facilities? I did not receive a single good report on RealCare from any of them.”

“What did you expect, Estelle? Most ex-employees are unhappy with their previous place of employment.”

Estelle slid another sheet across and waited for him to pick it up. He didn't. “This is a report from Dorothy Wild, our quality assurance director, who has been a proponent of yours many times in the past. I had her do a QA survey of our patients who have had experience with RealCare. The ratings that came back just yesterday were deplorable. In every health-care facility purchased by RealCare, the patients developed a lower perception of care over the period of a year. The doctor-patient ratio grew worse as physicians left the system and were not replaced. Don't you want to read the information, Bailey?” she asked as he refused to acknowledge the paper before him. “Afraid you'll see something you don't want to see?”

“No, actually, Estelle, I'm waiting for you to finish with the propaganda and get to your real agenda. What did you drag me here for?”

Estelle smiled pleasantly. She and Bailey had been opponents far too long. He knew her well. “Did you know that COBRA is investigating RealCare?”

He showed no surprise. “Welcome to the club. As you have seen here, that means nothing.”

“Maybe in RealCare's case it does. Apparently the preliminary investigation uncovered some compromising information, because reinforcements have been called into the Springfield facility. They could be shut down.”

Bailey held her gaze with the eagle-eyed stare for which he was famous. “You haven't answered my question yet. What am I doing here? If you expected me to buckle beneath these petty little threats…” He waved a hand dismissively at the sheets in front of him.

Fighting a wave of sorrow, Estelle met his stare and held it for several seconds, long enough for him to read what lay behind her eyes.

His face tightened, and he leaned back. “What is it?”

 

As people rushed from room to room and doctors worked and nurses helped and the telephone rang and more patients came in, Tedi knew that she would not want to be an E.R. doc. She watched Dr. Wong working over Abby in one exam room. Lukas was working on the man who'd come in by ambulance in the next room. Tedi was alone right now, but she knew Mom would be here any minute.

“What are you doing?” Mr. Cuendet cried to the doctor from the side of Abby's bed. “She's still bleeding!”

“Mr. Cuendet, if you can't control yourself, I will have to ask you to leave,” Dr. Wong said as he turned toward the nurse who was helping him. “Claudia, we need to get her into surgery.”

Mrs. Cuendet came racing through the E.R. door and saw her daughter immediately. “Abby, oh no, Abby,” she whispered as she rushed forward.

Mr. Cuendet reached out and stopped her before she could get to the bed. “Lindy, they're taking her to surgery. They've had trouble getting the bleeding stopped.”

“Let go of me!” She jerked from his grasp and rounded on him with fury in her eyes. “You didn't need me before, and I sure don't need you now.” She turned her back on him and rushed to the bed. “Abby? Honey, I'm here. Everything's going to be okay.”

“Tedi?” The calm, loving voice startled Tedi. She looked up to find Mom standing at the entrance to the room, her face pale. But she was smiling.

“Mom.” Tedi couldn't help it. Everything became too much. Tears rushed to her eyes and spilled down her cheeks, and she reached up like a little kid for her mother's embrace.

E
stelle picked up a file folder that contained copied sheets of medical charts. Labeled on the front was the name of their nearest E.R. neighbor to the south. She stood up and personally carried the file around the desk to Bailey.

She held it out to him and waited for him to take it. “I had hoped, Bailey, that it wouldn't come to this.”

His eyes narrowed. “What are you trying to pull this time?”

“This is one of seven files from hospitals in this region. It's about Dwayne. Read it.”

He took it at last, and Estelle walked back around her desk and sat down heavily. Dwayne had visited every hospital emergency department within a seventy-mile radius of Knolls. He did it in pursuit of pain medication—not just once or twice, but several times, until the personnel in each hospital grew suspicious.

As Bailey read, the color that had suffused his face now drained away.

“I could have done this sooner to protect the hospital,” Estelle said softly. “Your son was a drug abuser, very likely an addict, and Dr. Bower picked up on that. He suggested that Dwayne needed to be in a drug-rehab program. He offered alternative medication. He did everything accord
ing to COBRA protocol. Lukas Bower is above reproach.” She stood up and scooted the remainder of the files across the desk. “It's all there. You can't hide from the truth any longer.”

He did not look up or acknowledge her words in any way.

She sank into her seat once more, feeling no satisfaction. Her sorrow increased. This was the right thing to do. She had to keep reminding herself of that.

She turned in her seat to stare out the window as Bailey read. Now she saw no beauty or comfort in the sky or trees or sculpted lawns of the neighborhood. She listened to Bailey's measured breathing, which grew louder as he read, then caught for a couple of seconds as if in wounded shock, then grew shallow, as if every breath caused deeper pain.

It had always struck Estelle as ironic that her chosen profession as an attorney was supposed to define the search for truth. She had spent her working days in just that manner, searching for the facts of a case, presenting those facts, and then allowing the impact of them to speak for her. It had saddened her early in her career that many of her colleagues, most notably Bailey, spent their time trying to coerce the facts to take on new meaning, as if the truth needed to be rewritten. But there was too much truth in these medical files to be manipulated, and this time Bailey could not threaten or bribe or blackmail his way out of it.

Estelle dragged her gaze from the window to look at Bailey again. That was when she caught it—a faint whiff of smoke. She frowned and glanced once more out the window. Someone could be burning leaves, but outside smells never reached her past the triple barrier of sealed windowpanes and granite and insulated wall. Besides, this was a smoke-free facility.

She shot another look at Bailey, his head still bowed, his face pale as he read. He had given up cigars ten years ago after a judge caught him puffing on one in a courthouse and
threatened to have him permanently removed from the premises.

With a deepening frown, she placed her hands on the leather armrests of her chair to raise herself. She heard the crunch of leather as the smell of smoke grew stronger.

Before she could stand up, a loud, intermittent
buzz-buzz-buzz
stridently burst through the room from overhead speakers.

At first she couldn't believe what she heard. The only time that obnoxious sound had come through this office was during fire drills. But there were none scheduled. And she definitely smelled the smoke.

“Bailey, that's the fire alarm. We need to—”

The sprinkler system spurted a few drips of water over the top of the desk in warning before it broke into a twisting spray, dousing Estelle and Bailey as they both scrambled out of their seats. But before they could reach the door in the downpour, they heard a clap of thunder so intense it shook the room.

The floor shifted, the window shattered and Estelle's heavy desk jerked toward the back of the office as the floor beneath them buckled to the right. More smoke reached them, and they recognized the thunder for what it was—an explosion.

Bailey stumbled and fell hard against the wall. A heavy chair rolled toward him and struck him from behind, knocking him forward and pinning him. Estelle reached for him. The floor shifted again, and he slipped from her grasp as the desk crashed against her. The floor opened, and Bailey's legs fell through.

He turned terrified eyes toward Estelle. “Help me!” He reached for her, but the bucking floor knocked her sideways, forehead-first into the desk. For her, everything went black.

 

The alarm on the non-invasive ventilator—Bi Pap machine—beeped, went silent, and then beeped again as the
floor rocked with the force of an earthquake and the atmosphere pulsed with a
Boom!
from somewhere in the vicinity of the maintenance room below them.

Lukas grabbed at Mr. Weston, his emergency dialysis patient, to keep him from toppling out of the bed.

Patients screamed and staff shouted, and the faint smell of smoke was quickly overpowered by fear as the ceiling buckled and dropped two feet on the eastern side of the department, scattering debris over Lukas and his patient.

A voice reached Lukas over the frightened cries of his patient. It was a man shouting orders for evacuation to the staff. It was Buck. “Claudia, get the ambulatory patients out the front and into the far parking lot. Carol, empty the waiting room now! And take your cell phone. We may need it. Dr. Mercy, can we use your clinic? It's the closest, and these patients need a place—”

“It's open,” came Mercy's suddenly strong, authoritative voice.

“But, Mom, what about Abby?” Tedi cried. “She's still in surgery.”

“They'll get her out, Tedi. Let's go. Mrs. Lamberson, come with us. Come on, everybody. If you walked in here, you can walk out. We can take care of you over at the clinic.” Her voice receded as she led others out.

Lukas felt a rush of relief. She and Tedi would be safe.

Mr. Weston gripped Lukas with his free hand. “It's going to collapse on us!”

Lukas reached down and squeezed his patient's shoulder. “It's okay. I'm not going to leave you. Please try not to panic, Mr. Weston. I need you to stay calm.” He reached out toward the wall at the head of the bed and grabbed a nonrebreather mask, ripped it out of the package and placed it on the patient's chest to use when he detached from the electricity to move him. He attached the mask to the oxygen tank on the chassis of the bed.

There was a sound of glass breaking, then Buck appeared in the doorway with a fire extinguisher in his hands. He had automatically switched to fireman mode. Lukas could see it in his eyes. “Dr. Bower, we've got to get you out of here.”

Another rumble roared through the department, and someone called out, “Fire! I see fire!” Lights flickered and went out, plunging the E.R. into twilight as only the afternoon sun filtered in through the windows and entrance doors. Two battery-pack emergency floodlights came on in the department, but they barely reached the exam room. Lukas looked back toward the doorway, but Buck wasn't there. Seconds later came the blast of the extinguisher.

Mr. Weston cried out through the mask of his Bi Pap machine. “What's happening? The machine went off! I can't see anything! I can't breathe.”

“I know. I'll take care of it.” Lukas pulled off the mask that covered the patient's face, then replaced it with the nonrebreather mask he had just hooked to the oxygen tank. He turned the oxygen tank wide open. “Keep breathing, Mr. Weston. Please try to stay calm.” He grabbed the monitor from the top of the crash cart and set it on the foot of the bed.

The thin line of a light shot through the room. “Dr. Bower!” Lauren's frightened voice reached him from the dimly lit area of the hallway. “Here's a flashlight. Can I help?”

“Yes, we've got to get out of here. Have you evacuated the rest of the patients?”

“Yes, everybody's out.”

Lukas choked on the smoke that gradually thickened the air. “Grab a crash cart and—”

Another rumble shook the floor, and plaster scattered on them from the ceiling. “Hurry, Lauren! I'll bring Mr. Weston.” He kicked the brake on the wheeled bed and turned to push the patient out of the E.R. behind her. “If
Carol has that cell phone, we need to use it. We need to airlift him.”

“She's already calling. Rescue workers are on the way. Buck is afraid the main oxygen supply in respiratory therapy might be in trouble.”

The front right wheel of the bed caught on fallen debris and jerked to a stop. Mr. Weston moaned while Lukas pulled backward, rerouted and pushed forward again. If the main supply in respiratory therapy was affected, it could blow the whole side of this wing into the clouds. If they didn't get away from here in time, they could go with it.

Lauren rolled the crash cart forward and pushed open the double doors that led into the patient parking lot. “Do you want to take him to Dr. Mercy's clinic?” she asked as she pushed the cart out into the ambulance bay. “We're taking as many patients as we can get over there.”

“Not if we can get a chopper to land at the end of the parking lot. This patient needs to fly now.” As they stepped out into the parking lot away from the dust, smoke and rubble, Lukas felt a wash of relief. They pushed their patient and equipment to the far end of the long lot and turned to find staff and patients filing from all the doors in the hospital. They were following evacuation procedure.

“What's the hospital census?” he asked Lauren.

“I think about thirty patients upstairs, two in ICU.”

“Park the crash cart here.” Lukas stopped at the helicopter landing site and turned back to his patient. “Lauren, we have to intubate.”

She pushed the cart up beside the bed in the bright sunlight and nodded. She pulled a syringe and two medicine vials out of her pocket. “I already prepared.”

As the screams of sirens converged on them from three different directions, Lukas thanked God silently for a good nurse.

 

Mercy raced through her waiting room and offices, pushing open exam room doors, warning patients to reschedule. Tedi followed close behind. A disaster had been called over the hospital intercom, and the clinic was closest. They were bringing the patients here, where the doctors and staff would do their triage. Carol, as well as every other able-bodied adult, was helping to transport patients.

Josie and Loretta worked well in tandem as they led the patient influx. Mercy turned to direct Claudia and Carol to wheel their patients toward the exam room at the far end of the clinic.

Claudia pushed through with a woman in her seventies who looked pale and frightened. “It'll be okay, Mrs. Davis. We'll get that stomachache taken care of over here.” She stopped in front of Mercy. “We were just getting ready to give her a GI cocktail. If you want to tell me where your stash is, I'll see if I can't take over with the patients they bring over here.”

“Thank you, Claudia.” Mercy wanted to hug her. After giving the seasoned nurse the keys to the drug supply, Mercy gave the E.R. secretary instructions to get on the telephone in her office and call for backup physicians.

“Mom,” Tedi yelled from her place at the front desk, “what about Abby? She's still in surgery! I've got to go find her.”

“Oh, no you don't! You sit right there and help out where Claudia needs you. They'll be bringing a lot more patients in here, and I want you here, out of the way of danger. I'll make sure Abby's okay, but knowing Dr. Wong, you'll see Abby any time.”

The front door opened again, and respiratory and lab technicians came rushing in with more patients. “Dr. Mercy, where do you want these?” Carol asked from the hallway.

“Take them to Claudia. Is the outpatient area being evacuated?”

“Yes, just look at that mess out there.” Carol gestured toward the large front windows, where the blinds had been pulled back to reveal the scene in vivid detail down the street. The patient and employee parking lot, which formed an L around two sides of the hospital structure, was rapidly filling with emergency vehicles, lights flashing, rescue workers running to their designated stations. In the center of the milieu, Mercy caught sight of Lukas and Lauren working over Mr. Weston. Lukas, at least, was safe.

Smoke that billowed from a collapsed section of outside wall between the respiratory department and E.R. was confined to that part of the hospital wing. Mercy felt the real problem would lie in getting all those sick patients down from the second floor. Rescue workers would have to carry the disabled ones down the stairs with stretchers, since they couldn't use the elevators.

“Look, Mom, there she is,” Tedi said, pointing toward the side door closest to the O.R. Dr. Wong stepped out, accompanied by Abby's mother and father, and a nurse and a tech behind them, who pushed a gurney with Abby's skinny little body lying on top, draped in a sheet and still hooked to an IV.