Stress Test (16 page)

Although it was broad daylight, in the midst of a busy hospital, Matt still found himself looking over his shoulder. One kidnap attempt had gone awry, and two men with guns had failed in an attempt to kill him. But he remembered his mother saying that most things come in threes, and he wanted to take no chances.

Matt decided to hide out in the surgeons’ lounge until it was time
to start his shift in the ER. By this time of the afternoon, most surgeons had finished their morning cases and were back in their offices, seeing post-op and pre-op patients and probably working their way through a mound of paperwork between appointments. Matt had loved the patient contact, the sense of satisfaction when he made a particularly difficult diagnosis, performed a bit of surgical magic, even saved a life. But the ever-increasing regulations, the morass of forms, the constant battle with insurance companies and the occasional attorney had helped make his decision to leave private practice easier.

He realized there’d be the same problems in academic medicine—the paperwork and hassles wouldn’t go away—but he’d hoped there’d be more structure, maybe even more free time as he shared call with his fellow faculty members.

Matt had hoped that the change would please Jennifer as well. But now she’d disappeared from his life, taking with her any chance of a deeper relationship, maybe even marriage. As these thoughts rolled through his mind, the cloud of despair hovering over him since he awoke in that ICU room returned with a vengeance. If there was no Jennifer in his life, why had he—

His cell phone buzzed in his pocket. The caller ID was no help—private name, private number. Matt thumbed the button. “Dr. Newman.”

The connection was poor, with static overriding some of the words, but the voice was unmistakable, and Matt felt a smile playing around his lips when he recognized it. “Matt, it’s Joe. I heard what happened to you. Are you all right?”

“Where are you?” Matt asked. “I thought you were somewhere in the Amazonian jungle, and as best I recall, there aren’t a lot of phones or cell towers there.”

“Home base sent word to a nearby missionary via his amateur
radio that my brother had been injured and was in trouble. It’s taken me a few days to make it to a phone, but the bonus is that I get to take a hot shower and sleep in a real bed while I’m here.”

“Oh, man, is it good to hear your voice,” Matt said. “I had a head injury, but I’m recovering. The real bad news is that somehow, the police suspect me of murder, but I have a good lawyer working on that.”

“What? What happened?”

Matt filled him in. It helped him organize things in his mind as he related them to his brother.

When Matt finished, Joe said, “I’m glad you’re recovering from your injury. I know it must be tough, being unfairly accused. All things considered, how are you holding up?”

Matt took a deep breath. “If you’re inquiring about the state of my psyche, I’m hanging on. As for my soul, I’m not sure. I think maybe God’s mad because I’ve been ignoring Him for the past few years.”

“God doesn’t work that way. Even when you’re ignoring Him, He’s not ignoring you. And I’m sure He’ll be glad you’re getting back on speaking terms.” Joe’s laugh was like a tonic to Matt. His brother had always been able to get him through even the darkest times. Joe managed to hold it together and help Matt do the same when their parents died in a plane crash. “We’ve still got each other. And we’ve got God,” Joe had said. Matt needed that assurance now.

“Would it help if I came back to the US?” Joe said. “The Mission Board would probably approve an emergency furlough.”

Matt had thought about this and reached the hard conclusion that Joe’s physical presence couldn’t help. “No, there’s not really anything you can do if you were here, but I’m glad you called. And there is one thing you can do for me while we’re talking.”

“Name it, little brother.”

Matt looked around to make sure he was still alone in the surgeons’ lounge. “Would you pray for me?”

“I’ve been doing that ever since I got the news,” Joe said. “But one more time won’t hurt.”

Matt bowed his head, closed his eyes, and felt himself relax as he heard his brother’s voice, from five thousand miles away, lifting him up and asking for strength, peace, and grace in the midst of trials.

The cell phone was almost lost in the massive hand of Detective Virgil Grimes. “Yes?”

The detective looked around the squad room, but none of the few people there seemed interested in his conversation. He listened intently for a few minutes, then responded, “No, nothing new. What we have is a dead woman in the trunk of Newman’s car, with his wallet under her. His story’s thin, but there’s nothing so far to disprove it.”

The response was louder this time, and Grimes was torn between moving the phone away to spare his eardrums and leaving it tight against his ear for privacy. Privacy won. He received his orders silently and without any display of emotion. “Got it. I’ll look harder.”
And if
I have to be a little creative with evidence, I can do that
.

The voice on the other end of the phone spoke a few more words, and Grimes nodded. His response was almost a whisper. “I understand.”
You want Matt Newman to go down for murder
.

The detective shoved the phone into his pocket and left the squad room. He had work to do.

TWELVE

Matt was well into his ER shift when a nurse stuck her head through the door. “Dr. Newman, we need you in Trauma One stat!” The words weren’t spoken loudly, but there was no mistaking their urgency.

Matt hurriedly covered the area he’d just sutured with a sterile gauze pad. “You’ll need to see your doctor in about a week to have the stitches removed from your arm. Call him or us if the wound gets red or starts oozing pus.” He turned to the LVN assisting him. “Will you finish putting on the bandage and give Mr. Tomlinson instructions?”

He didn’t wait for an answer. Matt strode to the door, stripping off his gloves as he moved rapidly toward trauma room 1. As he went through the door, Matt took in the scene with a practiced glance: two EMTs, a nurse, and an aide surrounded a patient lying on the ambulance stretcher. The unresponsive man’s face was streaked with blood from an oozing cut above his eye.

“What have we got?” Matt asked, moving beside the patient.

The lead EMT answered. “Thirty-nine-year-old male ran his car into a concrete abutment on I-35 at high speed. Police think he
fell asleep. When we got him, he was shocky, breathing hard. EKG looked sort of funny. Wondered about a heart—”

“Let’s have a look,” Matt said. He nodded with approval at the two IV lines already in place, the oxygen mask on the patient’s face. The monitor displayed low-voltage EKG complexes.

A quick neurologic exam told Matt there was probably no serious brain injury. On the other hand, the heart situation . . .

Matt first noted the fullness of the veins in the young man’s neck. The recorded blood pressure was low. Two-thirds of Beck’s triad already. He pulled his stethoscope from around his neck and listened to the patient’s chest for a moment. Matt held his breath and concentrated. No question. Decreased heart sounds. Three signs out of three. Cardiac tamponade. Bleeding into the fibrous sac that surrounded the heart. A true medical emergency.

Untreated, continued bleeding would press on the heart like a giant hand grasping that life-giving organ, squeezing it to death. Matt had to relieve that pressure, and fast.

First get the blood pressure back up
. He spoke to the nurse. “Put a vial of Dobutamine in 250 milliliters of saline and piggyback it to his IV. I’ll adjust the dosage in a moment.”

Matt turned to the lead EMT. “One question. Was the air bag deployed?”

“Funny thing. No, it wasn’t. I wondered about that.”

“Some people disconnect them,” the second EMT added. “Think they might do more harm than good.” He shook his head.

“This patient has cardiac tamponade. We need to get a cardiac surgeon here stat,” Matt said. The aide hurried away to make the call. “Meanwhile, let’s intubate him.”

Matt hadn’t put an endotracheal tube into a patient for a while, but was pleased to find that he hadn’t lost his touch. The tube slid
between the man’s vocal cords and into his windpipe on the first attempt. When he had the airway secured, Matt said, “Let’s hook him up to the respirator.”

“How’s his blood pressure?” Matt asked. The EMT turned the monitor slightly so Matt could see it. The pressure had dropped further. “Speed up the Dobutamine drip.”

The oxygen saturation, measured by the pulse oximeter on the patient’s finger, was low despite the pure oxygen being delivered under pressure. The man was being smothered by his heart’s inability to pump blood throughout his body.

The phone in the corner of the room rang, and the nurse moved to answer it. She listened for a moment, hung up, and turned to Matt. “The cardiac team is tied up with another emergency case. It may be half an hour before someone can shake loose.”

“That’s too long.”
Well, I guess it’s up to me
. “We’ll need to do an emergency pericardiocentesis.”

“Don’t you want a chest film?” the EMT asked.

“Sure. I want a chest film, an echocardiogram, and a cardiologist standing beside me. But we don’t have time for any of that.” Matt nodded toward the patient. “This man is dying.”

The group went into action, and in a moment Matt looked down at the bared chest of the young man, bronzed by antiseptic, outlined with sterile green draping sheets. There’d been no time to run to the hospital library and check his knowledge of a procedure he’d never performed and only seen two or three times. The ER secretary was trying to locate a thoracic surgeon, a cardiologist, anyone who could help, but right now this was up to Matt.
Welcome
to ER medicine
.

After injecting a local anesthetic, Matt used a scalpel to make a small incision under the breastbone.
Careful. Just enough to let the
needle slide in easily
. With his gloved hand, he took a large syringe from the instrument tray, attached a long needle, and loaded it with a bit of sterile saline.

“Do we have an electric lead with an alligator clip? I need to put it on the needle and link it to the EKG,” Matt said. No one could find one.

Great. Well, there was one more option. Matt turned to the nurse and the EMTs. “Are you familiar enough with EKGs to tell me if the ST segments start getting higher?”

“I am,” said the nurse.

“Yes,” replied both EMTs.

“That’s the only warning I’ll have that my needle is touching the heart. If that happens, sing out loud and clear.”

Matt paused with the needle tip poised against the man’s bare chest.
Please, God. Give me this one
. Slowly he inserted the needle, working to maintain a forty-five-degree angle, aiming at the patient’s left shoulder. Every few millimeters, he pushed the plunger and injected a few drops of saline, just enough to keep the lumen of the needle clear. He needed to insert the needle to a depth of about two inches. Wasn’t he there yet? It seemed like he should be.
Maybe distance
is relative when the target is a beating heart
.

Matt pulled back on the plunger. Nothing. He advanced the needle a bit farther—and blood swirled in the saline remaining in the syringe.

“ST elevation!” Three voices rang out in unison.

Immediately Matt pulled the needle back a bit.

“EKG’s back to normal,” the nurse said.

“Thanks.” Matt advanced the needle again, a millimeter at a time, and with each movement he felt his gut tighten. Once more he pulled back on the plunger of the syringe. Blood, darker than the
bright blood of a moment ago, began to flow into the barrel of the syringe. He was in the pericardial sac, and it was filled with blood.
You got the diagnosis right, Matt. Now help the man
.

When the syringe was full, Matt handed it off and attached a fresh one. “What are his vital signs like?”

“Blood pressure is going up,” the nurse reported.

Matt repeated the aspiration twice, pulling the needle back once more when the EKG changes showed he was touching the heart again. “Now how’s he doing?”

“Vital signs looking better. Oxygen saturation back to almost normal,” the nurse said.

“You guys need me down here?”

Matt steadied the needle in place before he looked at the doorway. The speaker was a cardiac surgeon he recognized. “Glad to see you, Lonnie. I’ve just done my first pericardiocentesis. Let me tell you about it.”