A Man to Die for (6 page)

The work lane was in pandemonium with the unannounced arrival. Doctors and respiratory techs crashed through the door from the stairwell. Michael was swinging the red trauma cart out of its niche by telemetry. Marva thundered on his heels with the crash cart. And dead center in the hall, right in their way, a toddler stood frozen in openmouthed astonishment.

Casey saw him and knew that neither Marva nor Michael could stop in time. It looked like the quintessential western scene with an unwary child caught in the path of the runaway stagecoach. And Casey was the only cowboy close enough to intervene. Spinning on her heel, she scooped up the little boy on a dead run and reached the far side of the hall just as the carts thundered past.

“Whoa, pardner!” she crowed, swinging the child up into her arms. He turned astonished eyes on her and she grinned. “Didn’t your mom ever tell you to look both ways before crossing the street?”

“Child,” Marva called to Casey from the doorway where everyone was congregating. “You should play football. You got great hands.”

“That’s what I’ve been told.” Casey grinned back. “Anybody missing a pedestrian?”

She checked, three rooms before she found the little boy’s mother relaxing on a chair with the
Enquirer
.

“I’m going to close the door to the work lane,” she offered, setting the little boy down and giving him a little push toward his surprised mother when he looked as if he was going to follow her back out. “You don’t want him out in the work lane about now.”

“He’s bored,” she protested flatly.

“Better bored than trampled,” Casey retorted much more lightly than she would have liked and pulled the door shut after her.

“I can’t get a line in!” Marva was protesting from across the hall.

Casey trotted on into the room and accepted goggles and gloves from Michael where he was stationed at the big cart. “What about a gown?” she asked. “I don’t even have scrubs.”

He shrugged. “Central supply’s out.”

Casey took a look at what was left of the victim to calculate potential danger and caught sight of the long-abused veins. “And I don’t want AIDS,” she decided. “Call surgery or isolation and get some up here.”

Snapping the gloves in place, she grabbed a tourniquet and Cathlon catheter and went after a vein. It was her gift, her specialty. Marva called her a diviner. No matter what kind of condition the patient was in, Casey could usually get a peripheral vein to start IVs, especially in critical situations. Somehow the adrenaline rush improved her aim.

“I’ll do drugs,” she offered, noting that one of the paramedics was on top doing CPR and Janice was assessing as she cut off clothes. Marva was still trying for a line on the other side, and Steve was relegated to keeping track of everything that went on via flow chart.

“I heard that about you.” Marva grinned.

“Everybody has to be good at something,” Casey retorted, fingers probing the flaccid arm.

“Please, Jesus,” Marva crooned as she slid her needle into the patient’s other arm, “let me get this one. Please, sweet Jesus, help us out here, give your Marva the touch…Goddamn it, you son of a bitch, don’t roll on me!”

Casey considered Marva the perfect Baptist trauma nurse. Casey, on the other hand, was a hummer. She was no more than eight bars into “Stairway to Heaven,” when she felt a telltale pop at the end of the Cathlon.

“Damn, am I good!” she crowed, whipping her hand into the air like a successful calf roper. From just behind her, Michael handed her the end of the IV line. Slipping out the needle, she hooked the line up to the catheter and reached for her tape.

“Well, shit,” Marva whined. “Why do. I waste my time? All that heartfelt prayin’ and you still beat; me.”

“Clean livin’, girl.” She wasn’t going to have any teeth left in another five years between gnawing on needle caps and tearing tape. She was doing it again, ruining her incisors in her haste to secure the line.

“All right, all right, all right,” a voice behind her announced in stentorian tones with more than a touch of the Middle East in it. “What do we have here?”

Casey gave way to a silent groan. Damn. “Never Say Die” Ahmed, the surgical resident with the record for the longest unsuccessful code in Mother Mary history. Portly, swarthy, and usually ill-mannered, he was not a favorite in codes. The units had long since dubbed him Rip Van Trachea for his unique intubation technique. Luckily, the patient already had the endotracheal tube in place, and the respiratory tech was bagging him.

“Looks to me like we’ve got a man without half a face,” Casey answered without looking up from her work. Michael handed her a bristoject of epinephrine and she began to inject it into her line.

“Or you could say he’s a man with half a face still left,” Marva offered from where she’d just found similar success with her IV line and was hooking up the blood tubing.

Casey snorted in derision. “Optimist.”

“Who shot him?” Ahmed asked.

“From the powder burns on his right temple,” the paramedic answered. “I’d say he did.”

“Would you like to follow ACLS protocol?” Casey asked, passing the spent plastic prepackaged syringe back to Michael.

“Oh.” Ahmed stood like an island of silence in the midst of the chaos.

“He’s in arrest,” she clarified impatiently. “Let’s see a strip.” The paramedic paused and Janice ran a strip. “Fine v-fib. How ’bout we defibrillate?”

“All right, all right all right. Let’s go, then.” Ahmed was beginning to gear up. Once he finally got into the picture, he wouldn’t stop short of a power outage.

That was when Casey made a discovery. She’d been on the wrong side of the patient to see it, especially with everybody else crowded around. Of the injury she’d only seen the shattered remains of nose and eye socket, the blood and a bit of gray matter. She hadn’t noticed until she really looked what lay beneath that wound. Or around it.

Quickly she scanned the entire body to verify. What she’d taken as the effects of self-abuse had really been disease. The patient was in his sixties, and he was cachectic, ribs standing out like a starved horse. That and the purple markings that showed at the edge of his ear clinched it.

“Oh, God,” she breathed. “Chris, is the wife here?” Rocking back and forth over the patient like an oil-well arm, the paramedic shrugged. “Wasn’t at home when it happened. The neighbors were going to bring her in.”

“Clear, all clear,” Marva called, paddles in position. Chris pulled back.

“Does he have terminal cancer?” Casey asked.

Marva halted, thumbs poised over the red buttons.

“Shock him,” Ahmed shrilled, furious at the pause.

Marva hit the buttons and the patient convulsed.

“Nobody said anything,” Chris objected, leaning back into his CPR.

Casey turned to Janice. “Get out there and find the family. See if this guy has terminal CA. Find out what they want to do.”

“CA?” Ahmed echoed.

Casey pointed to the marking, the shaved hair that they wouldn’t have noticed beyond that devastating wound, the marking pen from where the radiologist had directed the radiation therapy that was meant to shrink the patient’s tumor.

“Maybe the gunshot was superfluous,” she suggested.

Until they found out there would be no choice. They would have to continue with full stops out. The patient had committed the cardinal sin of gunshot suicide, pointing the gun at his temple, almost ensuring failure. When the gun went off, it would jerk and send the bullet skipping toward the front. A survivable injury, a James Brady, they called it. Although this man had probably performed a self-inflicted lobotomy.

On the other hand, if he’d signed a statement forbidding extraordinary measures, there was no reason to revive him just to prolong his misery. If only they weren’t lucky before Janice got back with the word. If only they didn’t get him back. If only they could convince Ahmed to quit.

“I don’t care!” he shouted ten minutes later when the verdict—and the notarized statement forbidding extraordinary treatment—came in. “We do not quit! Get some more blood into him. Put a call in to the neurosurgeon on call. Open up dopamine and run it in.”

He was greeted by a forest of stricken faces. Nobody wanted to torture Mr. Melvin Tarlton any more than he had been. Nobody wanted to torture his wife or run up her already enormous bills. His private doctor had estimated him to have another month at best. The radiological oncologist had said that Melvin must have saved up what lucidity he had left to spare his family. And Ahmed wanted to drag them right back under.

Even so, it took Casey another ten minutes to finally reach her end point. They had long since passed into practice and experimentation, and she wasn’t in the mood for it. And still Ahmed wouldn’t quit.

“Ahmed, grow up,” Casey snapped at him after pleading, wheedling, and coercion hadn’t worked. “This is the twentieth century, and Mrs. Tarlton has a legal document. Let’s call this damn thing and get the fuck out of here.”

Only Casey had enough years to talk to him like that. Everyone else slowed their actions, inching toward finality.

Black eyes glittered with venom. “How dare you?” he demanded. “I am the doctor. I will have your job.”

“Trust me,” she retorted. “You wouldn’t want it. We’ve been running the code for forty minutes already and haven’t gotten squat.”

“What about the dopamine?” he demanded, turning on Marva.

“Running.” She shrugged, casting a glance up at the bag with a red tag on it. “Wide open.”

“We’re covered,” Casey wheedled, hating the necessity, hating the game. Hating Ahmed for wasting everybody’s time. “We’ve got the positive Nebraska sign, Ahmed. That EKG’s as flat as Marva’s chest. Mrs. Tarlton’s not going to sue us for giving up now.”

“We will call it when I say it is to be called,” he warned her.

It took everything in her to keep from hitting him. The rage welled in her like a red fire, almost blocking out the sight of the crowded, littered, fetid room. “Then I guess you’ll have to do it without me.”

She stalked out. She knew that once she was gone it would be safe for him to give in. After one more dose of epi and a stab at the pacemaker, he did just that. Four minutes and twenty seconds. Casey vented her rage on a plastic urinal that bounced with a satisfying clatter against the bathroom wall, and then washed her hands twice. She kept herself out of sight until she heard the dying whine of a discontinued monitor and knew she was calm enough to face Ahmed again.

She walked back out into the hall to bump into Hunsacker.

He was watching the desultory movements in the trauma room with interest, and didn’t notice Casey until she was almost at him.

“Back again?” she couldn’t help but ask. She was all set to walk on when Hunsacker turned his gaze on her.

Casey shuddered to a halt. Just for a second, as sudden as a death seizure, the light disappeared from Hunsacker’s eyes. Casey didn’t see recognition. She didn’t see charm or interest or avarice. What she saw was a flash of deadly cold hostility.

She couldn’t move, couldn’t react. The weight of his animosity pinned her, upended her. She couldn’t comprehend such venom. She couldn’t imagine what could possibly ignite it or fuel it. But it was there, a hard glint so vicious that it paralyzed her.

“You can be a real ballbuster,” he said, and that fast the light came back on. Steve was walking their way with the paperwork. Janice closed up equipment and Marva preserved tubes and lines for the coroner’s perusal later. Hunsacker turned to watch them. “Those camel jockeys can be real assholes, can’t they?”

Casey didn’t know how to answer him. Was that what had frozen his expression? Had he watched the fight with Ahmed and sided with her? Could he possibly have that much hatred stored away to strike out so suddenly, so capriciously? Could he be that controlled that he could lock it back away so neatly?

Casey had to admit that with all her chances to cultivate prejudices, the only one she’d succumbed to was against certain doctors of the third world persuasion. Unaccustomed to respecting women as equals because of societal traditions, those men usually were the most difficult to deal with. Theirs often seemed the most severe kind of medical chauvinism, which to Casey often seemed like male chauvinism at its worst. And Ahmed was among the high priests of that particular sect.

But where she might have let off steam with Janice or Marva or Steve, she couldn’t admit that kind of selfweakness with Hunsacker. She didn’t want him to think she shared his bigotry.

“Your lady still not doing anything upstairs?” she asked instead, shaken enough to stare after him. Still unsettled enough from the aftermath of the code to wonder if she’d just imagined it all.

Hunsacker turned an appraising eye on her. Casey had the distinct feeling that he was disappointed that she hadn’t snapped up his bait. She couldn’t dismiss the feeling that he was watching her for something. “Oh, no,” he finally said with another of those sudden smiles. “I’ve been forced to schedule her for a section. Then I have to go see that lady in at Izzy’s. I guess it’s going to be a busy evening for me, too.”

Casey just shook her head and walked past. “I told you you shouldn’t have said that word.”

The rest of the code team was filtering out. Casey carried her paperwork to join them.

“I’ll tell you something,” Steve was saying to no one in particular as he sat down to fill in the medical examiner’s information. “The cops have the right idea. You want results, you gotta bite down on the barrel. Anything else is just second best.”

“I heard you were offering an in-service on effective suicide techniques,” Marva offered from where she finished gathering personal effects. “Speaking of which, McDonough, we’ll discuss that crack about my chest later.”

Casey didn’t need to answer.

“It’d sure save us some time,” Steve groused. “I mean, that was a forty-five he used. Shit, he should have taken off his head and his next-door neighbor’s head with that thing.”

“Bite it, huh?” Janice asked dryly.

Steve nodded. “In far enough to get a good grip on it with your teeth. Like a real cold hot dog.”