Trauma Plan (28 page)

A fall from a roof? Riley’s breath caught, mind racing. Left abdomen . . . spleen? Or even a vascular tear?
Oh, please. Don’t let him bleed out in front of our eyes.

“Yes.
Lo siento, Mamá.
I’m sorry, but . . .” The boy nodded, tears brimming. “We were on the roof together. It’s two stories. I saw
Papá
fall.”

“I’ll get an IV,” Riley said, anxiety crowding her throat. “Ringer’s?”

“Or normal saline, if we don’t have it. Large bore needle. Two lines if we have time. I’ll get him on some high-flow oxygen. Tell Bandy to call for a Code 3 transport. Blunt trauma abdomen, status post-fall from roof. Grab me a neck collar too.”

“Will do,” Riley said, praying she could do any of the things she’d just promised. She yanked open the door, took off in a jog toward the supply room, and caught Bandy in the lab.

“Just tell me what you need,” he said, reading her expression.

“Your finger on the phone to 911.” Riley grabbed for the IV tray. “Tell them we have a man who fell from a second-story roof. That he has abdominal pain and shocky vital signs. We need a Code 3 transport.”

“You got it,” Bandy assured her. “Anything else I can do?”

“Tell our other patients there’ll be a delay, and . . .” Riley met Bandy’s gaze, her numb fingers tightening on the handle of the IV tray. “Pray. Please.”

* * *

“What’s going on?” Kate asked Bandy, after hearing Jack on the kitchen phone giving a report to Alamo Grace ER.

“Man fell from a roof. Belly pain, shock. The medics are on their way. Riley’s—”

“Which room?” Kate interrupted, hating what she was thinking.
She can’t handle this.

“Two.”

Kate was through the exam room door in seconds and confirmed that she’d been right; the chaplain was in way over her head. The trauma patient, his moans fogging the rebreather mask, was pale and glistening with sweat. A blood pressure alarm sounded: 76 over 38.

“Riley . . .” Kate snatched a pair of gloves from a box, nodded at the family.

Riley glanced up, her cheeks flushed, neck blotchy, pupils wide—adrenaline rush. And anxiety, Kate would bet. “I had an eighteen-gauge in, but the vein blew . . .” Riley pressed her gloved fingers against a gauze square soggy with blood from the failed stick. “I think there’s another good-size vein here.”

“Think” isn’t good enough.
Kate knew Riley wanted a chance to prove herself, but . . . She struggled against the image of the bruises from Riley’s practice attempts and the way Riley had demonstrated her clumsy fingers with that cookie. Crumbs everywhere.

“I got it.” Kate snatched a tourniquet off the tray. She extended the man’s other arm, applied the tourniquet, and tapped her fingers against the space at his elbow. Big vein, but flattening . . . because he was bleeding out. The blood pressure alarm sounded again. The family whispered in Spanish. Some of it sounded like a prayer. Kate pulled the tourniquet tighter, flicked the vein with her gloved finger, and—

“I’m going for this one,” Riley said from the other side of the exam table. “A twenty-gauge, but that will still infuse—”

“Hand me the needle,” Kate instructed, reaching out her palm.

“I’m already under the skin. And it’s looking pretty . . .”

“Stop—save a vein for the lab. Give me a sixteen-gauge instead. I’ve got this.” Kate’s eyes met Riley’s over the patient’s chest, and she wished her voice had sounded less brusque.

Riley passed her the sixteen-gauge needle set. Kate prepped the vein with surgical iodine, then touched a fingertip to it once more. “You’ll feel a needle stick, sir.” She held her breath, slid the needle through the skin bevel up, felt the pop as she entered the vessel . . . advanced it, and—
yes!

“I’m in,” Kate breathed, watching with relief as the blood flashed back into the needle set. She glanced up to ask for the IV tubing and tape and saw that Riley was already beside her, supplies in hand. “Thanks,” she whispered, wrestling with guilt she knew was irrational.

The door opened and Jack stepped in. He glanced from the patient to the monitor to Kate . . . then at Riley. “You got a line in?”

“Yes.” Riley glanced down, exhaling softly. “A sixteen-gauge, running wide open. Kate—”

“Team effort,” Kate interjected; she wasn’t sure anyone heard over the sudden wail of sirens.

* * *

Jack strode past his office, hearing the familiar strains of music through the door. It was barely nine, and Bandy didn’t usually start up this early; he was probably hoping some divine message would get through to Jack, derail the anger train. Fat chance of that.
Heartless hypocrites.

He forced himself to take a slow breath; Riley was in the kitchen. He wasn’t going to bring this up with her.

“Well,” he said, watching as she tucked her stethoscope into her purse. “The only thing I can offer to compete with that adrenaline rush is skydiving. Thursday at noon. Still time to change your mind.” He raised his brows. “This is my second and final offer.”

“No thanks.” Riley smiled halfheartedly. “After Hector, falling from heights is the last thing I want to think about.” She pulled the band off her ponytail, then closed her eyes for a moment as she rubbed the back of her neck. Jack wondered how she’d react if he offered to do that for her. “I called the ER,” she continued. “You were right. Ruptured spleen. And maybe a kidney contusion. Hector’s in the OR. Apparently he responded well to fluid resuscitation in the ER.” Riley’s teeth scraped across her lower lip. “Which reminds me that I should probably tell you . . .”

“What?” Jack saw the discomfort in her expression.

Riley sighed. “Kate started that IV. I had an eighteen-gauge in, but the vein blew. I found another one. I think I could have gotten it in, but Kate—”

“Hey.” Jack stepped close. “The man’s in the OR. We did our part. It’s done.”

“I know. I guess I just wanted my part to matter more.”

“Matter? Oh . . . that.” Jack shook his head. He’d almost forgotten. “You mean because I offered to write your letter.”

“Yes,” Riley said with raw honesty. “And because I needed to know, for myself, that I could do it.”

“Look . . .” Jack spread his hands, knowing anything he said was likely futile. Her determination was as clear as Bandy’s gospel music floating down the hallway. “The ER is a team situation too. Veins blow. Some days a buddy has your back; then it’s your turn to help him. The important thing is that we’re in there, doing something, trying. And as for here in the clinic . . . It’s not every day we have a guy fall twenty feet from a roof, to—” He stopped, barely biting back the curse he’d been wanting to shout for the past half hour. A low growl escaped his lips instead.

“What’s wrong?”

“I got more information from the son while they were loading Hector into the ambulance. The roof he fell from was a block away—in The Bluffs. Apparently it was suggested that they bring him here because hospitals are expensive. And because the free clinic doesn’t ask so many questions.”

Riley’s mouth sagged open. “Suggested by whom?”

“That’s the million-dollar question. Want to take bets on the chances of anyone owning up to it?”

Riley grimaced. “That’s why Hector’s son said it happened at home. They didn’t want to take the chance of anyone prying into their work situation. Or maybe even citizenship status.”

Jack nodded. “And our neighbors sure weren’t going to take responsibility for someone injured on their property. If Hector’s family had taken him home instead, he’d be dead right now.” Jack paused as the ugly irony hit him in the gut. “They’re itching to haul me before the city council and call
me
reckless and irresponsible, claim there’s no good reason to have my clinic here. But when it’s convenient for them . . .”

“What are you going to do?” she asked. The wariness in her eyes reminded Jack of why he’d decided against telling her any of this.

“Don’t know.” He glanced toward the hallway as the music seemed to swell. “Bandy’s telling me to let the police handle things and stay out of it.”

“That sounds like good advice.”

Jack shrugged. “Maybe. But it’s not going to stop me from taking a little detour on my way home. To see who’s got a brand-new roof. And no heart.”

* * *

He can’t see me. . . . It’s not him.

In the darkness, Vesta squinted through her binoculars toward San Antonio Street, and her breath caught. The enormous Hummer slowed to a crawl at the curb, then rolled slowly on—the second time in the last fifteen minutes. It was impossible to see the driver in the hopscotch pools of light from The Bluffs’ elegant streetlamps. Or even identify the color of the vehicle, though Vesta thought it was black. If she could make out the license plate, she’d report it to the neighborhood watch. And if she got a real glimpse of the driver, recognized him, she’d report it to the police.

Or would I?
She shivered, remembering the face that haunted her nightmares. Startling eyes, fair lashes, angular face, and that tangled mass of Medusa hair. Fear on his young face, panicky desperation validating unimaginable violence.
It’s not him. . . .

The Hummer moved on, and Vesta’s shoulders fell as she exhaled. The neighbors were keeping watch and there was talk of hiring private officers until the security gate installation was complete. The action committee had called a special meeting at the clubhouse on Saturday, with a police officer in attendance. They would be discussing the recent incidents of neighborhood crime. And ranting about the clinic, no doubt.

Vesta set the binoculars down, reached for her water, and took a long swallow. She hated all the strife concerning the clinic. She hadn’t told Bandy Biggs that she knew he worked there—her landlady was a tight link in the local gossip chain. But meeting him, little Hobo, and Riley had finally put a face on the clinic. A warm, friendly face. It made Vesta feel more secure than she’d felt in a long time, even with her own conflict surrounding Dr. Travis. And how that continued to affect her.

If I didn’t go to the police then, what makes me think I could now? Even if . . . it’s that man out there.

A shaking chill, one of several she’d had today, caused water to dribble down the glass. Her teeth chattered and she hugged her robe close. Fever. She wouldn’t worry unless it stayed above 101 despite the Tylenol. Vesta was no stranger to bladder infections; she’d recognized the symptoms this morning and had started taking the antibiotics she kept “just in case.” It explained the dull backache she’d had for several days, the headache, and her stubbornly high blood sugar readings. She’d take the medicine, drink extra fluids, rest, watch her diet—be careful. The last thing she wanted was to end up in the ER again.

No . . .
Vesta glanced toward the window, shivering again. The last thing she wanted was to find out that a murderer was really out there.

22

Riley peered through the NICU window at Baby Girl Paulson—the Doe nameplate had been ceremoniously dumped. The
Express-News
was calling her “a healthy dose of hope in a tiny pink cap.” Riley hoped this baby could provide that for the Alamo Grace staff as well, relief in the midst of too much tragedy. But the infant had developed a low-grade fever and episodes of vomiting, requiring her to be poked, prodded, and x-rayed in order to determine the cause. It called a temporary halt to the mother’s milk shipped from Austin and to the long line of volunteers eager to rock the babe. Last evening, one of those volunteers had been the baby’s shell-shocked grandmother.

Riley’s heart cramped, remembering. The Collinses had decided to discontinue life support measures for their Tinker Bell last night; without the ventilator and resuscitation drugs, it would only be a matter of time before she was gone. Riley had barely arrived home from the clinic when she got the call. She hurried in, sat with them at Stacy’s bedside for another heartbreaking hour. Offered prayers and much-needed hugs. A sad ending to Riley’s long, stressful, and disappointing day.

“Rah-lee,” Kate said, her voice husky-soft as she joined Riley at the window. She glanced away before Riley could read anything in her eyes. “I heard the grandmother held her last night.”

“Yes.” Riley’s stomach sank. Seeing Kate was usually a bright spot in her day, but after last night’s drama in the clinic, it felt awkward. She hated that.

“I was here.” Riley saw Kate’s confusion. “After the clinic. I got a call because they’d decided to sign the DNR papers. I came in to be with them.”

Kate winced, pressed a hand to her chest. “I don’t know how you do that.”

“Sometimes,” Riley admitted, meeting Kate’s gaze fully, “I don’t either. But it’s my job.”
Until I can get back to the ER. You do remember how much I want that, right?

Kate cleared her throat. “I called the SICU about your patient, Hector. Two units of blood in the OR. Kidney looks fine. He’s stable and awake, doing well.”