Trauma Plan (3 page)

He scraped his chair closer and propped his boot on the conference room table. Awkward and less than sterile, but it would suffice. The overhead light was decent, and the wound on his knee wasn’t that big of a deal. L-shaped, maybe 2.0 by 2.75 centimeters, and shallow. He’d have closed it with Dermabond skin glue or Steri-Strips, but it was over a joint and Jack had a skydiving appointment in San Marcos he wasn’t about to miss. You never knew how you’d land after falling thirteen thousand feet. A rough one could rip the wound open again. A few nylon sutures would hold better. But he wasn’t going to take up an emergency department gurney for something he could do himself right here.

Jack glanced at the cache of supplies he’d snagged from the ER: sterile gloves and drapes, 4-0 suture, disposable instrument kit, syringe, vial of Xylocaine, bottle of saline irrigation, needles, and gauze dressings. Plus some prep supplies, though it turned out he didn’t need them. Someone had left several iodine swab packets on the conference table. Along with a whole-grain bagel and fat-free cream cheese.

Fat-free.
He smiled, thinking of his unofficial but irreplaceable building manager, Bandy Biggs. The sixty-three-year-old former bull rider would laugh Jack out of the clinic if he brought bagels for the staff; he’d say, “Krispy Kremes or get outta Dodge.” Bandy always bragged that he’d cut his teeth on corn dogs and cotton candy. And started down the road to high cholesterol and heart disease, Jack continued to remind him. They made some compromises for the sake of Bandy’s happy longevity . . . and became close friends.

Jack glanced at his watch, wondering if the police and fire departments still had the clinic parking lot cordoned off. There had been several incidents of arson in the neighboring community of New Braunfels, and though this fire looked purely accidental, they were required to investigate. He’d warned tonight’s clinic volunteers to stay clear of reporters, to give no statements. He’d handle that himself. The first thing on Jack’s list had been to get Gilbert to the ER, and he’d done that. The man had been treated, fed lunch, and was fast asleep in the ER’s observation room. Now Jack would stitch this wound, grab a shower, and trade his uniform for scrubs before his ER shift began.

He pulled on a pair of exam gloves, ripped open two packages of iodine swabs, then filled a syringe with local anesthetic and changed the needles. After the skin prep, he’d punch a hole in the top of the bottle of irrigating saline and start squirting the wound like crazy, rinsing out any debris that he might have picked up from the clinic parking lot. A time-consuming, messy, and tedious procedure—a nurse’s job. He reminded himself to be respectful of the next one he saw. Especially if that nurse had decent skills and could be cajoled into volunteering at the clinic. The downturn in the economy had them in a pinch. He needed staff. And donations. But mostly he needed that pain-in-the-rear action committee to back off before they inspired some eager-beaver news reporter to start digging around in Jack’s past. He didn’t want to go through that mess again. Anything else, no problem. He’d handle it.

Jack grabbed the iodine swabs and scrubbed the edges of his wound. Then he reached for the syringe of Xylocaine. He pulled the cap off with his teeth, held his breath, and jabbed the needle through his skin.

* * *

Riley froze in the doorway, all thoughts of retrieving her bagel gone. She stared in disbelief as a man dressed in desert camouflage injected something into his leg. She shrank close to the doorframe and studied him: huge shoulders, sandy-blond hair cropped short, shadow of beard growth. Head down, intent on what he was doing.

And what exactly was that? Searching for a vein so he could . . . ? Riley squinted, taking it in.

The man handled the syringe like he’d done it countless times before. If he was injecting illegal drugs, he’d have to be desperate to risk doing it here, where anyone could walk in.

Desperate means dangerous.
She’d just covered that subject in safety instruction to the nursing staff.
Be safe; don’t confront.
Policy required that they have the operator page “Mr. Strong,” the code for help needed with a potential . . . assailant. Riley fought a shiver and an unbidden memory of her own assault a year ago. She backed up a step, holding her breath. But before she could turn away, the man in uniform raised his head and stared directly at her.

“I’m . . .” Riley yanked her hospital cell phone from her pocket and held it out like a weapon. “I’m going to call—”

“Call who?” he asked, holding the half-empty syringe in midair. His voice was deep, calm, and controlled. But his eyes seemed to dare her to take him on.

“Hospital security,” she said, though it sounded far less confident than she’d hoped. Her heart rose to her throat as the man set the syringe down, shifting in the chair as if he might suddenly stand. It occurred to her that he could be armed. She told herself that her injury didn’t affect her ability to run. Or scream her head off.

“Oh, right.” He glanced down at the syringe, frowning. “You think—”

“I don’t think; I
see
it. Very clearly. You’re injecting yourself.”

“Numbing myself.”

She raised the phone, kept her eyes on him. “Whatever you call it and whatever reasons you may think you have for doing it, that can’t happen here, sir.”

The man lifted his palms. “Whoa there. Wait. You’re riding that horse in the wrong direction. I’m a doctor. I lacerated my knee and I’m repairing it.” His fingers flexed. “Think about it: ever see a junkie wearing gloves?”

Riley lowered the phone very slightly, hating that the man’s lips were twitching toward a smirk. She cleared her throat. “I’ve never seen a doctor suture himself either.”

“First time for everything, ma’am. The point is that I trust myself more than I trust anyone else. And I didn’t want to take up a gurney in the ER—they’re busy. If you don’t believe me, then go ask the director. I’ll be starting a shift down there at three. I’m—”

Rambo.
Riley nearly groaned aloud.

“—Jack Travis,” he finished, shifting his leg on the table. “I followed the ambulance in with a burn patient. The uniform’s because I just got back from a Reserve weekend and didn’t have time to change. Or catch the sleep I needed. And you’re . . .” He seemed to scan her tailored business attire. “Hospital administration?”

“Trauma chaplain. And assistant safety officer,” Riley added, supposing that, if he really was a staff physician, the courteous thing to do would be to step closer and offer her name. She decided against it. “Regardless of who you are, it isn’t safe to have surgical equipment, soiled gloves and gauze—any of that—in a nonclinical area. A public area. And . . . I’m going to do exactly what you suggested.” She lifted her chin and met his gaze full on.

He sighed, suddenly looking far more fatigued than menacing. “Do what?”

“Ask the ER director to verify who you are.”

“Good. And while you do that, I’ll stitch my knee.” He was definitely smirking. “We’re back to square one, Chaplain.”

Riley gave a curt nod and escaped down the hallway, trading her initial anxiety for a growing sense of irritation. His being there unexpectedly had frightened her, but that fear was gone. Right now she was simply angry. At herself for being unprofessionally flustered, and at Jack Travis because . . . he’d apparently enjoyed it. She didn’t need anyone to confirm his identity. It was obvious now. Their brief encounter had underscored what she’d learned on the nurses’ lounge TV not twenty minutes ago.

A spokeswoman for a neighborhood action committee had been interviewed on the grounds of a free clinic. It was operating out of an old private residence, apparently the last such structure to resist a bulldozer in The Bluffs, a community boasting upscale shops and impressive custom homes. The TV interview was preceded by a dramatic camera-phone film clip of an elderly man with his clothing in flames, screaming for God to help him.

As it ended, the spokeswoman had peered into the camera, looking perfectly coiffed and undeniably sincere. “We feel for that poor soul. Of course we do. But he should never have been allowed to sleep on those grounds. There are shelters for that purpose. Downtown. This fire could have spread across the entire Bluffs community and endangered our homes and our children.” She pointed into the camera lens. “It happened because Dr. Jack Travis allowed it. He’s a reckless, irresponsible maverick who thinks he can make his own rules, regardless of the safety and well-being of others. I can assure you that the generous donor of this property never intended it for these purposes. And I guarantee that we will see this clinic closed.”

Riley knew nothing about the history of the dispute, but she’d already seen enough of Jack Travis to suspect that rules were indeed a foreign language to him. And arrogance second nature. She suspected, too, that danger was something he would embrace, not avoid.

So different from Riley. She hated, marrow-deep, that the conference room incident had rattled her. Almost as much as she hated that she’d failed at three attempts to insert an IV needle into Kate Callison’s vein. How could Kate talk her up at today’s charge nurse meeting after that?

Riley picked up her pace along the corridor toward the chaplain’s office, realizing that she’d told Jack Travis she was a chaplain and safety officer, but not that she was a nurse. Surprising, since all her efforts were focused on proving that. But for the first time she was glad she wasn’t part of the medical team down in the ER. Working alongside someone like Jack Travis was the last thing she needed.

* * *

Jack jogged toward the ambulance bay as its doors flew open. The medics shoved a stretcher through, shouting a report to him as they went. “Sixty-two-year-old woman found in her yard by a postal worker. BP 174 over 88. Pulse 90. Slurred speech, facial droop, confused and combative.” The young medic, wire-rimmed glasses askew, swiped at a bleeding scratch on his cheek. “She’s been fighting us the whole time. Can’t keep the oxygen on, couldn’t get an IV.” He pointed to where they’d attempted to cut away clothing to expose her right arm. “It was a short ETA, so we just rolled. Fire’s following us in with her meds. I hope. Her place was locked up behind her like Fort Knox. She finally settled down, stopped fighting so much, about the time we pulled in.”

Jack glanced down at the woman as the stretcher rolled toward the exam room. A second medic was doing his best to gently restrain her arms.
Moving both arms. Less suggestive of stroke.
She was glassy-eyed, pale as a fish belly; her skin glistened with sweat, and her well-cut ash-blonde hair was wet. Jack brushed his fingers against her forearm: cold to the touch. “Her name?”

“Vesta,” a balding EMT answered as they lined the stretcher up with the hospital gurney. He checked his notes. “Vesta Calder. That’s birdseed in her hair and all over the stretcher. She must have been carrying a sack of it when she went down.”

Jack patted the woman’s shoulder. “Vesta, I’m Dr. Travis. I’m going to help you.”

She stared up at him with a blank expression, saliva trickling from the corner of her mouth.

Jack signaled to Kate Callison. “We’ll need the works: labs including blood alcohol and tox screen, Foley catheter, EKG, portable chest films, arterial blood gases, brain CT.” He nodded as one of the other nurses grabbed the IV start tray and a bag of normal saline. “Get that line in and grab a blood sugar.” He turned back to his patient as the team prepared to transfer her to the ER’s gurney. “We’re going to move you, Vesta. It’s okay. The nurse will get a warming blanket, too. Bear with us.”

Kate slipped a tourniquet around the patient’s arm. A nurse’s aide got busy peeling away the remaining layers of clothing, while trying not to skid on birdseed spilling to the floor. Another tech warned Vesta about a finger stick, then poked, trying his best to eke a drop of blood from the woman’s ice-cold fingers.

The cardiac electrodes were placed, blood pressure cuff and pulse oximetry probe attached, and a staff nurse began reporting vital signs. “Sinus rhythm at 88, Dr. Travis. BP 140 over 70. Pulse ox . . . can’t get it yet; she’s too cold. I’ll get a temp and the warming system going as soon as we get this last sleeve off her arm.”

Kate slid the needle into the vein and pulled a vial of blood; she passed a droplet off to a tech to use for the glucose meter.

Vesta’s eyes rolled ominously sideways. Jack moved toward the head of the bed, watching her carefully.
Easy, Vesta . . .

The aide pulled the last of the clothing from the patient’s arm, bent close to stare at her wrist. “Dr. Travis, there’s a medical alert band here for diabetes—”

“Blood sugar’s reading low,” the tech interrupted.

“She’s twitching, Doctor, and—”

Vesta Calder’s body convulsed violently.

“Seizure!”

3

“Give the full amp of dextrose,” Jack ordered, sliding a suction tip into the corner of Vesta’s mouth. “And pull out the intubation tray. Let’s have some lorazepam standing by in case we haven’t got this right. But I suspect . . .” He watched for a moment, then released a slow breath as the seizure ended. “Okay then, good. She’s settling down. There now.” He smiled as his patient’s face infused with pink color and her eyelids fluttered. “Nothing like the miracle of intravenous sugar—except maybe those pecan pralines at Tia Rosa’s.”