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Lukas paused at the threshold to the E.R. call room. A big black spider at least an inch in width skittered across the wall and behind the curtain beside the twin-size bed. Lukas hated spiders. His oldest brother, Ben, had been bitten by a brown recluse years ago and would always bear a deep, ugly scar on his right forearm, just above the wrist. He’d been in the hospital for a week and a half. Lukas was only eight at the time, and the memory had scarred his psyche worse than it had Ben’s.
Good thing Mercy wasn’t here to see Wimp Bower in action. Of course, if Mercy were here, he would put on a brave front and chase the spider down and kill it, gritting his teeth and shuddering with every move. And Mercy would be laughing because she knew how much he hated spiders. And he wouldn’t mind, because he loved to hear her laugh. She laughed so much more now than she did when he first met her.
And here he was thinking about her again.
Ignoring the slight scent of mildew that hovered throughout the call room, he stepped inside and crossed to the student desk placed beneath the wall phone.
And just then it rang. He jumped backward, as if the spider hovering somewhere in the darkness had suddenly growled an attack signal.
Irritated with himself, he grabbed up the receiver. “Yes.”
“Dr. Bower, a man just came in by ambulance,” said the new, inexperienced secretary, Carmen. “They say he looks like a stroke. He’s strapped down, and Tex had just left to go down to the cafeteria to find something to eat, and I’m all alone here.”
“Is he responsive?” Lukas hadn’t heard an ambulance report, and he’d only walked back here a couple of minutes ago.
“Just a minute and I’ll ask.”
“Never mind. I’ll be right there. Have Tex paged over the speakers.” Lukas hung up and returned to the E.R. to the overhead blare of Carmen’s voice. He walked into the cardiac room to find Quinn Carnes and Sandra Davis—the paramedic and emergency tech—transferring a seemingly unconscious elderly man from a gurney to the exam cot. The patient was fully immobilized, arms and all, to a long spine board, with head blocks, C-collar, the works. He had a hundred percent nonrebreather mask over his face. But no IV. No ET tube, so his airway was not protected.
“Hey there, Doc,” Quinn said, walking over to the desk in the exam room and tossing his paperwork down. He reached up in a habitual gesture and scratched at the thick, wavy brown-gray hair that grew to his shirt collar. “Got you a gomer here.”
Lukas flinched. He hated that term. Gomer meant “Get Out of My E.R.” and was used by burned-out, unprofessional personnel who felt the patient wasn’t worth their trouble.
“His wife found him down and unresponsive and dialed nine-one-one,” Quinn continued. “Looks like a stroke. Finger-stick glucose was one-oh-seven on scene. The wife’s on the way in her own car, but no long-playing record here.”
Lukas cringed as he stepped over to the side of the bed, and he saw Sandra glare at her partner with obvious disgust. Although Quinn was probably in his midforties, he apparently had only been on an ambulance crew for a couple of years. Lukas believed he never should have been allowed to work with patients in the first place, but there were probably few contenders for the job in a town like Herald. Lukas knew the man was presently working as many hours as possible with the ambulance service and bugging hospital personnel to give him some shifts in the E.R. If Lukas had anything to say about it, that wasn’t going to happen.
“What’s the gentleman’s name? ” Lukas asked, unable to keep irritation from his voice.
“Mr. Wayne Powell,” Sandra replied for Quinn. Her voice was hesitant, soft, as it had been the other time Lukas had seen her in here. “His poor wife was almost hysterical when she called.”
Lukas leaned forward and squeezed the patient’s upper arm. “Mr. Powell?”
“Told you he’s out of it, Doc,” Quinn said over his shoulder as he sat down to do paperwork.
Lukas took the patient’s arm in a firmer grip. “Mr. Powell! Mr. Powell, can you hear me?” he called more loudly. “I’m Dr. Bower. Try to open your eyes if you can.”
No response.
Tex walked into the room, slightly breathless from her rush back down the hallway. Her large frame and broad shoulders seemed to fill the already crowded little exam room. “Can’t leave this place for two minutes without—Uh-oh, what’ve we got here?”
“I’m still trying to find out.” Lukas rubbed his knuckles hard against the man’s sternum and didn’t even get a groan. The sternal rub would rouse him if anything would. “Tex, we’ve got an unresponsive patient with an unprotected airway,” he said. “Set up for an intubation, but first let’s get the suction set up.” He couldn’t believe Quinn hadn’t intubated this patient.
Tex turned to the cabinets on the left and opened a door to pull out some equipment.
Quinn looked over at them and gave a quick chirp of irritated laughter. “Would you relax, Doc? Don’t you think I’d have done that if he needed it? He’s not throwing up or anything. His airway’s clear.”
Lukas grabbed the black box that Tex handed to him. He broke the safety lock and opened the box, pulled out the laryngoscope and endotracheal tube and snapped the blade into place. “An unobstructed airway is not the same as a protected airway. If this is a stroke patient, he’s at high risk for aspiration.”
Tex came around with the suction. “Got it, Dr. Bower.”
Lukas reached over to pull off the oxygen mask just as Mr. Powell retched. “Tex, get the suction catheter in. Quinn, Sandra, help me here.” He reached for the grips and turned the patient toward him as Sandra rushed to help. Good. The man’s body didn’t slip. They’d done a good job of securing him. Quinn ambled over to help.
“Sloppy job, Quinn,” Tex snapped above the sound of the suction. “Sloppy, sloppy. Why didn’t you intubate this guy on scene? I’d have taught you how if you needed me to. Maybe I could teach you how to do an IV, too, while I was at it, and how to hook up a monitor. And I didn’t hear your radio report. I was gone less than a minute. Trying to sneak up on us?”
“No time,’ Quinn said. “We were busy, and we were just about a mile away. There wasn’t time for little nonessentials.”
“You call lifesaving and preparation nonessentials?” Tex snapped. “If you’d spend a little more time worrying about your patients and less time whining about your bank account, you might make a good paramedic someday.”
“You try going on scene every once in a while.”
Tex returned his glare and shook her head. “I did it for five years.”
“Sure, but most of that was years ago,” he taunted. “Things have changed. You think being a med-school dropout makes you special.”
“I didn’t drop out, you stupid jerk.”
“Tex,” Lukas snapped, “keep your mind on what you’re doing.”
“Sorry, Dr. Bower.” She suctioned for a couple more seconds, then pulled the tube back. “He looks clear.”
“Good, let’s get him back over. I need an IV now, and give him Ativan, two milligrams. Sandra, take over that suction and keep it handy, just in case.” He called over to the secretary across the E.R. “Carmen, I need an EKG, CBC, electrolytes, PT and PTT—”
Carmen turned around in her chair, eyes widening in panic. “What? Slow down, I can’t get all this down.” She grabbed a pen and a pad. “Now, what was that?”
“Just do a standard cardiac workup,” Lukas said gently. “It’s taped on the wall to the right of the phone.” He turned back to Mr. Powell and tried to wake him up again. No response. He pulled out his penlight and checked the man’s pupils. They were sluggish, and the one on the left looked a little dilated. Nothing obvious.
“Call for a helicopter launch. He’s going to have to be flown to Columbia.” Lukas slipped off Mr. Powell’s shoe and, with the point of an ink pen, ran the tip up the bottom of the man’s foot. The big toe curled upward.
Positive Babinski’s. The abnormal reflex was found in stroke victims. Quinn should have intubated.
“Dr. Mercy, help me.” The feminine voice drifted to her from the dark mist, soft and indistinct. A sudden, frantic pounding reached her, and then the quiet voice again. “Help me.”
Mercy awakened suddenly with her face pressed against the hard surface of her desk. The overhead light blared down on her, and her right shoulder and arm were splayed across the back of her chair, cramped and stiff. The pounding continued to sound in her head from her dream, but as she listened all she heard were soft puffs of wind against the window and the scratch of branches from the cedar tree against the rain gutter.
She got up, stretched and walked to the darkened waiting room. All was quiet. Was she dreaming about Kendra? Were the worry and stress of the past few months finally taking their toll?
Just in case, she opened the entrance door, and freezing wind rushed in, mixed with a powdery feathering of snow. She shivered and stepped back into the warmth but didn’t close the door for a moment.
“Hello?” she called out into the cold. She felt foolish. Of course it had been a dream. “Is anybody out there?”
The snow had barely frosted the walk, and there probably wouldn’t be any accumulation. There hadn’t been much in the forecast for the weekend. Of course, that could change.
She shivered and started to close the door and lock it when she caught sight of something in the swirling snow, just outside the door—the bare outline of a footprint. Even as she watched, the force of the wind obliterated it.
“Hello?” she called again.
No one answered.
Lukas sat at his tiny workstation in the E.R. a few feet from the secretary. Carmen muttered under her breath every time she picked up a new chart to code. She had asked him so many questions in the past thirty minutes that he’d almost decided to offer to do the coding himself, but he wasn’t sure he knew the routine, either. Every E.R. had a different office procedure.
He rested his chin on his fist and fought to keep his eyes open, listening to Marin’s snores in the curtained exam room across the small aisle from the desk. Tex and Carmen were making bets on whether or not the bikers would return to get their buddy.
Carmen whistled suddenly. “Who’da thought Catcher would have such good insurance? Too bad he left AMA. Now we’ll probably be stuck with the bill.”
Lukas shook his head and picked up the phone to check on Mrs. Flaherty, who, at his request and upon agreement by the attending physician, had been placed on telemetry on the floor. He knew it wasn’t his responsibility, but he wanted to know how she was doing and if she’d had another episode of syncope—unconsciousness.
Finally a harried, breathless female voice answered. “What is it?”
“Uh, yes, hello, this is Dr. Bower checking on our telemetry patient, Mrs. Flaherty. Is everything okay there?”
There was a short silence, then a sigh. “Sorry, Dr. Bower, we didn’t have a unit available. Dr. Cain downgraded the admission for us so we could keep her here.”
Lukas let that sink in for a moment. “Mrs. Flaherty isn’t on telemetry?” Nobody was watching her? His request had been ignored? “Dr. Cain specifically agreed with me that—”
“Look, we’re operating on a skeleton crew, Dr. Bower. The patient looked fine to us, and she’s just a couple of doors down. We check on her when we can. Mr. Amos wouldn’t allow us to transfer her.”
Lukas clamped his teeth down on his tongue for a moment. Since when did the administrator for this hospital have a license to practice medicine? There had been a few guarded remarks about the fact that the man was paranoid about spending money, but when did money become more precious than human lives?
“How many nurses are on the floor tonight?” Lukas finally asked.
There was a pause. “One RN and one LPN.”
“That’s it? What’s the census?”
“We have nineteen patients on the floor.”
“And you’re the only RN in the whole hospital?”
“That’s about the size of it, Dr. Bower,” she said, sounding suddenly weary. “And you’d better not let Mr. Amos hear you complaining, or we’ll have one less doctor.” She hung up.
Lukas groaned. What else was new?
Chapter Five
T he loud, piercing cry of a hungry newborn baby streaked through the darkness of nineteen-year-old Marla Moore’s dreams, echoing through the small room like a ricocheting bullet. It was her baby. Her little Jerod. And only she could stop the crying.
Even as she opened her eyes to the dim room illumined by the night-light, her hands automatically pushed back the blankets and pillows. With stiff limbs and swollen feet, she climbed from bed as if Jerod were pressing a remote control programmed for Mommy.
She stepped once more onto the cold painted concrete floor, but before she reached the used crib that she’d bought at a yard sale, she tripped over the house shoes she’d pulled off when she got into bed. She stumbled backward against the bedside stand. The corner of the stand dug hard into the inside of her right calf, and she cried out. She grabbed the side of the crib for support.
Jerod’s cries grew louder and more insistent.
“Stop it!” she snapped. “Just stop it!” She bent over and rubbed her calf, then reached down and picked the newborn up into her arms. Feed him. Then she could get back to sleep for another couple of hours before she had to repeat the routine all over again.
She sat with him on the side of the bed and fumbled with her dirty pajama top. Everything was dirty. She barely had enough diapers for tomorrow, and she hadn’t done laundry in three weeks. How could she? Before she had Jerod, the doctor had told her to stay in bed so she wouldn’t go into premature labor. Now there was nobody to help her. Marla would have called a church for help, but every time she thought about calling someone, shame kept her from following through.
This little town had turned out to be a setting for a nightmare, and she was living it. She couldn’t help feeling she deserved some kind of punishment, but why did this little baby have to suffer for her sins?
Maybe he didn’t. There was an adoption agency in Jefferson City that her doctor had told her about. She had the card somewhere in her purse, and she could call them anytime, day or night. But she hadn’t even been able to think about asking for help without feeling horrible guilt.
Jerod’s cries stopped as soon as he started his early-morning snack, and gradually the pain in her leg began to let up. She’d have a monster of a bruise. She remembered those tight stockings they’d made her wear at the hospital. She was supposed to use them after she got home, too, and she’d done so the first day. But they were hard to put on, and she was so tired she just gave up. If there’d been anyone here to help her…
Against her will, Marla thought again about Dustin. She could close her eyes and see his long, lean face. Now that Jerod was quiet she could concentrate—again—on that last argument before she left Bolivar. She remembered Dustin’s voice when he told her to get an abortion.
Now he didn’t want anything to do with her. As far as Dustin was concerned, Jerod didn’t even exist. Neither did Marla. With Dad gone, there wasn’t anybody else to care.
She sniffed and her face puckered as her body ached all the way from her legs to the middle of her back. “Jesus, what am I going to do? Where are You? Do You hate me now?” They were questions she’d asked into the silence of this room many times these past months. Marla Moore had been a born-again Christian since she was eleven. She’d been raised right.
On the night she conceived, she’d been a virgin, and after that night she’d felt so guilty and so scared that she’d refused to give in again. And when her worst fears came true and the test read positive, she’d told Dustin. He’d dumped her, just that fast. Of course, when she thought about it honestly, their relationship had been going downhill for a long time. Had they ever even had a real relationship? What about the rumors about his other girls?
She looked down at the rounded top of Jerod’s head, the sparse dark hair shadowed in the night-light. For the past nine months she hadn’t planned past this time in her life. She thought about the name of that adoption agency in Jefferson City. It was called Alternative, and these people specialized in helping unwed mothers. The nurse at the clinic had encouraged Marla to give the place a call for help, even if she planned to keep Jerod.
As soon as she could get to a phone, she would make the call. But she couldn’t give Jerod to someone else to raise…could she? She loved him so much, even if he was driving her crazy right now.
She shivered. The room was cold. She tried to keep the heat turned off as much as possible so the bill wouldn’t be so high next month. Her telephone had already been cut off. Her landlord had come by twice looking for rent money that she didn’t have, even though the place was cheap, renting out weekly to whoever came along…right now her neighbors looked and sounded and partied like a biker gang.
When Jerod finished his meal she didn’t take him back to his crib. Instead, still shivering, she climbed back beneath the blankets and drew him in beside her. How much was she willing to sacrifice to make sure Jerod was warm, had clean diapers and had a home to live where the landlord wouldn’t threaten to kick him and his mother into the street?
Monday she would find a pay phone and call that place, Alternative. But she wouldn’t give Jerod to someone else. Who could love him as much as she did?
Clarence sat with his overlapping fat pressed against the handle of the pickup truck door, feeling it dig into his side and hoping the lock was a tough one. Too bad Buck didn’t have a king cab. That would have made this ride a lot more comfortable, and Kendra wouldn’t be squeezed between them like a baby sandwiched between two sumo wrestlers. Okay, maybe a sumo wrestler and Arnold Schwartz-his-name. Still a pretty tight fit. Clarence felt like he was being used as a giant plastic lid stuck over the end of a jar to keep the contents from pouring out. Kendra was pretty special contents.
Why hadn’t he at least thought to bring his sugar-free breath mints? He always carried them because they were the only thing Ivy let him eat. And why hadn’t he taken a shower tonight?
And why, oh, why, had he taken that stupid Lasix? The medicine had kicked up a notch, and it was running water into his bladder like a faucet.
Kendra’s quiet sniffles continued. “Why do you hate me?” she asked, her face highlighted in the glow from the dashboard lights.
“I don’t hate you.” Buck’s grip tightened on the steering wheel.
Clarence wanted to reach down and pat her on the knee and tell her everything would be okay. He wished he could explain to her how much Buck really did love her. Why did women have to talk such a different language from men?
He could tell folks a lot of things they probably didn’t realize. It was a funny thing about people who were average weight and height and didn’t have any disabilities—sometimes they ignored those who were different. They didn’t act that way on purpose, but people said and did things in front of him that they wouldn’t do in front of skinny people. When he retreated inside himself and kept his mouth shut, somehow he seemed to disappear from their sight—which was crazy, of course, big as he was. But maybe his size didn’t count as much as his silence.
Yeah, it was his silence. For two years he hadn’t spoken to anyone but Darlene, and she’d been so busy supporting them that she didn’t have that much time to talk. Ever since last spring, when Lukas and Mercy had barged into his life and turned everything upside down, things were different. And ever since then something had been changing in him. The depression that’d helped land him in this mess in the first place lifted, a little at a time. The talks he and Lukas had about God, about meeting human needs, had touched him and stayed with him. Lukas and Mercy both had a special calling from God to help people. Lukas had talked about that once, and for a long time Clarence hadn’t been able to get it out of his mind. He and his sister were both alive today because Lukas and Mercy had honored that calling.
And as Kendra continued to sniff and Buck continued to grip the steering wheel too hard, it occurred to Clarence that somehow he was still being touched by this calling. Maybe it was contagious—he felt a gentle urge to pass the healing on to others.
He remembered words Lukas had spoken to him only a few weeks ago during one of their talks. He’d said, “Trust me, Clarence, God has something in mind for you, too. I think He’s calling you, and you’re trying to avoid the call because you don’t think God has any use for you. But you’re wrong. Just listen for Him, Clarence. Just be ready.”
And Clarence had made some typically stupid remark like “God doesn’t need any more tubs of lard in His pantry” and the subject had been dropped.
Until now. Lukas and Mercy and Ivy were miles away, but Clarence suddenly realized what Lukas was talking about. And he was suddenly as sure of God’s presence as he was of the fact that if they didn’t stop at a service station soon, he was going to have to ask Buck to pull over alongside the road.
But before he could say anything, the first billboards came into view, and the lights of Springfield burst out over the trees. Kendra covered her face with her hands. Quiet sobs shook her shoulders.
“It’ll be okay, honey,” Buck said, his voice cracking from worry and lack of sleep.
