Silent Pledge

Clarence swallowed again. “Hol’ up, Buck. Ith’s okay.” One more swallow. There. “Mercy dropped Tedi off here a little bit ago, ’cause she was on her way to the clinic for some emergency. What’s the matter with Kendra?”

Buck took a breath. “She tried to kill herself. Carbon monoxide poisoning. She was running her car motor out in the garage when I found her. The doors and windows were all shut.”

Clarence grunted as if he’d been hit in the gut with a football. “Oh, man.” Poor Kendra. And poor Buck. “She okay? Where are you?” He knew they were still having trouble in their marriage, but was her life bad enough for her to want to die?

“We’re still at home. I’ve got to get her to Dr. Mercy’s,” Buck said. “There’ll be oxygen there.”

“Yeah, Dr. Mercy’ll check her out. Want me to call the clinic and see if I can let her know you’re coming?”

“Yeah. Thanks, Clarence.”

There was so much relief in Buck’s voice, Clarence went even further. “You’ll be coming right by here on your way….” He hesitated. He’d just started getting back out into public after losing all that weight, and he still had a long way to go. Could he do this?

Yeah, he’d do anything for Buck. Buck had been there for him when he was in trouble. “I could meet you out at the street. All you’d have to do would be stop and let me get in and ride with you. Then you wouldn’t have to do this all by yourself.” And maybe he could talk to Kendra some. He knew firsthand what depression could do to a person.

There was a pause, and he braced himself for Buck to turn him down. He’d lost over a hundred pounds since last spring, but he’d still draw a big crowd at a circus sideshow. He was big and clumsy and took up two seats wherever he went, and strangers stared and laughed, and he knew the few friends he had were probably ashamed to be seen—

“You’d do that for me, Clarence?” came Buck’s relieved voice. “It would help.”

Clarence blew out a bunch of air he hadn’t realized he was holding in his lungs. “Sure would, pal. Look at what you did for me last fall. I’ll be waiting out front when you get here.”

He hung up and glanced toward the hallway that led to Ivy’s bedroom suite. Good. No lights, and he thought he could hear her snoring over the hum of the refrigerator. Mercy’s daughter, Tedi, had gone straight to sleep in the spare bedroom without waking her grandma. He guessed neither of them had heard him on the phone.

Ivy had once compared his voice to a derailed locomotive running loose through the house, and she really griped when he woke her up in the middle of the night. Especially when she caught him eating.

Clarence and his sister, Darlene, had come to live with Ivy Richmond—Dr. Mercy’s mom—three months ago when their health got too bad to live on their own. And Ivy had bullied him every day since then to eat right, exercise, take his vitamins, exercise, take his medicine, drink a bucket of water a day and exercise. She’d even tried to make him go to church with her. He’d done everything but that.

Since he couldn’t bend over and pick up all the crumbs he’d scattered on his way to the phone, he shoved them aside with his foot. Though sloppy and crude, it might save his life. He had to hurry and brush his teeth and get out to the curb. He wanted to be there when that pickup truck came rolling by.

Shouldn’t’ve taken that Lasix a couple of hours ago. He knew from Mercy that the medicine kept him from retaining fluid, but it also kept him running to the bathroom all night long.

Crystal Hollis lay on Mercy’s softest, most comfortable exam bed in an overheated room, with a pink teddy-bear sheet draped over the lower half of her body. Some of the color had returned to her face, and the sound of her breathing was not as labored, nor her lips as blue, as a few moments before.

Mercy pressed the warmed bell of her stethoscope against the little girl’s chest. “Take a breath for me, honey.”

Seven-year-old Crystal had the body weight of a five-year-old, with stick-thin arms and legs and a slightly protruding abdomen—clearly the cystic fibrosis affected her pancreas as well as her pulmonary system. Which meant Crystal could eat as much as an adult and still not put on weight. It was a constant battle. She had an aura of maturity in her longsuffering expression and sad gray-blue eyes that befitted someone seventy years older.

Her chest sounded a little better, but not enough. She coughed and Mercy grimaced. The breathing treatments weren’t going to cut it this time.

“How’s she doin’, Dr. Mercy?” Odira’s deep voice rumbled from her chair four feet away. She leaned forward, her puffy face filled with tense worry.

Mercy sighed and placed the stethoscope back around her neck. She tucked the sheet back up over Crystal’s bony shoulders and took the little girl’s hand in her own. “I’d like to see her breathing better, Odira.” She perched on the exam stool beside the bed and faced the child’s great-grandmother. “The X-rays don’t show what I suspected, but this could be early pneumonia. I’d like to have her checked out by a pulmonologist in Springfield. I could transfer her to St. John’s and…” The expression of sudden fear in Odira’s face halted her words.

“But you’re her doctor,” the older woman argued. “You’re the one we trust. Couldn’t you just do one of those consults they talk about on TV? That big place up in Springfield would be so scary for Crystal, and they might not even let me stay with her. You know how those big places are.”

Mercy patted Crystal’s hand and released it, then stood up and walked over to the chest X-rays placed in the lighted viewer box. The films most definitely indicated bronchitis. Time to blast those lungs with high-powered antibiotics. Odira always made sure Crystal received the nutritional support Mercy suggested, including the pancreatic enzyme supplements and vitamins, but Mercy would increase the caloric intake even more for a while. Crystal’s fever had dropped a little, but Mercy didn’t want to take any chances.

Accompanied by the unrhythmic sound of Odira’s loud breathing, Mercy checked Crystal’s heart once more. With severe disease, right-sided heart failure could occur, but there was no sign that the CF had progressed that far. Would it be possible to keep them here?

Mercy turned around. “Odira, are you feeling okay?”

“Don’t worry about me, Dr. Mercy. I’m just worried about keepin’ our girl in Knolls. You people know how to take care of us right.”

“I’ll try,” Mercy said. “I’d like to get her temperature down before I decide.”

“You need me to be your nurse?” Odira asked. “I know how to follow orders, you know.”

“Yes, if you would.” Mercy gave her instructions to go to the staff break room and get a Popsicle out of the freezer for Crystal. It would be a special treat for the child and would be a painless way to help drop her temperature and add a little fluid.

Odira struggled to get to her feet and finally succeeded. “I sure do appreciate your heart, Dr. Mercy.”

Mercy knew her patients hated the thought of leaving Knolls for a hospital stay, even to places like Cox or St. John’s, two of the top-rated hospitals in the country. Mercy didn’t blame them. They liked a small community hospital with down-home caring, close to where they lived. Their indomitable hospital administrator took pro bono cases and occasionally paid for them from her own bank account. This would probably be one of those cases.

“Please, Dr. Mercy,” came Crystal’s soft, hoarse voice. “Can’t I stay here?”

Mercy sighed and looked over into the little girl’s solemn eyes. Her softheartedness always got her into trouble. But she supposed she could call Dr. Boxley as a consult. He was an expert on CF patients, especially children, and he’d given her advice on Crystal’s care before. And Robert Simeon wouldn’t mind checking her out as a favor. With his specialty in internal medicine, he’d had some experience with this, and he lived and practiced right here in town. And the ICU staff at this hospital was the best anywhere. Maybe…

She looked once more into Odira’s hopeful face and sighed. “I’ll set you up for an admission.”

The strain of worry gradually eased from the older woman’s heavy expression. She walked out into the hallway toward the back. “That’s our doc,” she called over her shoulder.

Chapter Two

D eep-voiced curses and shouts careened down the short hallway of the Herald, Missouri, emergency room, followed by the whiff of stale beer and marijuana smoke. The hospital was in for another exciting Saturday night on the shore of Lake of the Ozarks.

Dr. Lukas Bower stepped to an uncurtained window in the E.R. staff break room and stared out at the glimmer of frosty moonlight over the water. Ice crusted the shoreline but didn’t reach the center. He could see the bare branches of trees swaying in the wind like the fingers of skeletons, grasping through the air to catch the wispy clouds that drifted past.

He shivered. This place gave him the creeps, and he’d only been here a few days. He couldn’t say exactly why the town bothered him so much. Maybe it was just because he missed Mercy and Knolls and the friends he’d made there—the life to which he planned to return as soon as the new emergency room was built and his short-term contract here was up. Or maybe it was the depressing, uncooperative attitude of some of the staff here. Or maybe it was his own attitude.

He frowned at his image in the reflection from the window, at the harsh brilliance of fluorescent light that caught and bounced back from his glasses. With so many night and weekends shifts, he’d almost forgotten what the inside of a church looked like on Sunday morning, or how the crisp winter air smelled in the Mark Twain National Forest.

But by no means had he forgotten what Mercy Richmond looked like, the rich alto sound of her voice, the warmth and sweet fragrance of her on those rare occasions lately when they’d seen each other. The thoughts he was having only made things worse.

A shouted epithet echoed through the room once more. He turned from the window and glanced toward the open break-room door. All he’d heard for the past ten minutes was the arguing of the bikers who’d engaged in a brawl down the road at the apartments—if the rickety string of rock buildings by the lake could be called that.

The shouting grew louder. Lukas grimaced. Should he call the police to come and stand guard? With a population of about three thousand, Herald, Missouri, was only about a third the size of Knolls, and the police force had the same number of personnel. This was a rough town.

He walked back into the small five-bed E.R. to see if the X-rays were back on the patient who was shouting the loudest. They weren’t. Brandon Glass, the Saturday night tech, had to take care of both X-ray and lab, and sometimes he couldn’t keep up. He never attempted to disguise his resentment when Lukas gave him more orders.

“I’m not done with you yet, Moron,” one of the bikers muttered to the other through the thin curtain. “If my baby’s got a scratch on her, I’ll take it out of your hide.”

The privacy curtains were open, and Lukas turned around to glance at both men. The mouthy one held an ice pack to his nose, and the skin around his eyes had already begun to darken. Blood matted strands of his brown hair and stained his black T-shirt. Thanks to his running monologue, everybody within earshot knew that his “baby” was his Harley-Davidson. Thanks to his temper—and that of his antagonist in the next cubicle—and a broken beer bottle, his left forearm had just been prepped for suture repair.

Lukas sniffed. The room even smelled like motor oil and alcohol…and pot.

The other biker, who wore black jeans and boots and a black leather vest with nothing else, lay with his head turned way from his adversary. His name was Marin—from which, obviously, his biker buddies had hung the moniker of Moron, like little kids taunting one another. Marin’s antagonist attitude had apparently dissipated with the dwindling effects of the alcohol and other drugs coursing through his veins. His eyes gradually closed as Lukas watched. Good. They were winding down. Maybe the police could concentrate on breaking up barroom fights tonight. And maybe they could spend some time searching for that little girl who had disappeared from the Herald city park last week—if that acre of rusted swings and overgrown grass could be called a park. Lukas had overheard a conversation about that yesterday morning between a couple of policemen who were waiting for their prisoner to be X-rayed. Rumor said it was a kidnapping, and she apparently wasn’t the first child to disappear lately in Central Missouri. It made Lukas sick to think about it.

“Dr. Bower, the films are back,” came a strong, deep female voice behind Lukas.

He turned to see Tex McCaffrey—no one ever called her Theresa—hanging the X-rays up on the lighted panel.

“I had to do them myself. Godzilla’s in a bad mood tonight.” She cast a glare toward the open door that led directly into the radiology department. “Can’t get good help around here anymore.”

Lukas wouldn’t have dreamed of arguing with her. Tex was the paramedic-bouncer in this joint, and she served as the E.R. nurse on Saturday nights and quite a few weekdays, from what Lukas could pick up from the nursing schedule. If something came in she couldn’t handle, she could call for a nurse from the twenty-bed floor—not that Lukas had heard of that happening. He couldn’t imagine efficient, self-assured Tex getting anything she couldn’t handle. In just the short amount of time he’d worked with her, he’d been very impressed by her skills…and her size. He didn’t have the nerve to ask how tall she was, but he had to look up at her to make eye contact, so she was taller than five-ten.

Lukas checked the films, nodded, returned to the sink. Nothing broken. “Ready to help me with the sutures?” he asked.

“Got it all set up. I cleansed it, then irrigated it with five hundred of saline.” She paused and grinned in the direction of the glowering patient in question. She blew a couple of stray strands of curly dark blond hair from her face. “Care to guess his alcohol level? Three-twenty.” She almost sounded proud of him as she stepped in his direction. “I put the suture tray out of his reach.”

Broad-shouldered Tex was in her early thirties and could probably throw the whole biker gang on their kickstands if they got too rowdy. She was also Lukas’s next-door neighbor in a duplex at the edge of town. Her first cousin was Lauren McCaffrey, who was once one of Lukas’s favorite nurses down at Knolls—until she got him involved in this mess.

Lukas pulled on a pair of sterile gloves as he followed Tex’s athletic form to the curtained exam cubicle. She had set out 5.0 nylon for the suture and the requested lidocaine for anesthetic. Good. He glanced at the patient’s name on the chart again, hoping he could pronounce the last name properly. Proper name enunciation helped raise the patient comfort level, and he really wanted this particular patient to be comfortable.

“We’re ready to start, Mr. Golho—”

“I told you when I came in, don’t call me mister,” the muscled, tattooed man growled from beneath the ice pack on his nose. “Nobody calls me mister when I’m on the road.”

Oh, yeah. Lukas glanced at a note Tex had penciled in on her chart. So much for proper name enunciation. How could he have forgotten? “Catcher.”

“Ha!” came a voice from the other side of the curtain. Apparently Catcher’s antagonist hadn’t fallen asleep after all. “Why don’t you tell ’em where you got the name?”

“Shut up.”

“You want to know where it came from, Doc? They called him that ’cause he used to ride without a shield, and he caught bugs in his teeth.”

“I said shut up!” Catcher came halfway off his exam bed before Tex grabbed him by the arm and pulled him back.

“How do you feel about another tattoo, Catcher?” she asked, giving him a leering grin as she eased him back onto the exam bed. “Dr. Bower, here, is gonna test your pain tolerance.”

While Lukas cringed at her choice of words, Catcher repositioned the ice pack on his nose and laid his head back against the pillow. “No prob. Go to it.” He closed his eyes.

Lukas nodded. “Okay, Catcher. Have you ever had an allergic reaction to any anesthetic in the past?”

One eye came open. “Why?”

“Because I’ll be injecting lidocaine into the wound.”

“No, you won’t.” Both eyes were open now, and their dark brown-gray gaze held Lukas in a hard stare.

“Excuse me?”

“No ’caines. Can’t do them.”

No lidocaine? No anesthesia? Lukas did not want to hear this. He did not feel safe sticking a needle and Dermalon into the flesh of an already combative drunk. “You mean you’ve had a reaction in the past?”

“I mean I’ve been busting a cocaine habit, and I’m not going back to that.” Catcher took a firmer grip on his ice pack. “Just do it.”

Lukas looked at Tex and shrugged. Coming to work in Herald had been a big mistake. Oh, Lord, let my fingers be tender, because any moment I may have to eat them.

“Am I gonna die now?” Crystal’s matter-of-fact tone stabbed the silence in the exam room.

Mercy turned from her vigil by the telephone, where she’d been waiting for Dr. Boxley to return her call. Thank goodness Odira was still in the other room. “No, honey.” She got up and crossed to Crystal’s side and pressed the back of her hand against the child’s face. “You’re just sick again. Are you feeling worse?”

“No.”

Mercy gently stuck the wand of the tympanic thermometer into Crystal’s ear. She waited a few seconds to get a reading. The temp was almost back down to normal. “Aren’t you feeling any better?”

Crystal tilted her head sideways, seriously considering the question. “Yes.”

Mercy sat down on the exam stool next to the bed and took Crystal’s left hand in both of her own. “Then why do you think you’re going to die?”

Crystal’s clear water-blue eyes held Mercy’s for a long, quiet moment. “A girl at school told me.”

“Then don’t listen to her.”

“But then I asked Gramma. She said I might, but when I do, I’ll go straight to heaven and I’ll never get sick again.” She paused for a few seconds. “I’d like that.”

As a mother, Mercy couldn’t help imagining her own daughter saying those words. She’d never heard a child so young expressing a wish to die. What hurt the worst was the realization of Crystal’s suffering, both physical and emotional. From a year of treating Crystal, Mercy knew that the little girl, with her soft heart, worried more about her great-grandma Odira than she did about herself. Odira wasn’t in the best health, with her excess weight and high blood pressure. What would become of Crystal if anything happened to her great-grandmother?

“But, Crystal, we want to keep you here with us longer,” Mercy said softly. “I know it might be selfish of us, when heaven is so wonderful, but do you think you could be strong for Gramma and me?” Jesus, what do I say? How can this be happening? She tried not to think about the situation, but the questions grew too numerous too quickly. Her faith still felt so fragile.

“Gramma needs me,” Crystal said quietly. “I’ll stay awhile.”

They heard the sound of Odira’s footsteps and heavy breathing, and then she came lumbering through the open exam-room door. “I didn’t even think about using a Popsicle to get Crystal’s temperature down. Here’s a red one, her favorite. You’ve got a nice little freezer in there. Looks like you’ve got that back room all set up like an emergency room. I bet you use it a lot, what with the hospital—”

They heard the crash of a door flying open out in the waiting room, then the boom of a familiar voice—like a jet during takeoff. “Dr. Mercy! You in here?”

Clarence held the door open for Buck to carry Kendra through. “Dr. Mercy!” he called again. “Got those patients for you.” He tapped Buck’s shoulder and gestured toward the open doorway that led to the exam rooms at the back of the waiting room. When he’d telephoned Mercy she’d told him just to bring Kendra to the first exam room. Clarence knew where everything was. He should. He’d been here enough times.

After he’d finally lost enough weight to get around on his feet a little better, Dr. Mercy had made him come to her office once a week so she could weigh him and check him over. He hated going, hated the way the other patients in the waiting room stared at him and whispered. Still, when Mercy asked him to do something, he did it. If she asked nice.

Mercy came rushing down the hallway, her long dark hair drawn back in a loose ponytail, wearing baggy old jeans and a thick wool sweater. Her dark eyes looked tired. “Hi, Buck. Bring her back here. I have a bed ready for her. I’ll need you and Clarence to help keep an eye on her.” She reached forward and laid a gentle hand against Kendra’s cheek, and some of the tiredness cleared from her eyes. “Hang in there, Kendra. We’ll get you on some oxygen.” She pulled the stethoscope from around her neck, warmed it in her hand for a second, then placed it against Kendra’s chest.

Clarence watched Mercy as she guided Buck into the exam room and helped him lay his wife on the bed. He enjoyed watching her work. When she treated patients, she acted as if they were a part of her own family. Of course, that also meant she nagged them like family. At five feet eight, she was four inches shorter than Clarence, but there were times when she seemed bigger than life, especially when she stood over him as he balanced on that dinky little exam bed wearing nothing but his shorts and a sheet.

But the times she made the biggest impact on him were when she saw his depression and bullied it out of him. He didn’t get that way as often as he used to, but some days the heaviness of his thoughts messed him up big-time. Those were the days he didn’t want to diet, didn’t want to exercise, didn’t even want to get out of bed. That was when her tender toughness showed itself. She could look into his eyes and say, “Clarence, we’re going for a walk. Get your shoes on,” or “You haven’t come this far to give up. Just get through today,” and then she would tell Ivy to keep watch. And Ivy could be the queen of mean.

As soon as Buck eased Kendra down onto the exam bed, Kendra covered her face with her hands. Her body shook with sobs that grew louder and more forceful. “Why didn’t you just let me die?” She turned her head sideways on the pillow, and her light brown hair, as soft-looking as a sparrow’s breast, fell across her cheek. “Everybody’d be better off that way.”

Buck took a deep breath and hung his head, his square jaw working like a grinding machine. Buck was a big man, lots of muscles, with hair cut so short that his ears, which were already big, looked like doorknobs. He had a big heart, and nobody doubted that he loved his wife. Except her.

Clarence wished there was something he could do to help them both.

Mercy leaned over. “Kendra, tell me how you feel. Do you have a bad headache?”

Tears dripped across Kendra’s nose onto the pillow, and her lower lip trembled. “Yeah, real bad.”

Mercy gestured to Buck. “Would you please hook up the oxygen? I want her on a one hundred percent nonrebreather mask.” She reached toward a box beside the bed. “Kendra, I’m going to put this little clip on the end of your finger. It’s attached to something called a pulse oximeter, which will tell me how much oxygen you have in your system. And I’m sorry, honey, but I’m going to have to stick you for blood. It’s going to hurt, because I have to go deep enough for an artery. We’ve got to find out how aggressively we need to treat you. Buck, has she been confused?”

“Yes, at first.” Buck scrambled around until he found the tubing and mask he needed. “On the drive in I had the windows open, and she cleared up. Now she just keeps crying.” He stepped back over to his wife’s side.

Mercy leaned over Kendra again. “Are you dizzy? Do you feel sick to your stomach?”

Kendra’s face puckered. She covered it with her hands once more and didn’t reply.