Silent Pledge

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.

“You don’t know.” She fumbled in her pocket and pulled out a shredded tissue to wipe her nose. “You don’t even know what it’s like to feel this way. You save lives and put out fires for a living. Everybody thinks you’re wonderful. They just think I’m useless, like some leech attached to you.”

“You’re the only one who feels that way. I thought we’d settled this a long time ago.” Buck slowed as they drew nearer to the city and more cars appeared on the four-lane highway.

“Why did you even bother to take me out of the car? I’d’ve been out of your way for good then.”

Clarence winced at that and glanced at Buck’s expression in the light from an oncoming car. She’d cut deep on that one. Muscles tensed at Buck’s jaw, and his eyes filled with the quick kind of tears that even the toughest man couldn’t prevent when his heart was being mangled. He didn’t say a word.

Clarence cleared his throat. “Ain’t gonna work, Kendra.”

She sniffed and dabbed her nose and looked at him.

“Nothing’s gonna make Buck stop this truck and turn around and take you home, because then you might try to kill yourself again, just like Dr. Mercy said. And Buck couldn’t stand that. Losing you would tear him up.”

The tears on her cheeks sparkled in the city light.

“Try thinking about how that’d make him feel,” Clarence said, knowing even that would be hard for her right now. A depressed person had trouble thinking about other people.

And then, as he tried to imagine what might be going through her mind right now, another powerful revelation struck him. He was thinking about other people. All those things Lukas told him were true, about loving your neighbor as yourself, about caring for the needs of others, of giving what was in your heart, and how good that could make you feel. Lukas had said living like that was just about the most important thing in life.

Lukas also said there was one thing more important—to love God first. Ivy had said the same thing, and so had Mercy. When you loved God first, everything else fell into place.

And God took your life and made it mean something.

Clarence blinked and looked out his window at the lights of a residential section of the eastern edge of Springfield. The window reflected the outlines of Buck and Kendra and his own dark bulk, as big as both of them put together.

As Buck touched the brake and turned from Highway 60 to Highway 65, Clarence replayed Lukas’s words in his mind. Was God really using him tonight to help Odira and Crystal and Buck and Kendra?

The thought overwhelmed him and brought tears to his eyes.

He sniffed. Kendra turned and looked up at him. Oh, great, here was big, bumbling Clarence crying and getting ready to drip all over the place.

“What’s wrong?” she asked softly.

The compassionate sound of her voice made his tears come faster, and he didn’t really know why. Maybe it was just because all the pain in this truck cab couldn’t help but affect him.

Or maybe it was something else. Maybe God was here with them. What did Ivy put in those chocolate chip cookies?

“Clarence?” Kendra said.

He shook his head. “I’m okay.” He wanted to tell her she would be okay, too, but he didn’t know. Who was he to predict how everything would turn out in the end?

But maybe, like Lukas was always telling him, things could be better. With prayer.

Could he pray?

Out of respect for Ivy, he always bowed his head when she said grace over the meal—even though he barely had enough of a meal to pray over. If she could talk to God for his sake, why couldn’t he talk to God for Kendra’s sake and for Buck’s?

He closed his eyes and felt tears slip down his cheeks. He knew, from those preachers Ivy listened to on TV, that all he had to do was think the prayer.

God, let me help them. Let me show them everything will be okay because You’re here and You care. You are here, aren’t You?

The sudden, soft touch of a hand on his arm startled his eyes open.

“Clarence?” Kendra said. “You sure you’re not sick?”

He smiled and looked down at her. “Nope, but I could sure use a bathroom. Buck? Think you could pull over at that station over there? Looks like the place is open.”

Marla heard Jerod’s tiny baby voice again. She turned toward him on the bed before she even opened her eyes, but a sudden sharp pain caught her in the chest.

She gasped and grabbed at the spot between her ribs. Her breath came in shallow pockets of air, and she could feel her heart beating faster.

Fear washed through her. Was she having a heart attack? Was this what it felt like?

Jerod cried louder. Marla struggled against the pillows and finally pulled herself up.

About five seconds later the pain went away. Oxygen once more entered her lungs, and the sudden relief washed over her in a powerful wave. What was going on?

She took a few more deep breaths and reached for her crying baby, but before she could pull him into her arms, the piercing shaft stabbed her again and forced her backward. She cried out from the shock. “God, help!”

Again the pain subsided and her lungs filled. Was this some weird kind of asthma attack? It didn’t feel like one. And there hadn’t been the usual warning. Still, her inhalers—the ones her doctor gave her for free because she couldn’t afford them—were in the top drawer of her rickety bedside stand. She’d better get them out.

More carefully this time, she reached toward Jerod. He needed changing before she did anything else. She picked up one of the last three clean diapers, and as she did so, she pressed against the new bruise on her right calf.

“Ouch!” She couldn’t hear her own voice over the sound of Jerod’s squalling. And she barely caught another breath before the shaft struck her chest again, harder than before. She dropped the diaper on the floor and gasped. The pain grew worse, and the dim room went black for a few seconds.

But Jerod’s cries brought her back.

She took shallow breaths, willing her heart to slow its beating. She felt weaker now, and she didn’t have the strength to pick up the diaper. She pulled open the drawer and took out both inhalers. While Jerod continued to cry, she fumbled with the sprays. She could barely concentrate on breathing.

Someone pounded from the other side of the paper-thin wall at the head of her bed. “Shut that kid up in there!” came a rusty female growl.

The woman must be a part of that biker gang. Marla wanted to tell her to shut up, but she didn’t have the courage, or the energy.

Another throb in her leg made her grimace. If she’d worn the stockings they gave her, she would have had some protection.

She reached down to unfasten Jerod’s dirty diaper when she felt the hit again. This time the pain shocked her like a kitchen knife jutting through her ribs. She nearly fell on top of the baby before she could push herself away. The room grew blacker. In desperation she slid from the bed to the cold, dirty floor and groped for the telephone, but then she remembered that it had been disconnected.

She had to get help. What if something happened to her? Jerod would be all alone. He could freeze in this room before daylight.

As the pain once more let up, she glanced toward the thin wall. “Help me!” she called as loudly as breath would allow. “Somebody help me, please!”

She heard a muffled groan, and again someone pounded on the wall. “Turn off that TV!”

She closed her eyes in hopeless despair. “No, God, please, don’t let this happen.” With the last of her strength, and the healthy cries of her cheering section, she shoved the inhalers into the pocket of her pajama top, scrambled to the door of the tiny efficiency apartment, unlocked it, and used the threshold to pull herself to her feet.

That was a big mistake. Everything went black again. She dropped to her knees and pushed the door open and felt the bite of winter wind brace her exposed flesh.

“Somebody help me!” she called out into the night. “Please!” As she said the last word the pain came again, and her baby’s cries grew softer as she slumped across the front walk.

Clarence shivered as he climbed back up into the darkened cab of the truck. “Sorry about that, guys. Couldn’t help it. Mercy has me taking this stuff that—” He broke off when he realized that Kendra was crying again, and Buck was sitting at the steering wheel, facing forward, his hands practically white from gripping so hard. The human emotional pain was thick enough in this truck to cut with a chainsaw.

They’d been arguing again. He felt guilty for making them stop. While he was gone, they had just hurt each other worse. But maybe he could help them.

“Look, you two, it’s really late and you’re tired, I know. I’ve gotta tell you, things aren’t gonna be this bad all the time.” He reached over and patted Kendra on the arm. “I’ve been there. I wanted to die, but I don’t anymore. There really are people who care about you, and even though you don’t see it right now, you’re gonna have to trust that I’m telling you the truth.”

Buck’s hands loosened on the steering wheel, and he shot a glance across the cab at Clarence, then at Kendra. She didn’t move. It was as if she felt her husband looking at her, and she refused to give him the satisfaction of reacting.

Clarence hoped he was doing the right thing. “Would you just let me do something to help?” He waited until they both turned to look at him, and then he took a deep breath and let it out. How hard could it be? “I want to pray for you.”

He couldn’t believe he’d said the words until they left his mouth. Suddenly he thought he might have to go back to the bathroom.

He saw Buck’s eyes widen, and he felt a hot flush rushing over his body. Where’d he get the stupid idea he could pray? Who’d’ve thought that he, church-hater Clarence Knight, would pull something like this at three-thirty on Sunday morning? Had to be lack of sleep.

But then something happened to Buck’s expression. Surprise seemed to gradually change to hope. Maybe it was the dim light in the cab or the weird shadows cast by the blinking sign on the front of the convenience store, but it looked real. Clarence remembered Ivy’s constant harping: “‘Ask and it will be given to you….’ God answers our prayers.” And he didn’t know of anybody who needed prayer more than these two right now. And there wasn’t anybody else in this truck.

“Yeah, I know, sounds funny coming from me, but what could it hurt?” he said at last. “I mean, what’ve you got to lose?”

Buck sighed and closed his eyes. “Nothing, Clarence. We’ve got nothing to lose. Go for it.” He bowed his head.

Kendra turned and stared at her husband for a long moment. Clarence watched her. For a few seconds some of the pain left her eyes.

Then Clarence bowed his head, like Ivy always did. “God, first of all I need to say that we’re praying this in the name of Jesus, just so I don’t forget at the end.” He didn’t understand all that yet because he’d never tried that hard to listen, but he knew Ivy always said these words to end her prayers. “And then I want to ask You to give Buck and Kendra some of the love I think You’ve been showing me lately. And then I want You to stay with Kendra after Buck and I leave, because I think she’s going to need You worse than anybody. And that’s all I can think of to say right now.” He raised his head and looked at them. “Guess that oughta do it.”

Chapter Six

L ukas was drifting to sleep in the call room early Sunday morning when he heard the blare of a siren. He opened his eyes to the sight of orange and red flames racing across the wall, and he sat up with a shout.

And then he realized that the flicker was from an ambulance outside. Its lights penetrated the window blinds in fiery streaks of color. Lukas pushed his blanket back and got out of bed. Sometimes he still had nightmares about the explosions in October, of following Buck Oppenheimer through the collapsing E.R. and fighting the inferno that nearly engulfed them.

The telephone rang. He reached over, felt for his glasses on the desktop and picked up the receiver.

“Dr. Bower, this is Tex,” came the voice over the phone. She sounded irritated, but with Tex’s deep voice it was hard to tell. “Quinn and Sandra are bringing somebody in. Of course they didn’t radio us, so I don’t know what’s going on. I tell you, that man should not be wearing a uniform. Want to join us?”

“I’m on my way.” Lukas grabbed his stethoscope from the desk and rubbed at the lenses of his glasses with the hem of his scrubs as he squinted his way out of the call room.

When he reached the E.R. he saw Quinn and Sandra wheeling a slightly overweight, unresponsive young woman into the E.R. from the ambulance bay while Tex held the door and helped push. Quinn was doing chest compressions and an IV had been established, with a needle and tubing connected to her left arm. The patient had been intubated, and an ambu bag was attached to the tube, which Sandra squeezed rhythmically to help the woman breathe. Sandra was pushing the cot with her free hand. The woman had been stripped to the waist. The odor of sour milk lingered around her.

Lukas rushed toward them. “Carmen,” he called to the secretary over his shoulder, “call a code and launch a chopper.”

Carmen swiveled in her chair and stared at him blankly. “What?”

Lukas shook his head. “Get me a nurse down here from the floor. Tell her we’ve got a code. Then call our airlift service and get them here.” He grabbed the end of the gurney and helped Sandra and Tex push it inside. “What’s the rhythm?”

“V-fib,” Quinn said. “I’d just intubated her on scene, and then she crashed.” His words came fast, almost as if he were trying to convince Lukas he’d done everything right. “She was unresponsive, and she had inhalers in her pajama pocket. Had to be asthma—”

“How many times have you shocked?” Lukas asked.

“Three with one dose of epi.”

“What?” came an irritable voice from the doorway.

Lukas turned to find Tex already in the trauma room, snapping the plastic lock from the tool chest-shaped crash cart beside the exam bed. “That’s not current ACLS guidelines,” she muttered.

On the count of three, they transferred the patient from the gurney to the bed, and Tex immediately replaced the leads to the hospital monitor on the woman’s bare chest. The v-fib rhythm continued, with the line racing across the monitor screen above the bed in an irregular steak knife-edge pattern. The monitor emitted a high, continuous beep.

“Well, you got your intubation this time, Dr. Bower,” Quinn muttered. “Hope you’re happy, because it’s not doing her any good.”

Lukas ignored the comment. “What drugs have you given?”

“I just finished the first dose of epinephrine as we pulled in.”

“Then we’ll have to shock again quickly. Stop compressions but keep bagging.” Lukas positioned his stethoscope on the woman’s chest, listened, frowned. “I don’t hear good breath sounds.”

“So? She was obviously in broncho spasm,” Quinn snapped. “She had inhalers, remember? Or weren’t you listening?”

“And you just took that for granted?” Tex’s voice rose like mercury in a hot room. If she saw Quinn’s flush of anger or glare of growing resentment, she didn’t acknowledge it. “Did you even check the placement of the tube when you did the procedure?”

“What good would it do if she was in broncho spasm?” Quinn’s lips thinned and whitened.

Lukas raised his hand for silence and repositioned the stethoscope over the belly. Now he heard breath sounds, and he felt a chill of foreboding. “It’s in the wrong place. The tube’s in the esophagus instead of the trachea.” The oxygen was flowing straight into her stomach. She wasn’t getting any oxygen. “We have to reintubate.” He turned to the others. “Sandra, stop bagging and take over the compressions. Hurry! Tex, get me a syringe, then get the suction ready.”

Tex moved quickly. “It’s one thing to miss placing the tube correctly, Quinn,” she said as she worked. “That’s happened to all of us. But to leave it there…unforgivable! You might as well have placed a pillow over her face and suffocated her! Why didn’t you check?”

Quinn’s jaw jutted forward. “I told you she had inhalers. If you hadn’t made such a big deal about that old man’s tube earlier, I wouldn’t have even wasted my time on this one.” He took a step backward, then pivoted and stalked out of the room.

“No!” Lukas shouted after him. “Quinn! You don’t walk out on a code!”

“Just let him go, Dr. Bower,” Sandra said, her soft voice growing softer as she worked hard to continue chest compressions. “He won’t listen to anybody. I tried to get him to check his work, but he was in too big of a hurry. If I can’t get another partner I might as well quit. This is stupid.”

As soon as Tex handed Lukas the syringe, he attached it to the tiny balloon at the mouth end of the endotracheal tube and deflated the air from the gear that kept it in place. He pulled the tube out of the patient’s mouth and checked the monitor to make sure the rhythm was still v-fib.

“It’s time for another shock. Sandra, bag her again.”

Sandra stood at the head of the bed and placed the bag valve mask over the patient’s face. Tex charged the defibrillator to 360 joules and handed the paddles to Lukas.

“Clear,” he called, and made sure everyone was out of touch with the bed, then pressed the paddles to the patient’s chest. The body jerked into an arch with the sizzle of electric current, then fell back onto the bed. Everyone looked at the monitor. The rhythm had changed.

“All right!” Tex exclaimed. The v-fib had stopped, and now the blip danced across the screen with more powerful strokes.

Lukas pressed his fingers against the woman’s throat, feeling for the carotid artery, and the hope that had flared within him died painfully. There was nothing. “Oh, no. Pulseless electrical activity.” This was worse! They couldn’t break this new rhythm with a shock. What was happening here?

“Sandra, bag her again,” he said.

The nurse from upstairs came rushing into the room, and Lukas gestured to her. “You’re just in time. I want you to do chest compressions.” What could be causing this? “Let’s intubate now, Tex. And let’s get some fluids in.” What would cause respiratory arrest and pulseless electrical activity in such a young woman?

“Dr. Bower,” Sandra said softly, “the bra we cut off her was a nursing bra.” She indicated the young woman. “She’s been nursing. She was all alone outside the apartment building.”

Lukas felt as if he were on a treadmill going twenty miles an hour. He had to keep up. “Carmen, contact the police,” he called toward the secretary as he worked. “They need to check the area for a baby!” He had to focus. If the woman was recently pregnant…severe respiratory distress…pulseless electrical activity…He caught his breath.

“Oh, no, Dr. Bower,” Tex groaned. “That sounds like massive pulmonary embolism.” Lukas nodded. A blood clot in the lung was deadly.

Quinn came rushing back into the room, puffing from exertion and wiping his eyes with the back of his hand. “I’m sorry, Dr. Bower. That won’t happen again. I mean it. I’m sorry. I was just so—”

“Can it, Quinn,” Tex snapped. “We don’t have time tonight for your theatrics.”

Lukas ignored the interruption. “Let’s get her set up for a pacer, and get me dopamine.” Now he knew what to do. But was there time?

Marla drifted in a dark fog, for a few moments far from the pain and cold and terror. But the drifting didn’t last. Her baby…Jerod! She could hear echoes of his cries, and she couldn’t get to him. He needed changing. He would have to be fed again soon, and there was no one to help him.

And then another voice reached her from some distant place…. “We’ve got a pulse….” Marla’s chest hurt again, and somebody was pushing her, hard. Her throat hurt. She felt the pressure in her ribs and heard more people talking around her…. “We’ve got a blood pressure, Dr…” She felt something hard pinch her arm…. “The helicopter’s landing, Dr….”

Something brushed across her shoulder, and light beamed past her closed lids. But she couldn’t open her eyes. She felt the rise and fall of her chest, and the continued sharp pain under her ribs, as if someone was stabbing her from the inside out.

The pain was too much. Even with the echoes in her memory of Jerod’s cries, she couldn’t force past that barrier of pain. She tried to form words on her lips, but something was in her way. She couldn’t speak. Jesus, take care of Jerod. He’s so little and helpless.

She could almost hear her baby’s cries again, wished she were back in the cold, grungy room with wet diapers and neighbors banging on the wall for silence.

And then, as if from somewhere besides the room where she lay, a strong, familiar voice reached her, a voice different from the ones that shot around her with businesslike efficiency. This one was unhurried, calm, even joyful. “It’s time to come home, Marla. I’ll be here with you.”

The sound of the voice permeated her and gave her a feeling of warmth, and she wondered if she were in a coma. But that voice… Dad? She thought the word and heard her own voice, though her mouth did not move.

“Remember the verses I read for you so often when Mom died? ‘The righteous perish, and no one ponders it in his heart—devout men are taken away, and no one understands that the righteous are taken away to be spared from evil.’”

You mean I’m dying? she asked.

“‘Those who walk uprightly enter into peace—they find rest as they lie in death.’”

But, Dad, I’m not righteous, she said sadly. Look what I’ve done.

“Your righteousness has been purchased. It’s time to come home.”

But my baby…

“Dr. Bower, I’ve lost the pulse,” came a brisk voice from nearby.

The wall of pain slipped down and pulled away. Marla felt as if a blanket of comfort were being wrapped around her. She could see again. Her father was holding out his hand.

“No blood pressure,” came another voice, this one receding, growing fainter. “Doctor, we’ve got asystole…flat line!”

But the alarm in the fading voices did not disturb her. Dad spoke again. “I have some people for you to meet.” And he took her in his arms and led her home.

Lukas called the code long after they lost the pulse and the rhythm flattened, battling his own sense of horror and pain as he’d battled to keep death from taking this young mother. He called time of death for the record, then took a deep breath and willed himself to be composed.

Sandra sniffed with silent tears as she gathered the trash that had collected on the floor. Tex muttered under her breath as she disconnected the monitor from the leads. She paused and glanced at Quinn, her green cat’s eyes narrowed with angry disgust. She shook her head and resumed her work.