Sacred Trust

Shoving open the glass doors into the emergency room reception area, Mercy barely slowed her stride. “Carol, where’s Grandma?”

“She was in exam room eight, but they called a code and moved her to trauma room one.”

Mercy stopped and wheeled back. “What? There’s not supposed to be a code!”

Carol shook her head in sympathy. “I’m sorry. Dr. Bower called it. He had to.”

“We’ll see about that.” Mercy swung back on course. First, administration had arbitrarily decided to bring in a full-time E.R. doc from Kansas City, and now this hotshot doc had decided to ignore a perfectly legal DNR request. Perhaps he’d never learned to read.

She pushed through the swinging double doors that pretended to lend privacy to the open emergency room. A secretary manned the central station. All other hands were gathered in the trauma room, six people altogether, including Grandma’s frail, still body on the bed. Others worked with quick efficiency, responding without question to the soft-spoken commands of a slender, brown-haired man in green scrubs. He knew the drill well.

“Get me a blood gas…. Push the epi now, Lauren…. Any pulse…? Continue CPR.”

Mercy stopped just inside the doorway as a nurse from upstairs pushed methodically against Grandma’s chest and another bagged her.

“What’s going on here?” Mercy demanded. “Doctor, what are you doing to my grandmother?”

He looked up, his blue eyes behind gray-framed spectacles holding her with gentle concern. “You must be Dr. Richmond. I’m sorry, but as per your mother’s request, we are attempting resuscitation.” He turned back to the table.

“Stand clear,” he called as he prepared the paddles to send a jolt of electricity through Grandma’s chest. He placed one paddle above her right breast, and the other paddle he placed to the side below her left breast.

Mercy stood in stunned horror as the frail body jerked, arms flying out, legs up. Mercy had done the same procedure herself many times during her shifts in E.R. but not on someone she loved like Grandma.

“Check pulse,” Dr. Bower said.

Lauren gently felt the carotid artery for a moment, then shook her head. “Nothing, Doctor.”

“Continue CPR. Prepare more epi, and I need lidocaine, 1.5 milligrams per kilogram. What’s that blood gas?”

“Not back yet, Doctor.”

Mercy stepped toward him. “Dr. Bower, I’m her granddaughter. Stop this code.”

He was barely taller than her five feet eight inches, but his expression held calm authority. “As I said, Dr. Richmond, your mother—”

“I heard what you said, but my grandmother signed a DNR form weeks ago. Surely that has some bearing on this case.”

“You know that form does me no good. Believe me, I wish it did.” Dr. Bower’s voice betrayed frustration. He lowered his voice. “Your mother showed me her papers for legal power of attorney. Her order is to resuscitate.”

“Forget that order. As a fellow physician—”

“I can’t break the law, Dr. Richmond.”

“Don’t abuse this patient any more than she has already been abused!”

Dr. Bower grimaced at her words, sighed and shook his head. “I’d love to comply, but I can’t. If you want to sway the decision, please talk to your mother. I tried.” He turned back to the table. “Stop CPR.”

The monitor showed an irregular, sawtooth pattern. Grandma’s heart was in ventricular fibrillation. Mercy hoped it would not change back.

“Where is my mother?” she asked, her voice heavy with frustration.

“She was in the private waiting room when I left her.” Dr. Bower shook his head at the monitor. “No change. We need to shock again.”

He charged the defibrillator to 360 joules. “Clear.”

Mercy stepped back and almost turned to leave, but she couldn’t. A sort of morbid amazement held her there, watching the scene of horror play out before her. She gripped the door frame. A loud pop and flash preceded the stench of burned flesh. An electrode had blown. Lauren and Dr. Bower checked for signs of life while another nurse replaced the electrode.

“No change,” Dr. Bower said.

Mercy felt sick. Mom should be here to see what her crazy order was doing to Grandma. But then, Mom, too, had suffered enough.

Again they shocked, and Mercy could not bring herself to leave. CPR resumed. The longer they worked, the more convinced she became that Grandma was already far past their so-called help. And that meant she was also past any more pain.

Dr. Bower called a halt a seeming eternity later. Mercy did not move until he pronounced the time of death.

She stepped from the doorway as the code team cleaned up the mess of scattered monitor strips and plastic wrapping that had been tossed on the floor during the code. One by one, they filed out past her, some avoiding her eyes as if ashamed of the work they had just done.

Lauren stopped and laid a tanned, slender hand on Mercy’s shoulder. “I’m sorry, Dr. Mercy.” Tears filled her pretty green eyes.

“So am I, Lauren. Thanks for calling me over.”

“It was Dr. Bower’s request. Your mom told us not to.”

“Figures.” Mercy was thirty-nine, and Mom had still not overcome the need to hem her in with maternal over-protectiveness. Often it rankled. It showed lack of respect for Mercy’s ability to cope. For goodness’ sake, she was a doctor.

Dr. Bower paused for a moment at the bedside, his hand resting gently on Grandma’s arm, his head bent and eyes closed. When the last team member had left the room, Mercy walked over to stand beside the man and gaze into Grandma’s silent, scarred face.

Dr. Bower raised his head and looked at her. “I’m sorry, Dr. Richmond, I’ve been told she was a much loved lady.” He had a kind voice, deep and masculine, but with a gentle quality.

Mercy nodded, dry eyed. “She was.”

“I apologize for my abruptness. I could have handled the situation better.”

The sincerity in his voice disarmed her. She’d been prepared for battle when she came in here. Now she felt spent. Empty. “I wouldn’t let you.” She shook her head. “I had always sworn that I would never do to another doc what patients and families have done to me, and here I led the pack—aided by my mother, of course. I know the law, Dr. Bower. It’s just that she’s my grandma.” Her voice caught, and her professional demeanor abandoned her for a moment. Her throat ached with tears she refused to shed. She was grateful for the man’s thoughtful silence.

“My mother died of metastatic breast cancer three years ago,” he said after a few moments. “I remember the feelings of helplessness and anger. I wanted to do so much more for her, and there was nothing more to do except keep her comfortable. Had we revived your grandmother…”

“I know.”

There was another pause, then Dr. Bower asked, “Would you like me to go with you to tell your mother?”

Mercy took a final look at Grandma and turned away. “No, thank you. It’ll be best coming from me.”

He hesitated. “Did you not have a chance to discuss the DNR form with your mother?”

“I tried. Mom wouldn’t talk about it.”

“It’s a difficult subject to discuss. I gathered that your mother was the main caregiver.”

“Yes. I tried to help more, just to keep her from exhausting herself.” Mercy shook her head. “Mom can be stubborn and self-sufficient. She’s lost so much sleep lately…she hasn’t been her usual, rational self—not that she’s ever been a perfect example of rationality.” Why was she talking to this stranger like this? And a man, to boot.

“I know what you mean,” he said. “My father was the same way after Mom’s death. Be patient with your mother. This kind of grief and exhaustion can do strange things to the mind. And it can last a lot longer than anyone expects.”

“Let me talk to Mom.” She forced a smile and looked again into those blue eyes. “It’ll be easier for all of us.”

A few moments later, after taking a drink of water from the fountain and a few deep breaths to compose herself, Mercy opened the door to the private waiting room. The first thing she saw was Mom standing there in the middle of the floor, glaring in her direction.

“Where is that blasted doctor? I told them not to call you yet.” Ivy Richmond turned to pace across the room toward the thickly cushioned sofa on the far side, then back again. “It’s been over an hour, and no one has seen fit to tell me anything. Do you know that man came in here and asked for permission to just let Mother die?”

“Grandma had an advance directive, Mom.”

“How can he just take it upon himself to decide who is and who isn’t worthy to live? Mother couldn’t have known what she was doing when she signed that form.” Tears filled Ivy’s eyes. “Oh, Mother.”

Mercy’s eyes grew moist, too. She’d thought they would have been drained of emotion months ago, but the stages of grief had continued to batter them. Right now confusion ran high, and Mercy knew Mom was exhausted and weak from too many nights of sleeplessness.

Ivy jerked another tissue from the box on an end table and blew her reddened nose. “I wish they hadn’t called you against my wishes.”

“It’s a good thing they did.”

Ivy stiffened at those words.

“She’s gone, Mom.”

Ivy’s face twisted into a mask of pain. “Mother wasn’t ready to die.”

Mercy closed the door behind her and took a seat on the nearby recliner, perching on the edge with her hands in her pockets. “We’re the ones who weren’t ready.”

Ivy turned away. “I can’t believe my own daughter, the learned doctor, cannot grasp the reality of an afterlife.”

Mercy suppressed a sigh. Now was not the time to bring up that old argument again, but if Mom had found peace in her so-called God these past few years, where was that peace now?

Ivy reached up toward her chest with both hands and bent forward, as if on a sob.

“Mom…?”

Ivy shook her head.

Mercy stepped up and laid a hand on her mother’s shoulder. “Mom? Are you okay?”

Slowly Ivy straightened and turned around. Her face was as gray as the clouds gathering outside, but she nodded and patted Mercy’s hand.

“I’ll be fine. This just brings back so many memories.”

“I know.” Mercy’s father had also died a lingering, painful death five years ago. That was when Mom had suddenly started babbling about “finding Jesus.” At the time, Mercy was sure she would get over it, but she hadn’t. Where was her Jesus now?

Ivy took a deep breath and squared her shoulders. “That doctor is dangerous. He doesn’t hold human life sacred. He tried to manipulate me into allowing Mother to die. He was going to go over my head to keep from doing anything for her. Did he even try to save her?”

“He called a code. I saw it.”

“How hard did he try?”

“He did everything to resuscitate her. He had already begun when I arrived.”

“And he didn’t revive her at all?”

“No.”

“Is that normal for someone whose heart has just stopped?”

“It would be hard for me to say, Mom. Everyone is different. Most of the codes I get have been out for at least fifteen minutes.”

“I think he could have bought us more time. Do you know that he as much as told me he had other patients who needed him more than she did and that doing more for her would be inhumane?” Ivy put a hand to her chest again, then quickly dropped it.

Mercy held her mother’s dark gaze and said nothing.

“Jarvis didn’t want this new doctor here in the first place, did he?” Ivy asked. They both knew that Dr. Jarvis George, E.R. director, had been bitterly opposed to bring in a full-time physician for the E.R.

“No, and neither did I. But to be fair, I disagreed with the code, too. I even tried to stop him. He did what he felt he had to, and I can’t blame him for that. Granted, he could have been a little more tactful with you, but…”

“I’ll have a talk with Jarvis. Maybe he can put my mind at ease about this guy, but if he can’t, I may have to have a talk with administration.”

Lukas Bower could find his way around an unfamiliar hospital or a forest trail almost by instinct. Let him loose in a strange town, however, and he would be lost the moment he stepped out the door. By the time he entered the front door of the cantina—little more than a house with a small unlit sign in the front yard—where he was supposed to meet the others Wednesday night, the tiny place was nearly empty and a Hispanic waiter was clearing the tables. It still smelled wonderful, full of smoky spices and warmth.

Lauren waved at him from the far back left corner, where two smaller tables had been pushed together for a larger group. Much larger. Only Lauren was left.

“You’re late,” she called out, still waving for him to join her.

Lukas stood, staring at her in dismay. He had no desire to be rude, but he also had no desire to have dinner alone with a nurse who worked with him. Was he that late? Where were the others? Still, how could he turn around and walk out now?

He stepped hesitantly toward the back. “Sorry. I had to finish my charts; then I had to find this place. That turned out to be more of a challenge than I’d expected.” He glanced at his watch. It was eight-thirty and the shift had ended at seven. Okay, so he was pretty late. “How long have you been waiting?”

“It’s only been about twenty minutes since the last person left. Carol and Rita had to get home to their hubbies as soon as they ate. Connie and Ron, the ambulance team on duty tonight, got a call. Beverly and Buck had a lion to feed, and I know for a fact that Beverly took that Mustang by the car wash to clean it out.” Lauren indicated the cluttered stack of plates that had not yet been cleared. “Sorry, you’re stuck with just me.” She signaled the waiter and kicked out a chair across the table from her. She had released her long, blond hair from its rubber band, and wispy tendrils framed a face devoid of makeup. “I ordered for you, and they’ve been keeping it warm in back.”

Lukas wished she hadn’t done that. “Could they make it to go? I’ll just take it with me. There’s no reason for you to have to sit—”

“Sorry, too late.” She gestured toward the waiter, who carried out a sizzling platter of chicken, onion and peppers, and a steamer with hot flour tortillas. “I overheard you telling one of the patients today how much you loved authentic chicken fajitas, so I took the liberty of ordering them for you. Come on, sit down. They won’t taste nearly as good cold.”

This had been a stupid idea. Why had he agreed to come? But Lukas was hungry, and that hunger overrode his sense of caution. And this wasn’t a date. He pushed the chair back in that she had kicked out for him, and instead he took the chair next to it, in spite of the mess of cluttered dishes he had to move aside. He would not get lured into an intimate dinner for two, or even the appearance of one.

If Lauren took offense at his small act of rebellion, her expression hid it well. She leaned back and rested her feet on the rail of the chair he had discarded. “Dig in, Doc. I know you’re hungry. I don’t think you’ve eaten anything since lunch, have you?”

“Breakfast, actually. Late breakfast.” He bent his head in a short, silent blessing, then looked up to find Lauren nodding with approval. Big deal. The nurse in KC had pretended to approve of his faith, too, at first, until it got in the way of other things she wanted.

“Found a church yet?” Lauren asked, watching Lukas overstuff his first tortilla.

“Not yet. I haven’t had a chance.” He took a large bite, the force of which pushed half the meat and veggies back onto the plate from the wrap. The smoky heat so filled his mouth and senses that for a few seconds he didn’t realize Lauren had resumed talking.

“…Covenant Baptist, just about four blocks from where you live.”

Lukas shot her a wary glance as he chewed and swallowed. “You already know where I live?” He’d just been there a few days.

“Oh, don’t worry, I’m not checking up on you. The real estate agent who sold you the place is a friend of mine,” she explained as he took another bite and washed it down with water. “You don’t grow up in a small town like Knolls without getting to know most of the other natives. Everyone’s talking about the new full-time E.R. doc, and they probably all know where you live.”

Lukas gulped another bite without comment. He, too, was from a small town, and because of that he knew he probably wouldn’t be accepted here as one of them for twenty years.

“So do you think you’ll come?” she asked.

He stopped chewing and looked at her.

“To church Sunday.”

“I’ll probably go somewhere.” He built another fajita, this time with less filling, while Lauren chatted on about the hospital.

He learned quite a few interesting facts about his new place of employment, such as the doubled volume of patients seen through the emergency department since Mrs. Estelle Pinkley took over as administrator five years ago. The lady had, according to Lauren, brought the hospital out of the computerless dark ages and out of debt for the first time in over a decade.

“But you’d better watch yourself,” Lauren warned as Lukas finished his last bite of chicken. “The E.R. director doesn’t want a full-time physician working here.”

“Why not?”

She shrugged. “With Dr. George, who knows? He fought Mrs. Pinkley about the computers, too. He’s about ready to retire, and he doesn’t like change.”

Lukas glanced around to find the waiter flipping around the Closed side of the sign in the front window. “Looks like we should be leaving. Will they give us a ticket at the cash register?”

“Don’t worry, I paid it already.”

Lukas reached into his pocket and pulled out a ten-dollar bill. He smiled as kindly as he knew how and placed the money on the table in front of her. He knew as he left that he was behaving like a jerk. It bothered him. Lauren seemed like a good, caring person, and she was probably just being kindhearted to a newcomer. Still, he wasn’t going to take any chances.

Chapter Four

T hursday morning Lukas arrived at work later than usual, dripping with dew from the light rain outside. He could have kicked himself for oversleeping. The shift change would just have to be with the emergency department director, Dr. Jarvis George.

“Morning, Judy. Any patients waiting?” Lukas asked as he checked his mail cubicle.

“Good morning, Dr. Bower.” The E.R. secretary for today’s shift turned from her computer and smiled at him. “Dr. George is in the laceration room sewing a nursing-home patient who was injured when she became combative. We’ve got an irritable child in five and a possible sprain or fracture in seven. Dr. George hasn’t seen them.”

Lukas glanced at his watch. Even though he was ten minutes late, he had time to change into his scrubs. The patients weren’t critical, and Dr. George would want to finish his own sutures. “Thanks, Judy. I’ll be right back.”

He glanced into the emergency room and glimpsed the director bent over his patient. Jarvis George’s graywhite hair, army-cut short, could have depicted a kindly older gentleman who loved his patients and whose patients trusted and loved him. Maybe that was the case. Lauren’s warning about Dr. George echoed from last night.

When Lukas walked into the laceration room a few moments later, he was friendly and upbeat.

“Good morning, Jarvis. Do we have any patients you want me to take?” He glanced at the elderly female who lay prone on the table, her nearly fleshless tailbone and hip exposing a small gash beside a partially healed bedsore.

The older man straightened from his work and pierced Lukas’s friendliness with a glare. “I don’t know how you were taught to address your superiors in your Kansas City hospital, Dr. Bower, but I prefer a little less familiarity, if you don’t mind.”

Lukas managed not to stare. “Excuse me, Dr. George. I meant no disrespect. I guess I am accustomed to a more casual atmosphere.” Wow, Lauren was right. There seemed to be a problem here.

Dr. George returned to his sewing. “You can see to the whiny kid in five. He’s got an earache. The patient in seven has a probable sprained ankle. I’ve been busy sewing, and since you came in late, I haven’t had a chance to—Ouch!”

Lukas had watched it happen, had seen the needle pierce the glove in the palm of the man’s left hand, and winced as he imagined the puncture.

“Can’t believe I did that,” the director muttered to himself. He shot a quick look toward Lukas, as if blaming him for the distraction.

Lukas stepped out of the room. “Nurse,” he called and found redheaded Beverly coming from the child’s room. “We need a needlestick protocol in here, please.”

“I beg your pardon,” Dr. George rumbled as he stepped around the laceration table and out toward Lukas. “Nurse, ignore that request,” he said, not taking his gaze from Lukas.

Lukas cleared his throat, staring back at his new director in dismay. “I’m sorry, Dr. George, I didn’t mean to offend. I’ve just been reading about protocol, and—”

“I’m aware of protocol, Bower,” Dr. George snapped. “I helped write it.”

Lukas winced. He was not winning a friend here.

The director waved Beverly away, still glaring at Lukas. “If you will kindly take care of your patients and leave me alone with mine, I’ll be able to get home sometime this morning.”

“Yes, Dr. George. Sorry. I’ll go see my patients now.” Lukas hustled away, resisting the urge to ask the director if his tetanus was at least up-to-date.

The sprain turned out to be a hairline fracture. The earache did not require antibiotics. After Lukas had splinted the ankle and convinced a distraught mother that the medicine she requested could actually set her child up for a more resistant strain of ear infection later, Lukas finished his charts and checked for more arrivals.

“Think I’ll go to breakfast now, Beverly,” he said when he found no other patients listed on the schedule board. He started down the hallway, then turned back. “Oh, by the way, where are the incident report forms kept?”

Beverly raised a brow at him. “They’re filed in the secretary’s cabinet. Tell me you’re not going to report Dr. George.”

“Rules are rules. Even if he doesn’t follow protocol, I’m required to make a report. It’s plainly listed in the little booklet I received the other day.”

“You’re going to find that we don’t always follow the rules to the letter around here.”

“Thanks, Beverly, but safety comes first. There’s a good reason for those rules.” He’d gotten into trouble before when he’d been lenient with a nurse and overlooked a break in protocol when she had violated a direct order from him. It gave her a chance to falsify the record.

“He’ll find out. He knows everything that goes on around here,” Beverly warned.

He waved and left for breakfast.

Theadra Zimmerman—Tedi to anyone who valued life—couldn’t concentrate. She could barely keep her eyes open even to look outside, where the rain fell as if God had decided to wash off the new leaves and speed the growth of the grass.

Good thing she sat behind Jeff McCullough in class. His broad shoulders would cover her from Mrs. Watson’s probing eyes and catch-you-off-balance questions. The fifth-grade teacher always seemed to ask Tedi more questions than anyone, and she even expected better answers from Tedi than she did from Abby Cuendet, who always got straight As.

Tedi leaned her chin down onto her fists on the desk as Mrs. Watson droned on about new discoveries regarding the rings of Saturn.

Dad and Julie had fought last night, the first time Tedi had heard them fight since they’d begun dating two months ago. Julie didn’t like Dad drinking so much. Big surprise. Tedi didn’t like it, either, but that didn’t stop him. Last night she’d sat up in the hallway, eavesdropping, wondering if maybe he would listen to Julie, even though he wouldn’t listen to anyone else.

When Julie finally left, she’d slammed the front door behind her. Apparently Dad had not listened to her, either.