Fatal (21 page)

Ellen jumped up and threw her arms around Rudy’s neck.

“I knew you’d come through. Rudy, you’ve been just the best friend in the world to me.”

“That’s not exactly the hardest thing I’ve ever had to do,” he said, looking away.

 
CHAPTER
18

“
CODE BLUE, ICU . . . CODE BLUE, ICU . . .
”

Matt was on Med/Surg 2, writing orders regarding Nikki’s transfer to a private room, when the code call sounded. There was little doubt in his mind that the subject of the code was the sixty-something woodsman who had taken her bed. Matt had passed him in the corridor as he was being brought into the unit, and had noticed the pallor around his mouth and slight mottling of his skin, suggesting that his heart was not pumping effectively.

Matt raced to the unit, arriving simultaneously with two nurses and the respiratory therapist. Although he didn’t regret the decision to switch from the one-patient-after-another approach in the ER to the more intense, in-depth relationships of primary care, he remained something of a hybrid, and the intense action surrounding a code blue or multiple trauma still brought a welcome rush.

He was in the room before he realized that the cardiologist at the man’s bedside was Robert Crook. Matt hadn’t seen his nemesis at all since the ill-fated meeting at BC&C. Crook greeted his arrival with a scowl and a derisive shake of his head.

“Need help?” Matt asked with accentuated cheeriness.

“I think I have enough,” Crook grumbled.

From behind him, nurse Julie Bellet vehemently shook her head and mouthed the word “Stay!”

“Why don’t I hang around just in case.”

“Suit yourself. Get ready to shock at four hundred joules, please.”

One twenty-five should be enough
, Matt was thinking. Bellet looked over at him imploringly, but all he could do was shrug. The 400 was definitely overkill, but not a serious enough breach to go to war with Crook over.

The cardiologist plowed ahead, setting the defibrillator paddles against the man’s chest.

“Clear! . . . Ready, shock!”

Julie Bellet depressed the button delivering 400 joules of electricity through the woodsman’s chest. Almost immediately, the chaotic spikes of fibrillation were replaced by a rapid, regular rhythm.

“Okay,” Crook said in a purposefully matter-of-fact tone, “he’s now in a nice, supraventricular tachycardia. Let’s give him a milligram of propranolol IV.”

No!
Matt’s mind screamed.
Wrong diagnosis, wrong treatment.
He moved forward next to Crook.

“Robert,” he said, softly enough so that most of those in the room weren’t even aware he was speaking, “that’s V. tach. I’m certain of it. Xylocaine, not propranolol.”

Crook glared at him.

“A milligram of propranolol IV,” he ordered again. “Make that two. Give it slowly.”

Damn!
Matt thought, unsuccessfully trying to avoid Julie Bellet’s desperate gaze as she and another nurse responded slowly, clearly stalling. War was about to break out.

“Robert,” he whispered again, “get some Xylocaine in him and you might be able to keep him from fibrillating.”

Crook’s sideways look was, if anything, more piercing than before.

“I’ll thank you to—”

At that instant, with a flurry of ineffective beats, the woodsman’s unstable ventricular tachycardia rhythm degenerated into immediately life-threatening ventricular fibrillation.

“Four hundred joules,” Crook ordered, pointedly looking away from Matt. “Get a hundred of Xylocaine into him also. Let’s hold off on the propranolol for now.”

At that moment, the resuscitation, which should have been straightforward and successful, could easily have gone either way. Fortunately, a power greater than any in the room decided it simply wasn’t the old woodsman’s time. The electrical countershock was followed by the Xylocaine he should have gotten in the first place, which was then followed by another shock, and suddenly there they were—a decent monitor pattern and a functional blood pressure.

“Nicely done,” Matt said.

There was no response from Robert Crook.

In minutes, the patient’s cardiac situation had stabilized. His color had improved and his pressure rose and remained constant. Crook motioned Matt to one side of the cubicle, where he could whisper without being overheard.

“Take a word to the wise,” he said harshly, “and think about finding another place to practice. Someplace far away from here.”

“But I like it here,” Matt said. “I grew up here. I always thought I’d grow old here.”

“Well, you can damn well grow old someplace else. That is, if you
want
to grow old. You’ve stepped over the line, Rutledge.”

“I don’t know what you’re talking about.”

“People are going to get hurt, and I won’t be a bit surprised if you’re one of them.”

“Are you threatening m—”

“Dr. Crook?”

Julie Bellet was pointing to the monitor screen, where some irregular beats had appeared.

“Another fifty of Xylocaine IV,” Crook blustered. He turned back to Matt. “You didn’t fool anyone,” he said.

Matt suddenly reached out and grabbed the man by his tie and shirt in such a way that Crook’s back screened the move from view of the nurses.

“Neither do you,” he rasped. “Don’t ever threaten me again.”

Stunned, his cheeks flushed with crimson, Crook pulled away and, adjusting his shirt and tie, returned to the bedside.

Matt couldn’t remember physically assaulting anyone in his adult life.
Stupid! Absolutely stupid!
It was dumb luck that no one saw what he did. Fists clenched, he whirled and, without so much as a glance backward, left the ICU. Crook clearly knew about their penetration of the toxic dump, Matt was thinking. But was the warning from Armand Stevenson, or was the cardiologist overstepping the bounds of his position with BC&C? And exactly what did he mean by “People are going to get hurt”? What people?

The Slocumbs!

Matt hurried to Nikki’s room to see if the police guard had shown up. He had been away from Lewis Slocumb and his brothers way too long already. He arrived at the room just as Officer Tarvis Lyons came lumbering down the hall. Lyons had been Matt’s classmate at Montgomery Regional High School. Tarvis’s unofficial nickname, Tar Pits, referred to the speed with which he did just about everything. Matt’s surprise that Tarvis had made it to graduation at all, let alone without a police record, was nothing compared to his shock when he returned home after his residency to find Lyons was on the force. It was hard to believe anyone would entrust the man with a pair of handcuffs, let alone a service revolver.

“Hey, Ledge, wazzapnin’,” Lyons said, using Matt’s high school nickname. His voice was an octave higher than one would have expected from his bulk.

“Grimes sent you?”

Matt hoped he hadn’t emphasized the “you” as much as he feared he had.

“I was off today. That means I’m available for overtime. The big O.T. The chief says there’s a babe that needs watchin’.”

“Grimes called Dr. Solari a babe?”

“Um, I can’t remember exactly.”

“She’s a doctor, Tarvis. That’s like twelve years of education after high school. I think she’s earned something a little more respectful from you than ‘babe.’ Grimes coming over?”

“He said he’ll be by soon to talk with her.”

“Do exactly what he says.”

“That’s what he said.”

“What?”

“He said to wait and do exactly what he says.”

Matt sighed. “Listen, post yourself out here. Make sure you or one of the nurses knows anyone who comes in to see her. I have to leave the hospital for a few hours. I’ll be on my beeper. Just call the hospital operator if you have any questions and she’ll find me.”

“I’m all over it, Ledge,” Lyons said. “You still playin’ hoops?”

“I still play at it. Not much left of the shot, though, or the legs, for that matter.”

“You always were a great shot, Ledge.”

“Thank you for remembering, Tarvis. Keep a close eye on Dr. Solari.”

Matt stood by the doorway and let his eyes adjust to the dimly lit room. Nikki was asleep, breathing sonorously through her oxygen mask. Concerned by what Crook had said, he was anxious to get out to the Slocumbs’ farm. He hurried to the nurses’ station and wrote an order for a neuro check every thirty minutes for two hours, then every hour after that for five hours. A final glance at Tarvis Lyons, who was pulling a chair out from a deserted room, and he raced off to his motorcycle.

The ride out to the farm seemed interminable. Once again, all the guilt Matt felt about putting Lewis Slocumb in harm’s way welled to the surface. Crook was a jerk, but he was right. He had stepped over the line. Maybe it would be better just to let the whole thing drop—forget about the toxic dump and admit that he was no more of a match for Belinda Coal and Coke and their self-serving policies than his father had been. Then he pictured the horribly deformed faces of Darryl Teague and Teddy Rideout. How many others like them would there be? How many were there already? No, he decided as he pulled up in front of the farmhouse, he wasn’t going to back off no matter what. He would just be careful not to place anyone else in danger on the altar of his crusade.

Just as Lewis had been waiting for him on the porch for their trip to the mine, Frank was there now. He was leaning against a railing, a potent-looking shotgun cradled loosely in his arms. Matt wondered in passing if they somehow knew he was coming.

“How’s he doing?” Matt asked.

“He’s had a doggone mizrable time of it, mosly from the pain in ’is shoulder. But he’s still alive an’ cussin’.”

“That’s a good sign. Frank, I’m really sorry it took me so long to get back here. The hospital got incredibly busy. I couldn’t get away before now.”

“We knowed you’d be back soon’s ya could.”

Not a hint of irritation or entitlement. These men, tough as nails, were used to taking life as it came and to giving their friends every benefit of the doubt. Lewis, wearing tattered jeans and nothing from the waist up, was in the upstairs room, propped by two pillows in a straight-backed oak armchair. His color was surprisingly good. The bandage around his upper chest was blood-soaked, but that was to be expected. The drainage system was intact, and the gauze he had wrapped loosely about the end of the condom was soaked with dried and drying blood. Clearly, the apparatus was functioning quite well.

Frank Slocumb and his brothers had proven to be quite capable nurses. The room was surprisingly clean, and the linens looked as if they might have been washed since he was last there. The three men stood proudly and respectfully to one side of the room as he worked.

“Your brothers have done well by you, Lewis,” Matt said, listening with his stethoscope and noting that breath sounds extended to all fields of both lungs.

“They knowed what’d happ’n to ’em if’n they din’t. Am Ah gonna live?”

“Frank said you were too ornery to die, and he was right.”

Matt put an IV rig together and asked for a heavy wire to be hung from the rough-hewn ceiling as a hook. In less than two minutes Lyle had nailed in precisely what was needed. Matt hung up the small plastic sack filled with powerful antibiotic and started the medication running into Lewis’s arm.

“This’ll help make sure there’s no infection,” he said.

“What ’bout this here contraption?” Lewis asked, motioning to the siphon tube.

“Well,” Matt replied, “incredible as it may seem, it appears that this here contraption has saved your life.” No doubt about it, he was thinking, a letter to the author of
Field Emergencies
was definitely in order. “Now, the way I see it, we’ve got three choices. Leave it in, pull it out, or change it.”

“You want us ta vote?” Frank asked.

The four brothers whooped at his humor, which had sailed over Matt’s head.

“Fit’s all the same ta ya, Doc,” Lewis said, “Ah’d jes a soon ya din’t go stickin’ no more stuff in ma chest. Ah din’t have the heart ta tell ya, but them pliers ya jammed in thar last time hurt lak hell.”

Out of respect for Matt, the three standing brothers kept their guffaws to a minimum.

“Okay, Lewis,” Matt said. “I’m going to leave things as they are. The problem is, if I take the tube out too soon, the lung might collapse again, and if I leave it in too long, infection might set in. But listen, guys, if he starts to get sick with infection—fever, cough, pain, pus, redness spreading through the skin around the hole, anything like that, cut the stitch and just pull the tube out immediately. Got that?”

“Got it,” Frank said. “Ya done a fine job, Doc.”

Matt took the bandages down, cleaned the wound, and then redressed it.

“Listen,” he said. “I’ve got to talk to you all about something else. I think the people at the mine know it was me who was in that waste dump of theirs. I’m not sure they know that it was Lewis that was with me, but I wanted to warn you. This jerk at the hospital, Crook, is on the board. He made it sound like someone was going to be hurt or killed because of what I did, and that their blood was going to be on my hands.”

Lyle and Kyle exchanged sly looks.

“What?” Matt asked. “What’s with you two?”

This time it was Lewis who spoke.

“They knowed it ’uz me, Doc. We’re sure a thet. Contrary ta what lots a folks round here thank, we got us some frands about—good uns, too. We hear thangs.”