Trauma Plan, page 20
“Ah.” Griff was quiet for a moment. He took a sip of his coffee and Kate noticed, once again, the scars on his hand. From the same explosion that injured his back, most likely. Then Griff spoke, meeting Kate’s gaze directly. “You’re wondering if you should date a man who’s associated with a movement to shut that good and charitable effort down.” He tilted his head, his expression hardening just a bit. “And maybe you’re extrapolating that thought into . . . if I’m mean-spirited enough to deny poor people health care, then maybe I also park in handicap spaces and pick the wings off butterflies and—”
“Are you?” Kate interrupted.
“An insect abuser?”
“No.” Kate couldn’t help but smile. Griff Payton, contractor, had hit the nail on the head; he knew she was checking him out. Fine, then she could be direct. “Are you associated with the action committee that’s trying to close the clinic?” She raised her voice to be heard over the musicians warming up a few yards away. “Is that what you want?”
“Two separate questions,” Griff acknowledged. “And I don’t have a problem answering either of them. First of all, no. I’m not associated with The Bluffs’ action committee. I have no issues with the work that’s done at the clinic. I honestly don’t know much about it.” His smile came back, charming again. “But if you volunteer there, I have no doubt that it’s valuable.”
“Your father’s company plans to bid on the property.”
“Yes. It’s adjacent to The Bluffs—his development, my parents’ neighborhood—so it makes sense. Convenient and close to his heart. He’d envisioned condos there years ago but the property was never available.”
“Still isn’t,” Kate said, imagining Jack in this conversation. Wearing Army boots.
“That’s right. It will be up to the city council to decide what happens with that property. I accept that, absolutely. But you also asked if shutting down the clinic is what I want.” Griff met her gaze. “I’m going to be honest with you, Kate. I’ve been waiting for a project like this. Obviously because it would help my career. But also—” he swallowed—“because working alongside my father could go a long way toward fixing some things between us. I don’t know if you can understand that. But I’ve disappointed my father in the past. Now I’m back, and I just want a chance to—”
“Make him proud,” Kate murmured. She’d felt the same way when she’d returned home after running away.
“Yes. Exactly.” Griff nodded. “I guess that sounds corny.”
“It doesn’t.” Kate released the breath she’d been holding and wondered if she’d jumped to the wrong conclusions about this man. He wanted his father’s approval. There was nothing wrong with that. Maybe beneath Griff Payton’s handsome exterior and arrogant charm, there was a decent, good-hearted man. Now that would be a first. But there was still that other question. The red flag waving furiously since he’d refused the shot in the ER.
“So,” Kate began casually after glancing toward the musicians. Several couples had moved to the small dance floor. “How’s your back? Pain medication helping?”
Griff laughed, raised a palm. “No disrespect to the hospitals, but I’ll take a good chiropractor over a pill pusher any day. Snap, crackle, pop—fixed.”
“Fixed?” Kate asked, surprised at how much she wanted to believe him.
“Not enough to heft cement sacks. But . . .” Griff rose from his chair, extending his hand toward her. “I’m definitely healthy enough for a slow dance.” He chuckled at the look on her face. “I think we’ve established that I don’t pick the wings off butterflies, and I promise not to step on your toes.”
“Okay,” she said, her face warming. “One dance.”
You’ve tempted me after all.
* * *
“Se cayó?” Riley asked her patient, pulling the stethoscope from her ears. She turned toward the man’s son, trying to understand. “He fell on the stairs?”
“Uh . . . right.” The boy, about fifteen and dressed in dusty work clothes, glanced toward his mother before continuing. “At home.” His father moaned with pain, and anxiety flooded into the boy’s dark eyes. “The doctor’s coming?”
“Yes.” Riley’s gaze moved to the monitoring equipment. Blood pressure 94 over 32. Pulse 102. Oxygen saturation 95. A fit thirty-six-year-old man, somewhat pale despite his olive complexion and guarding his breathing because of pain in his left lower ribs. “Will you please help him get undressed? Everything off but his undershorts. Here’s a gown.”
Riley patted her patient’s arm and noted with concern that he’d begun to perspire. “Vamos a ayudarle, Hector.” We’re going to help you. She glanced up at the clock, thinking with a sudden foreboding that the last half hour of her shift was headed in the wrong direction. She hoped she was wrong about that.
In moments Riley returned to the exam room with Jack. She pushed the buttons on the automatic blood pressure cuff as he introduced himself to Hector and his family. Despite her hopes, the man looked even paler stretched out on the exam table; he grunted softly with each breath. The Velcro crackled as the blood pressure cuff inflated, and she watched the digital display as the machine attempted to locate a systolic pressure. It reinflated, tried again. Not a good sign. Riley’s pulse kicked up a notch.
“Breathe in . . . Respire, por favor,” Jack repeated in Spanish, attempting to listen to Hector’s lungs.
“Blood pressure is 87 over 46,” Riley reported. “Pulse 112.”
Jack glanced at the oxygen saturation display, then turned to Hector’s son. “Do you know if he lost consciousness, or—?” Hector groaned as Jack palpated his abdomen. “Were you there when he fell?”
Riley saw panicky confusion on the son’s face and then fear on his mother’s as she gave a terse shake of her head, lips forming the word no.
“I didn’t see . . . ,” the boy said, chewing his lip. His face was nearly as pale as his father’s.
Riley set the blood pressure monitor to take readings every five minutes.
“Belly’s distended,” Jack said, turning to her. “He’s guarding in the left upper quadrant. I don’t like—” He stopped short as he spotted something on the floor beside the exam table. “What are these? Roofing nails? Did these come from his pocket?” He stared at the son, forehead wrinkling. “Was your father on a roof?”
A fall from a roof? Riley’s breath caught, mind racing. Left abdomen . . . spleen? Or even a vascular tear? Oh, please. Don’t let him bleed out in front of our eyes.
“Yes. Lo siento, Mamá. I’m sorry, but . . .” The boy nodded, tears brimming. “We were on the roof together. It’s two stories. I saw Papá fall.”
“I’ll get an IV,” Riley said, anxiety crowding her throat. “Ringer’s?”
“Or normal saline, if we don’t have it. Large bore needle. Two lines if we have time. I’ll get him on some high-flow oxygen. Tell Bandy to call for a Code 3 transport. Blunt trauma abdomen, status post-fall from roof. Grab me a neck collar too.”
“Will do,” Riley said, praying she could do any of the things she’d just promised. She yanked open the door, took off in a jog toward the supply room, and caught Bandy in the lab.
“Just tell me what you need,” he said, reading her expression.
“Your finger on the phone to 911.” Riley grabbed for the IV tray. “Tell them we have a man who fell from a second-story roof. That he has abdominal pain and shocky vital signs. We need a Code 3 transport.”
“You got it,” Bandy assured her. “Anything else I can do?”
“Tell our other patients there’ll be a delay, and . . .” Riley met Bandy’s gaze, her numb fingers tightening on the handle of the IV tray. “Pray. Please.”
* * *
“What’s going on?” Kate asked Bandy, after hearing Jack on the kitchen phone giving a report to Alamo Grace ER.
“Man fell from a roof. Belly pain, shock. The medics are on their way. Riley’s—”
“Which room?” Kate interrupted, hating what she was thinking. She can’t handle this.
“Two.”
Kate was through the exam room door in seconds and confirmed that she’d been right; the chaplain was in way over her head. The trauma patient, his moans fogging the rebreather mask, was pale and glistening with sweat. A blood pressure alarm sounded: 76 over 38.
“Riley . . .” Kate snatched a pair of gloves from a box, nodded at the family.
Riley glanced up, her cheeks flushed, neck blotchy, pupils wide—adrenaline rush. And anxiety, Kate would bet. “I had an eighteen-gauge in, but the vein blew . . .” Riley pressed her gloved fingers against a gauze square soggy with blood from the failed stick. “I think there’s another good-size vein here.”
“Think” isn’t good enough. Kate knew Riley wanted a chance to prove herself, but . . . She struggled against the image of the bruises from Riley’s practice attempts and the way Riley had demonstrated her clumsy fingers with that cookie. Crumbs everywhere.
“I got it.” Kate snatched a tourniquet off the tray. She extended the man’s other arm, applied the tourniquet, and tapped her fingers against the space at his elbow. Big vein, but flattening . . . because he was bleeding out. The blood pressure alarm sounded again. The family whispered in Spanish. Some of it sounded like a prayer. Kate pulled the tourniquet tighter, flicked the vein with her gloved finger, and—
“I’m going for this one,” Riley said from the other side of the exam table. “A twenty-gauge, but that will still infuse—”
“Hand me the needle,” Kate instructed, reaching out her palm.
“I’m already under the skin. And it’s looking pretty . . .”
“Stop—save a vein for the lab. Give me a sixteen-gauge instead. I’ve got this.” Kate’s eyes met Riley’s over the patient’s chest, and she wished her voice had sounded less brusque.
Riley passed her the sixteen-gauge needle set. Kate prepped the vein with surgical iodine, then touched a fingertip to it once more. “You’ll feel a needle stick, sir.” She held her breath, slid the needle through the skin bevel up, felt the pop as she entered the vessel . . . advanced it, and—yes!
“I’m in,” Kate breathed, watching with relief as the blood flashed back into the needle set. She glanced up to ask for the IV tubing and tape and saw that Riley was already beside her, supplies in hand. “Thanks,” she whispered, wrestling with guilt she knew was irrational.
The door opened and Jack stepped in. He glanced from the patient to the monitor to Kate . . . then at Riley. “You got a line in?”
“Yes.” Riley glanced down, exhaling softly. “A sixteen-gauge, running wide open. Kate—”
“Team effort,” Kate interjected; she wasn’t sure anyone heard over the sudden wail of sirens.
* * *
Jack strode past his office, hearing the familiar strains of music through the door. It was barely nine, and Bandy didn’t usually start up this early; he was probably hoping some divine message would get through to Jack, derail the anger train. Fat chance of that. Heartless hypocrites.
He forced himself to take a slow breath; Riley was in the kitchen. He wasn’t going to bring this up with her.
“Well,” he said, watching as she tucked her stethoscope into her purse. “The only thing I can offer to compete with that adrenaline rush is skydiving. Thursday at noon. Still time to change your mind.” He raised his brows. “This is my second and final offer.”
“No thanks.” Riley smiled halfheartedly. “After Hector, falling from heights is the last thing I want to think about.” She pulled the band off her ponytail, then closed her eyes for a moment as she rubbed the back of her neck. Jack wondered how she’d react if he offered to do that for her. “I called the ER,” she continued. “You were right. Ruptured spleen. And maybe a kidney contusion. Hector’s in the OR. Apparently he responded well to fluid resuscitation in the ER.” Riley’s teeth scraped across her lower lip. “Which reminds me that I should probably tell you . . .”
“What?” Jack saw the discomfort in her expression.
Riley sighed. “Kate started that IV. I had an eighteen-gauge in, but the vein blew. I found another one. I think I could have gotten it in, but Kate—”
“Hey.” Jack stepped close. “The man’s in the OR. We did our part. It’s done.”
“I know. I guess I just wanted my part to matter more.”
“Matter? Oh . . . that.” Jack shook his head. He’d almost forgotten. “You mean because I offered to write your letter.”
“Yes,” Riley said with raw honesty. “And because I needed to know, for myself, that I could do it.”
“Look . . .” Jack spread his hands, knowing anything he said was likely futile. Her determination was as clear as Bandy’s gospel music floating down the hallway. “The ER is a team situation too. Veins blow. Some days a buddy has your back; then it’s your turn to help him. The important thing is that we’re in there, doing something, trying. And as for here in the clinic . . . It’s not every day we have a guy fall twenty feet from a roof, to—” He stopped, barely biting back the curse he’d been wanting to shout for the past half hour. A low growl escaped his lips instead.
“What’s wrong?”
“I got more information from the son while they were loading Hector into the ambulance. The roof he fell from was a block away—in The Bluffs. Apparently it was suggested that they bring him here because hospitals are expensive. And because the free clinic doesn’t ask so many questions.”
Riley’s mouth sagged open. “Suggested by whom?”
“That’s the million-dollar question. Want to take bets on the chances of anyone owning up to it?”
Riley grimaced. “That’s why Hector’s son said it happened at home. They didn’t want to take the chance of anyone prying into their work situation. Or maybe even citizenship status.”
Jack nodded. “And our neighbors sure weren’t going to take responsibility for someone injured on their property. If Hector’s family had taken him home instead, he’d be dead right now.” Jack paused as the ugly irony hit him in the gut. “They’re itching to haul me before the city council and call me reckless and irresponsible, claim there’s no good reason to have my clinic here. But when it’s convenient for them . . .”
“What are you going to do?” she asked. The wariness in her eyes reminded Jack of why he’d decided against telling her any of this.
“Don’t know.” He glanced toward the hallway as the music seemed to swell. “Bandy’s telling me to let the police handle things and stay out of it.”
“That sounds like good advice.”
Jack shrugged. “Maybe. But it’s not going to stop me from taking a little detour on my way home. To see who’s got a brand-new roof. And no heart.”
* * *
He can’t see me. . . . It’s not him.
In the darkness, Vesta squinted through her binoculars toward San Antonio Street, and her breath caught. The enormous Hummer slowed to a crawl at the curb, then rolled slowly on—the second time in the last fifteen minutes. It was impossible to see the driver in the hopscotch pools of light from The Bluffs’ elegant streetlamps. Or even identify the color of the vehicle, though Vesta thought it was black. If she could make out the license plate, she’d report it to the neighborhood watch. And if she got a real glimpse of the driver, recognized him, she’d report it to the police.
Or would I? She shivered, remembering the face that haunted her nightmares. Startling eyes, fair lashes, angular face, and that tangled mass of Medusa hair. Fear on his young face, panicky desperation validating unimaginable violence. It’s not him. . . .
The Hummer moved on, and Vesta’s shoulders fell as she exhaled. The neighbors were keeping watch and there was talk of hiring private officers until the security gate installation was complete. The action committee had called a special meeting at the clubhouse on Saturday, with a police officer in attendance. They would be discussing the recent incidents of neighborhood crime. And ranting about the clinic, no doubt.
Vesta set the binoculars down, reached for her water, and took a long swallow. She hated all the strife concerning the clinic. She hadn’t told Bandy Biggs that she knew he worked there—her landlady was a tight link in the local gossip chain. But meeting him, little Hobo, and Riley had finally put a face on the clinic. A warm, friendly face. It made Vesta feel more secure than she’d felt in a long time, even with her own conflict surrounding Dr. Travis. And how that continued to affect her.
If I didn’t go to the police then, what makes me think I could now? Even if . . . it’s that man out there.
A shaking chill, one of several she’d had today, caused water to dribble down the glass. Her teeth chattered and she hugged her robe close. Fever. She wouldn’t worry unless it stayed above 101 despite the Tylenol. Vesta was no stranger to bladder infections; she’d recognized the symptoms this morning and had started taking the antibiotics she kept “just in case.” It explained the dull backache she’d had for several days, the headache, and her stubbornly high blood sugar readings. She’d take the medicine, drink extra fluids, rest, watch her diet—be careful. The last thing she wanted was to end up in the ER again.
No . . . Vesta glanced toward the window, shivering again. The last thing she wanted was to find out that a murderer was really out there.
22
Riley peered through the NICU window at Baby Girl Paulson—the Doe nameplate had been ceremoniously dumped. The Express-News was calling her “a healthy dose of hope in a tiny pink cap.” Riley hoped this baby could provide that for the Alamo Grace staff as well, relief in the midst of too much tragedy. But the infant had developed a low-grade fever and episodes of vomiting, requiring her to be poked, prodded, and x-rayed in order to determine the cause. It called a temporary halt to the mother’s milk shipped from Austin and to the long line of volunteers eager to rock the babe. Last evening, one of those volunteers had been the baby’s shell-shocked grandmother.
