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A Rhea Lynch, M.D. Novel (Book 3)
Author: Gwen Hunter
I never put much stock
in omens and portents, but that strange August Wednesday had been rife
with them, according to Miss Essie, who knew more about such things than
I ever would. Temps went from typically hot and muggy to oddly cool and
wet as a Canadian front blew through. And the appearance of sun-dogs and
a double rainbow on the heels of a nasty summer lightning storm, together
with the screaming crows perched high in the trees, were portents enough
to have the older woman muttering to herself and banging pans in her kitchen.
When I stopped by on the way in to work, I tried
reminding her that the rain was a welcome relief, drenching the overheated
earth and straw-dry crops still in the fields, making a dent in the awful
drought we had been suffering, and bringing cooler weather. Miss Essie
was having nothing of it. When I left her, she was casting dark glances
at the sky and talking to God as if He had made a mistake somewhere and
needed her advice to fix things.
I, on the other hand, reveled in the sudden return
to fresh air and temperatures in the eighties. Delighted in the vision
of brilliant rainbows on one horizon, framed against furious purpled clouds.
Loved the sun-dogsweird refracted spots of light to the left and
right of the sun on the other horizon. It had been breathtaking for all
of fifteen minutes just after the storm passed. Now, as I left Miss Essie's
and drove in to the small rural ER of Dawkins County, South Carolina,
they had all faded. The sun-dogs had vanished. The rainbows were little
more than broken curves low in the sky. And the black crows that alighted
in the topmost branches of the white oaks in the woods between Miss Essie's
home and mine were not a harbinger of death and change. No matter what
Miss Essie said.
Omens. Portents. Hogwash.
Simply a prism of sunlight refracted through rain-mist
on one side, and sun-dog-forming mile-high ice crystals on the other.
Science. Meteorology. Just big black birds celebrating having lived through
the wind and lightning, flapping their wings and calling out to other
birds. Nothing more. Though ice crystals in August were rare. After
all, this was the South. And crows usually didn't make that much noise.
Still, I had experienced enough of the religiously
weird recently and I wasn't buying into any more. I had helped put the
Reverend Lamb of God behind bars and seen his TV station shut down. And
lived to tell about it. I wasn't going to listen to spiritual nonsense,
no matter what happened in the heavens.
At 6:00 p.m., I pulled into the doctors' parking
lot of Dawkins County Hospital, where I worked under contract as an ER
physician, and knew instantly that it would be a busy night. The surrounding
parking area was filled with cars and trucks, many with yellow emergency
lights affixed to the roofs. Three county ambulances, two rescue squad
vehicles loaded with equipment, a fire truck, and a crowd of milling people
met me. Hot time in the old town tonight. Busy? Yes. Kaleidoscopes and
Omens? Portents? No way.
Storms and Misery
The storm started
three brush fires and kept the rescue squad on its toes, though the rain
put the flames out before extensive damage was done. Fire wasn't the reason
why my ER looked like a major disaster area. The bus accident on I-77,
about nine miles from the hospital, had a far greater impact. And lightning
had hit the hospital, resulting in minor damage to the surgical department
and bringing out the rest of the county crews and volunteers.
I spent half an hour treating minor burns, cuts,
and scrapes so my boss could head home. We usually switched shifts at
7:00 p.m., but I owed the hospital some time. Together, Dr. Wallace Chadwick
and I moved patients in and out and cleared the backlog of victims before
he left for the night. It was good to get the place emptied out and start
with a clean slate.
While the nurses changed shifts and the security
guard made rounds, I settled in. Ignoring the weakness in my healing back
muscles, I picked up my bag, abandoned under a desk chair in the nurses'
station, and headed up the hall. On the way I took in a brisk earful from
Trisha Singletary, the nursing supervisor called in to help deal with
the mess. She was shorter than I, cute and buxom, and had a way with men
that bordered on the mystical.
"It's mostly over now, but Dr. Rhea, you
shoulda seen the smoke. I was clocking in when it hitthe lightning,
I mean. It shook the whole building, made the lights go out. Knocked a
hole in the last surgical suite, up high near the ceiling, and let in
rain and leaves. Ruined any pretense at sterility. There's smoke damage
in two rooms. Thank God they weren't doing the procedure in either one."
"Someone was cutting at the time?" I
asked, as I led the way to my call room. It was calmer in ER but I didn't
know how long that might last, and I wanted to drop off my overnight bag,
make sure the call room had clean sheets and towels.
"Dr. Haynes was assisting Statler with an
appendix on a seven-year-old with muscular dystrophy. Statler was closing
and the lightning hit. Lorella Shirleyyou know her?"
I shook my head no, tossed my bag to the bed,
checked the room for cleanliness and decided it was fine. Locking the
door behind me, we started back to the ER.
"Well, she's an OR tech, and she said she
jumped outta her skin when it hit and landed on a tray of sterile instruments.
Statler started cussing and Haynes slipped and fell on the anesthetist's
equipment. Lights were out about twenty seconds before they came back
on. And to make it worse, Lorella said she saw a bat fly through."
"A bat." I would be careful not to mention
that part to Miss Essie. It would surely feed her omen talk.
"It musta found its way into the eaves from
outside and been sleeping there till dark, then got knocked out of its
place by the lightning. Now it's inside. The kid's okay, and the maintenance
crew has a tarp over the hole. The fire started by the lightning was put
out by the rain, but fire crews are here to make sure nothing is still
hot in the walls."
As she spoke, a fireman in full protective gear,
heavy coat, boots, gloves, helmet tucked under his arm, approached. Trisha
slowed, preened and stuck out her chest a bit, though her impressive bustline
didn't require any effort to draw the man's attention. He slowed, too,
and smiled, and after a moment, met her eyes.
"Miss Trish. You gonna be at McDowries Bar
and Billards Friday? They got a deejay with shagging." The fireman's
dark eyes held hungrily to Trisha as he mentioned the state dance of South
"That divorce finalized yet?" she asked
archly. Trisha was perpetually looking for a man, but her standards were
well known in the area. Married men were not a part of her social calendar.
"Last Monday. I'm a free man." They
both kept moving as the flirtation continued, turning and walking backward
in the halls.
"I may be there." She flipped back an
imaginary strand of hair, touching her neck in the process, the motion
unconsciously sexual. "You can buy me a drink to celebrate."
A wide grin split his face. "It's a date."
"Well, I wouldn't go that far. But you catch
that bat, I might consider dancing with you."
"Not my job, gorgeous. But speaking of bats
. . ." The fireman pointed past us at a dark corner just ahead.
Trisha jumped and stared, then shivered. A dark
form moved in the corner, turning its head as we neared.
"Lordy, I hate bats. I'll get the cops after
it now. When's this backwater county gonna get an animal control officer?"
she demanded of the fireman. But he was gone.
"Close the fire doors to the other wings,"
I recommended, "and trap him here. And be careful. A small percentage
of bats carry rabies."
"Well ain't that just fine and dandy,"
Trish muttered. "A big strong man all dressed out to save me and
he can't kill a single little old flying rabies factory."
I grinned. The recently divorced fireman had passed
up an opportunity to play knight in shining armor to the damsel in distress.
If he had visions of dancing Friday night with his Miss Trish, I figured
he was in for a disappointment.
My beeper went off, the code in the little LED
window displaying the ER extension followed by the numerals 911. "Got
an emergency, Trish." I half-jogged away from her. "If it stays
quiet, I'll spring for pizza for the ER crew around nine. Join us if you
"Beep me if you need help," she said.
"Oh, and we got a whole bunch of new agency nurses starting tonight,
so things may be a little chaotic."
"Little chaotic?" I said to myself as
I rounded the corner to the ER. The emergency scanner crackled with coded
general information, and the ambulance scanner with more specific info,
reporting on a patient being brought to the ER, code three. I had a sixteen-year-old
female quadriplegic with a severe headache, shortness of breath, and blood
pressure that was sky high. My best guess from hearing the paramedic's
report was autonomic dysreflexia, or toxic hypertension. That was a dangerous
condition in a quadriplegic, sometimes resulting hemorrhagic stroke, respiratory
shutdown, and death.
"From the address, I can tell it's Venetia
Gordon," Anne, one of the ER nurses, commented.
The ability of a nurse to tell a patient's name
just by the address was not particularly unusual in Dawkins. The rural
county had around fifty thousand residents, and just like any business,
we had our regulars. "Do we have an old chart on her?" I asked.
I wanted to see the original report on the cause of the girl's paralysis,
and a breakdown of everything that had happened to her since.
"She was in the ER last week," Anne
said. "UTI from a permanent catheter. But the original accident happened
six months ago down in Lancaster County. Two car MVA on a back road,"
she said, referring to a moving vehicular accidentmedspeak for a
car wreck. "They flew her out from the scene to CMC in Charlotte.
Except for a minor infection, you'll be flying blind."
"Lovely. Ask the crew where the spinal break
When the scratchy words came back at C4, I sighed.
Vertebrae were named and numbered from the base of the scull to the tailbone,
with cervical vertebrae at the top. The lower the number, the greater
the amount of paralytic damage. Damage at C7 would have left Venetia's
upper body under her own control. At C4, things could get dicey.
I told Anne what I would likely need in terms
of meds and equipment, and asked her to get respiratory therapy down here
stat. If this girl crashed, I wanted help getting her intubated and on
the ventilator. There was an old saying, "C3, 4, 5, keep you alive."
My patient was barely in the safety zone. Anything could happen with spinal
damage at that location.
Anne nodded, writing nothing, remembering everything.
She was a medium woman in every way except her memory. Medium-length medium-brown
hair, medium height, medium weight, medium disposition. But her memory
was phenomenal, as I was learning. Tell her something once and she'd remember
it forever. And she was really great in an emergency, which was a good
thing, as the other RN on duty tonight was a newbie, fresh out of nursing
school and likely useless. She'd get good eventually, but for now she
needed to be watched so she didn't kill somebody. Coreen was her name.
Dark-skinned and brown-eyed, petite as a model, and twenty years old.
So fresh-faced and innocent she made me feel ancient at twenty-nine.
Venetia Gordon, still with the healthy-looking
limbs of her pre-accident life, was wheeled in, strapped to an ambulance
gurney. She was breathing fast and shallowly. Not much air was being exchanged.
The girl was on 100 percent oxygen but her color
was poor, an ashen blue shade that told me her lungs were shutting down.
I looked at the monitor sitting atop the stretcher as the EMS guys moved
with her: blood pressure 230 over 145. Pulse 72. I bent over her head,
moving with her as she was swept into the cardiac room, and checked for
papilledema of her optic nerves. They looked fine, no swelling that might
lead to blindness if not corrected. "What is her O2 sat?" I
asked, referring to the oxygen saturation level.
"Eighty-four percent last time we checked
the pulse-ox," a voice answered, referring to a device that clipped
to a patient's finger and measured both pulse and oxygen levels.
"I want ABGs, repeat O2 sat, and Catapress
PO," I said, ordering the same tests and drugs I had mentioned to
Anne only moments before. I told them the dosage and stood back as the
EMTs lifted the patient and moved her to the ER stretcher. "How long
on the ABGs?" I asked no one in particular. My attention was on the
patient's ragged, shallow breathing. There was a look of panic in her
eyes, a mottled appearance to her skin.
"Beth?" Anne asked the lab tech.
"Fast. Maybe three minutes."
ABGs referred to arterial blood gases, which would
tell me how well or poorly Venetia's lungs were working. I positioned
my stethoscope on her chest. While not much air was moving, there didn't
appear to be any fluid buildup. Her skin was damp and cold, not feverish.
Not pneumonia, then. Symptoms matched classic toxic hypertension. At least,
"Get me an EKG after you get the ABGs back.
Family here with her?"
"I'm her mama. Almera Gordon."
I turned away from the sight of the lab tech drawing
blood gasses to the soft voice, and found a timid-looking woman, mousy
brown all over, wearing sturdy matronly shoes and a sturdy matronly skirt,
her hair pulled back in a tight bun. But her eyes were amazing. Wide and
a vivid deep blue, almost lavender, fringed around with odd double lashes,
thick and lustrous. Her entire demeanor may have been subdued, but her
eyes claimed something else about her, a hidden strength, some powerful
determination. I nodded at her. "Tell me what was happening when
Mrs. Gordon checked her watch. "At six p.m.
I got her outta the bath. The water temp was jist warmer than tepid, and
she wasn't in for very long," she said, anticipating my next question.
Quadriplegics were not supposed to spend much time in heat, which could
cause all sorts of weird things to happen to them. "I dried her off,
got her half-way dressed in PJs and swung her to the bed."
"Swung? You have a transport sling?"
"On moveable tracks, but we usually keep
the system set up between the bathroom and bed. It makes bathing her jist
so much easier," she said in her drawn-out mill-hill accent.
I nodded my understanding.
"O2 sat on the pulse-ox is 82 percent, Doc.
BP 242 over 147," Anne said.
I checked my watch. "Blood Gases?"
Beth put the result strip in my hand. Venetia's
pH was 7.053, her CO2 at 74, and her O2 at 52. Not good. Her oxygen saturation
levels matched the results for the pulse-ox. Bad all around. "Go
on," I said, addressing Mrs. Gordon.
"She seemed to be having trouble breathing.
And she said her head was hurtin'. I checked her blood pressure and it
was 190 over 120. Her eyes looked kinda funny, like she wasn't seeing
so good. So I called the EMS."
"When did you check her blood pressure?"
"The call came in at 6:24, Doc," an
"Blood pressure is still rising," Anne
Panic bloomed in the dark-brown depths of Venetia's
eyes. She was using accessory muscles to breathe, her shoulders lifted
and the sternocleidomastoid muscles of the neck and the very upper chest
stretched with effort, all the movement the girl could make to force in
air. With her breathing so difficult, she didn't speak, but I understood
her fear. "Venetia," I said, leaning over her chest, "Is
your head hurting?" She nodded once. "Is your vision blurred?"
She nodded again, the movement spastic and jerky. "Do you have a
throbbing in your neck, right here?" I asked, brushing the skin over
the carotid where the baroreceptors measured pressure in the carotid artery.
Venetia nodded shakily.
"I'm going to get your blood pressure down
so your headache will go away, okay? And your breathing should ease at
the same time." She managed a nod, lifting her shoulders slightly.
Besides the desperate breathing, it was the only motion I had seen her
make. "Bag her. Give another Catapress. Get me a Nipride drip ready."
"Nipride is ready, Doc," Coreen said,
her voice steady and composed.
I raised my eyebrows. "Thanks."
"And I got another line going," she
added, indicating the IV line in the patient's right hand.
The respiratory therapist moved into place beside
Venetia's head and put a tight-fitting, blue plastic mask over her face.
She attached an ambu bag and pumped the large balloon; 100 percent oxygen
began to fill the girl's lungs.
"Do you understand what's happening here?"
I asked Mrs. Gordon, not taking my eyes from the girl.
"Not to say," she said softly, which
meant "not really" in the local lingo.
"Injuries to spinal cords can be tricky things.
Venetia's was six months ago?"
The woman nodded, her eyes on her daughter with
a single-minded intensity. "Six months ago next Monday.
"Do you know if she had any sacral sparing?"
I asked. When the woman looked blank, I added, "Does she feel anything
anywhere on her body? Heat or cold? Pain? Pressure sensations?"
"No. Nothing. My baby don't feel nothing,"
she whispered. "Dr. Danthari, her neurosurgeon, said she won't never
feel no more than she does now. It's at C4. She had a lot of swelling
there and it caused more damage than he expected."
Spinal cord injuries often resulted in strange
reactions, depending on the location of the injury. Even though there
are only seven cervical vertebra, there are eight pairs of cervical nerves.
Injuries on the dorsal spine will cause one type of sensory loss, injury
to the lateral spine will cause other types, depending on which pair of
nerves are affected. I had once seen a patient with a spinal fracture
at C7 who had lost his intrinsics, responsible for abduction and adduction
of the fingers and his ability to key-pinchmeaning that he was able
to flex and extend all of his fingers and make a fist, but not able to
pinch his car key or move his fingers side to side.
I really needed to know what kind of injury Venetia
had received, but there likely wasn't time to get a call through to her
neurosurgeon. I told Anne to try to call Dr. Danthari, just in case, to
cover my backside. She ran to the phone at the nurses' desk.
"Her blood pressure is very high, and swelling
may be what we're seeing here. The original injury could be causing pressure
on the part of the lower brain that controls blood pressure, much higher
than C4. The high blood pressure could then slow down her ability to breathe."
Mrs. Gordon bit her lip, her almost-lavender eyes
filling with tears. "I don't want her on no ventilator. She don't
want to be on no vent."
I checked the BP on the monitor. It was down a
bit. I smiled at the woman. "We'll avoid
that if at all possible." I wasn't closing any doors, not on a patient
who seemed fully aware of what was going on in the room. This was no brain-damaged
person without the ability to interact with life. This was a vibrant young
woman with a future ahead of her, especially if modern medicine made some
small leaps in the next few years.
"We got a living will. It's in the van,"
the timid voice sounded suddenly firmer.
The room seemed to go still. If her breathing deteriorated further and
she was not put on a ventilator, Venetia Gordon could die. I crossed my
arms over my chest and glanced quickly at Anne.
"Would you get it so we can make a copy?"
Anne said, reading my look.
"Yes. Of course." The timid woman reached
out and lovingly touched the unfeeling toes of her daughter before she
turned and moved away on her sturdy shoes. Almera. Gordon was a sudden
inconsistencyloving her daughter, yet willing to let her die.
Checking my watch, I said, "Get the Nipride
going. I want that pressure down." I bent over Venetia's chest again
and listened. If I couldn't get her stabilized, I might have to initiate
a legal battle to keep a sixteen-year-old-girl from dying. Slipping the
stethoscope around my neck, I left the room and checked the administrative
call sheet for the night. I wasn't letting this girl die without a fight.
"Nipride's going," Coreen said through
the open door.
Rolanda Higgenbotham was on call for the night.
Good. Rolanda was a take-charge, no-nonsense woman. I motioned Anne to
the side. "When you get that living will, fax a copy to Ms. Higgenbotham
and call her with the problem. I may need to intubate. And this is a minor.
We may need DSS or a judge." Department of Social Services would
remove the girl from her mother's custody and have her given lifesaving
medical treatment. There wasn't any doubt about it.
Anne nodded, her eyes troubled. Whatever we did
with Venetia, it was legal trouble. To allow a mentally healthy minor
to die was impossible. To ignore a legally correct living will was a nightmare.
It would be a mess both legally and emotionally, no matter what I chose
to do. But I had made my decision already and everyone around me knew
it, except Mrs. Gordon and her daughter.
"Pressure is dropping," Coreen said
from the room where Venetia Gordon struggled, and fought the headache
pain caused by high blood pressure. "It's 204 over 136. O2 sat is
up to 90."
"She's breathing easier," the respiratory
tech said. "Bagging isn't as stiff."
It was too soon to feel relief, but I felt a surge
of comfort anyway. Leaving the room, I called Dr. Haynes, Venetia's medical
doctor, and filled him in. The man sounded sleepy, as though I had interrupted
a post-fire, post-surgery, post-embarrassing-spill-in-the-OR nap, but
he instantly knew which patient I was dealing with, listened to the litany
of symptoms, and then recommended admission. "Mrs. Gordon will say
no. She always does. But offer it anyway. And call me back if you can't
get the pressure down. She and Venetia saw a lawyer about a living will.
It's pretty airtight." He yawned hugely, the sound making me sleepy.
"We'll have to get DSS involved to get the girl on a vent. I'll come
in and help you with the mother. She's a handful."
"Thanks. If you don't hear from me, you'll
either find her admitted, or sent home."
I was holding a pair of latex gloves, and absently
folded them and stuffed them into the pocket that held my reflex hammer,
a small Maglite flashlight, and a collection of other medical junk I usually
found myself carrying when at work.
"Pressure is 198 over 130, pulse 81, O2 sat
at 92." Coreen looked up at me through the door, her eyes bright
with excitement. For a newbie, she was doing great. And she was young
enough and inexperienced enough to still find the medical successes exhilarating.
There were compensations for the lack of experience.
Venetia's mom stood by the copier while Anne made
copies, then folded the original papers that could end her daughter's
life and slipped them in her purse. Returning to the cardiac room where
Venetia lay, I stood to the side where I could view both mother and daughter
without moving my head. Drinking a cup of coffee I scarcely tasted, I
watched Venetia's color return to pink, her BP continuing to drop, her
O2 sat rising.
When Venetia could draw enough air to speak, she
said, "My head feels a little better." I nodded at her, pleased.
Mrs. Gordon sat through the procedures with tightly
clasped hands and a strained face, body rocking slightly, silent, staying
out of the way, but with her lips moving, her eyes tight on her child.
I figured she was praying. There was no doubt she loved the girl. The
living will was a mystery.
Forty-seven minutes from the time Venetia was
wheeled into the ER, I asked for a repeat ABG. The results were good enough
for me to turn down the O2 and tell the respiratory tech to stop bagging
her. At an hour and fifteen minutes, Venetia was sitting up, strapped
in the bed to keep her from slipping down again, laughing and telling
knock-knock jokes to the respiratory therapist. Her pressure was stabilized.
Her breathing was near normal. The respiratory therapist was satisfied
with her blood gasses, her O2 sat, everything. The threat of fighting
a legal battle while trying to save a life had been neutralized, just
I poured a couple cups of coffee and motioned
Mrs. Gordon into the office the contract doctors used when working ER
duty. It was little more than a closet, but it did have chairs and a desk
and a new print hanging on one wall, depicting the Charleston Battery
under attack by hurricane winds.
"Venetia is going to be fine," I started.
And then wished I could take back the words as Mrs. Gordon's face twisted
in grief. Venetia was paralyzed. Fine was relative. I took a breath and
started over. "You called 911 quickly enough for us to catch and
treat Venetia's condition before it went too far. You did well, Mrs. Gordon."
The woman nodded her head, still biting her lips.
Her vivid lavender eyes were tear-filled but steady.
"She developed a disorder called Autonomic
Dysreflexia, or toxic hypertension. It's a condition, not uncommon in
quadriplegics, caused by stimulation of the autonomic nervous system by
something as simple as a urinary tract infection. It could have happened
just by moving her from the tub, if her catheter got a slight yank. You
understand what I mean by autonomic nervous system?"
When Almera shook her head no, I said, "That's
the part of the nervous system that controls automatic things like breathing
and heart rate and blood pressure. In quadriplegics, it can be affected
by many things. The blood pressure goes up fast and to frightening levels,
and if not treated, can result in stroke and death. We have her stabilized
at the moment, but I called Dr. Haynes and he recommended that she be
admitted overnight, to monitor her better."
The woman's face grew hard. Her hands, which had
gripped one another repeatedly during treatment, began to work on each
other again. The skin was rough and reddened from what appeared to be
constant abrasion. "No insult to Dr. Haynes," she said steadily.
"He's a good man. But my girl's seen enough doctors. Can't none of
them fix her. A few say she could maybe get some feeling back. Maybe get
some use of her arms. Maybe. But can't not a one of 'em fix her. And I'm
not making her stay in a hospital any more than I have to. Not unless
you say she'll die tonight without it."
I shrugged, uncomfortable with the statement.
Venetia could die at any time. Sometimes toxic hypertension could hit
so fast, a five-minute wait for an ambulance might be the difference between
life and death. It wasn't likely. But I had to consider the possibility.
When I said this to Mrs. Gordon, her face hardened
again, a mask of frustration that I understood. "You're jist riding
a fence like all the others. Make sure you cover your backside so I can't
sue. Well, you ain't got to live with a sixteen-year-old who can't move
to even scratch her nose. A little girl who has lost everything. Who wants
to die so bad I can hardly keep her alive." The tears that had threatened
for the last hour finally fell in a steady stream. I forced myself not
to look away. "You ain't got to pay the bills for every overnight
stay in a hospital, or listen to the bill collectors hound us on the phone.
Venetia's got a one-million-dollar lifetime limit on her health insurance
and a probable life span of sixty years." She sniffed hard. "I'll
be broke and dead long before then."
Disconcerted, I looked away for a moment. "You're
Mrs. Gordon's eyebrows went up. Her hands, which
had continued kneading one another, stilled. Our coffees sat untouched
on the desk between us, a curl of steam lifting from each.
"She initiated the living will?" I guessed
"'Bout drove me nuts till I took her to a
lawyer. She wants to die. Can't stand the thought of living like she is.
Tonight, jist now, is the first time I seen her laugh in six months."
Almera Gordon fished in her neat handbag and pulled out a small, thin
pack of tissues. Delicately she blew her nose.
I remembered the knock-knock jokes the girl had
been telling. Had the freedom from extreme fear temporarily reversed extreme
depression? I waited until Almera had put away the tissues before resuming
speaking. "It's easy for a doctor to get so caught up in potential
medical problems that we forget the realities of time and cost."
I focused on her bright tear-filled eyes. Her skin was mottled and flushed
with the effort of controlling the crying jag. The tissue she still held
was already crushed and wilted. "I'm sorry. I know this is hard for
you, but we sometimes have to save patients against their will."
The woman's eyes dropped, but not before I saw
tears gather again. She took a shuddering breath.
"Call me Almera."
I figured that meant I had passed some test in
her eyes and I nodded my thanks. "And I'm Rhea." I leaned across
the desk toward her. "Almera, Venetia could get this condition at
any time. Once someone has had toxic hypertension, it's easier for them
to get it a second time. The next time, it could come on her so fast that
you wouldn't have time to get an ambulance to her before she had a stroke
I nodded. "Died." This woman wanted
plain talk. I could give her that. "But it isn't likely that it will
happen again tonight, any more than it's likely to happen any other specific
time. She's as stable as I can get her in an ER."
"I'll be taking her home then. I followed
the ambulance in my van." Almera stood, straight-backed and resolute,
opened the door and stepped out into the hallway. I accompanied her, leaving
the coffees on the desk. "I'll stay up tonight watching her,"
Mrs. Gordon said. "I can check her BP every half hour if I need to."
She paused, looking up at me, her face once again hard, eyes calculating.
As if to challenge me. "We have an appointment with a faith healer
tomorrow. I ain't missing that for nothing."
My heart fell. I opened my mouth to say that was
foolish. To tell her they were all charlatans. Fakes. To tell her that
in a few years medicine would have a cure or at least a good treatment
for people in Venetia's condition. But I remembered the tears in Almera's
eyes and her worry-roughened hands, and kept my mouth closed. The words
strangled there. Right now, medicine couldn't provide the kind of help
Venetia needed. And the Gordon's needed something to give them hope.
I settled on, "Would you call us in the morning
and let us know how she's doing? We'll be here till seven."
"I'll do that. And thank you, doctor."
"Rhea," I said again. But she shook
"Doctor. And you're a good one. You talk
With that, she turned her attention to her daughter
and getting the girl strapped into her specially made wheelchair. I stood
in the ambulance bay and watched as they loaded her up, the gray van situated
against a backdrop of vibrant fuchsia clouds and a dying scarlet sun.
It was eight-thirty and growing dark, the sunset seeming alive in the
dusky sky. I looked up. Not a rainbow to be seen. The cool temperatures
wouldn't last. By morning it would likely be back in the high nineties.
For now, the false fall was blissful.
Coreen stood beside me as the van drove off, her
wispy brown curls shaded rosy in the light. "They used to go to my
church. Now they stay home. Watch TV preachers." The Gordon's van
turned onto the road in front of the hospital and moved slowly away, the
brake lights glowing.
In the distance, an engine revved, the whine high
and growing shrill as it approached. Headlights rounded the far curve.
It was another van, this one vibrant as the sunset, flying up the hill.
Foreboding gripped me.
"That thing's moving too fast," Coreen
said. "It ain't gonna make the"
The van, silhouetted in the orange sun, made a
hard left in front of the hospital. Tires squealed. Its headlights flickered.
The van seemed to lift and topple then rolled and disappeared off the
road into the ditch. The sound of it hitting earth and the utility pole
was like a bomb going off. The pole splintered and flew up into the air.
An instant later the impact was over. And I was moving.