GWEN HUNTER - PRESCRIBED DANGER

According to my mother, I had breeding, good genes, and the right to success. Of course, my mother said that during one of her many drunken binges, and so it was something I took with a grain of salt. She was a Rheaburn, of the Charleston Rheaburns, but had married beneath herself, had a baby within five months of the marriage, been quickly widowed, and then taken up with a bottle of Jack Daniel’s. The Rheaburns could have forgiven her the marriage – after all, the man had the good sense to die quickly enough – but it was the baby and the Jack that caused her disgrace. I was that baby, and I have been paying the cost of her rebellion ever since.

The price has been a peculiar sort of aloneness. I tend to stand back and watch as others interact, rather than joining in myself. I spend a lot of time evaluating and assessing people and situations, which makes me a good diagnostician, a quick thinker, and someone who reacts instantly in times of stress or trouble. It’s a personality trait that makes me a capable ER physician. It also makes me a bit of a cold fish.

That last is the opinion of Miss DeeDee, the woman who took me under her wing, taught me all I ever knew about family and friendships, and put me through medical school. She also killed a man and maimed three people, but insists it can’t really be held against her. She was under a bit of strain financially at the time. Miss DeeDee is now a ward of the state, occupying a private room in our state mental facility, the price of her fatal financial negotiations. She is a bit of a cold fish herself, I suppose.

One good thing came of my isolated upbringing, and that was my ability to make and keep friends. I value friendships, and work hard to keep them fresh and strong. It was this gift for friendship, combined with the ability to keep a clear head and diagnose obscure medical conditions, that led me to the murderer of Leon Hawkins….

Leon’s death was a bad one. No easy passing in his sleep. Not even a quick bullet to the brain. And the manner in which he died led me to some strange and incorrect conclusions before the truth was finally known.

His story and his death reminded me of one of my mama’s drunken aphorisms – ‘Things aren’t always as they seem.’

Lightning tripped the breaker. The overhead fluorescents died, throwing the ER into blackness. In theory, the backup generator was supposed to prevent blackouts, but the reality was often something different. Just outside of my range of hearing, thunder boomed, more a vibration of the foundations than a sound. The old building groaned as wind battered the southeast side. Water poured through lighting fixtures and into buckets procured by the roaming security guard. The rattle of metal was soothing, like the sound of rain on a tin roof. I paused mid-suture, waiting for the lights to be restored or for someone to bring me a flashlight. Beneath the sterile drape, my three-year-old patient whimpered. "Mom?" he said, his voice quivering.

"It’s okay, Charlie," I said, knowing I was soothing both mother and son. "Almost done." I could hear his mother swallow. When the lights finally flickered back on, I made a of not looking at her, but kept my expression cool and professional as I tied off the last suture and sat the toddler up. "All done. See?" I turned his leg so Charlie could see the neat row of stitches that replaced the gaping laceration and shooting streams of blood.

I grinned at him. The neat row of stitches did look like a many-legged bug. "Not so bad, and for being a big boy, you get five stickers." I held out my hand, fingers splayed. "Want Pooh or Pokemon?"

"Both," he said promptly, and then laughed through his tears. He was a cute kid, and I ran my hand across his short, curly hair as I left the room, knowing that one or another of the nurses on duty would see to the stickers and his mother’s instructions for wound care.

I stretched, moved into the break room and sighed, then poured a cup of raspberry-cream flavored coffee and picked up my copy of the New England Journal of Medicine, opening it to an article pertinent to gastric lavage in the gut-shot gang patient – not that the Journal writers would ever put it so baldly. Anne and Zack, the RNs on duty tonight, were puttering around in the drug room, counting tablets, capsules, and vials of various drugs. I was alone with the police scanner, listening to reports of storm-tossed mayhem, bored enough to actually consider filing and painting my nails with the clear polish Anne had left on the break room table. It had been over a year since I’d bothered, however, and there was no sense in putting my cuticles into shock.

The lights went out again. In the strange dark, I heard someone crying, the sound muffled and choked.

My only other patient, diagnosed with lower lobe pneumonia, had been admitted but was still waiting for a room on the medical floor. She also had a bad case of grief. Her husband had died in the last week, leaving her alone and mourning herself to death in that dry-eyed form of grief where everything simply shuts down and the mourner feels nothing.

I had examined her, tried to get her to talk to me, and been rebuffed. She had been willing to accept my medical help but not my more personal concern, turning her face away when I asked about her emotional state. But now she was crying.

The lights finally flickered back on, and I stepped into the treatment room. The woman, Regina – her last name was gone from my memory – was weeping, her dark-skinned face buried in the thin hospital blanket. Putting down my coffee, I pulled up a chair and slowly sat, bending forward so our faces were level. I wasn’t much good in counseling sessions, but I understood pain, and my patient was in agony. I held out a hand, pulled gently at the blanket.

Regina moaned, her red-rimmed eyes focusing on mine, her mouth opening and closing at each painful breath. With a sudden jerk, she took my hand, her icy grip transmitting her desperate grief. "Want to tell me about it?" I asked.

I blinked. I hadn’t understood that her husband had committed suicide. I gripped her hand tighter, enfolding the frigid flesh in my warmth.

"He was so heavy. I couldn’t lift him good. And he…" she sucked a tear-wet breath, "dead. He dead." Fresh sobs tore through her. After a moment she looked up. "I got up top and my friend Louise, she went back for a knife. We cut him down. And he fall. I still hear that sound. Him falling. Heavy, big man, onto the rock. He hurt his head when he fall. Thump sound, like a melon breaking. My man dead. My man dead."

There was nothing I could say. Nothing. Regina rocked, and I held her hand. Motioning to a passing nurse, I ordered a strong sedative, and stayed by Regina’s side until it took effect. When the woman’s frail body relaxed, uncurling from the tight ball beneath the blanket, her eyes fluttering into sleep, I slipped my hand free and found my cold coffee. But I stayed with her until the nurses took her to the floor.

Even at eight p.m., there were no more patients,.. No crying babies, no drunks, no mothers-to-be with phantom pains for me to diagnose and treat. Just a freak spring storm weather forecasters were referring to with awe. The storm had settled in over the upper part of the state as if it intended to stay. Back in the break room with a fresh cup of coffee, I listened to the scanner report flooding in the lowlands, as creeks and ponds expanded their banks to include neighborhoods and roadways. Mud-slides threatened as hillsides weakened by too much April rain gave way. Nature seldom listened to the projections of engineers on hundred-year floodplains and storm runoff.

South Rocky Creek, normally winding its peaceful way behind the hospital property, was taking over the doctor’s parking lot, and I had been forced to park uphill from the hospital to protect my little BMW through the night. It was a mess out there.

High winds were taking off roofs and downing trees all over the state, shutting off electricity for tens of thousands. Vinyl siding torn from houses was flying in the wind, shattered windows were letting in rain by the bucket, buildings were lying flat. Bridges were being washed out and electrical lines whipped in the wind, throwing sparks and starting small fires which the rain quickly damped. Phones were out throughout the piedmont region of the state.

According to the radio, Charleston, where I was raised, was heavily damaged. DorCity, my adopted home, had also been hit badly.

I was intimately familiar with the condition of the town, having just made the run from my house though DorCity to the rural hospital. I thought my toy-sized car might take up wings and fly away a few times, but I had made it in under my estimated time. And truth to tell, I was glad to be in the hospital instead of my old, bungalow-style home, which might be reduced to matchsticks by morning if the hundred-year-old oaks that surrounded it decided to give in to the wind and crash down. Even my dogs hadn’t wanted to stay home through the storm, so I had left them with the cop across the street for the night. Mark Stafford was half-boyfriend, half-annoyance, but he loved dogs; Belle and Yellow Pup were safe there, with his half-dozen hunting dogs in their brick-lined shelter.

When the storm finally passed over, the small rural ER would fill up with typical Thursday night problems, as well as stress-induced heart attacks, babies being born too early, minor injuries, and accident victims who couldn’t wait to get out and ride around to see the damage. The latter were fools, a danger to themselves and the rescue personnel out doing their jobs, and I would likely tell several so by morning. It was the perk of being a doctor. I could tell strangers the truth and they had to take it. I sipped at the coffee, now cool enough to drink.

The ambulance service airlock opened with an ear-popping whoosh. Humid air and shredded leaves blew in, but no one entered. Just the wind, too strong to hold the doors shut one moment, then reversing directions, becoming too strong to force them open at all.

The lights flickered again, blackness and light like a strobe above me. The elevator was out, and the high winds had closed the second floor, where pediatrics and obstetrics were located. The patients had all been moved to the medical wing. Three pediatric patients and one jaundiced baby under a bili-light. No OB patients. Those would have to go to Ford County tonight and all weekend, as the OB/GYN was out of town. Dawkins boasted exactly one doctor who delivered babies, and Michelle Geiger was in New York at a conference.

The hospital was not a modern monstrosity, a solid rectangular block of stacked hallways and units, but a haphazard "U-shaped" construction put together over the years on cheap county land. Units went every which way, with ICU heading south, the medical floor facing east, and the nursing center situated down a long connecting hallway back around to the south. Surgery was a new section to the north. All parts of the building, both old and new, were being battered as the wind groaned overhead.

Behind me, the EMS scanner crackled to life. "Dawkins County Hospital, this is Unit 52. Come in." It was an EMS unit, out in this storm. I wandered closer to hear what patient would be brought in.

Anne picked up the mike and depressed the button on the side. "Unit 52, go ahead."

"Dawkins, we have two patients. First is a white male, age twenty-four, with multiple contusions, abrasions, bruising over large portions of torso, abdomen and groin area. Bruising on both wrists, possible broken fingers on both hands. Patient is a victim of assault." Anne sighed as she took notes. "BP is 125 over 85, pulse is 105 and tachy. Temp is 96.5, say again, 96.5.

"Patient two is Asian female, age twenty-two, also victim of assault, para 1, gravida 2, six months gestation." I moved closer, not sure I had heard correctly. A pregnant patient who had been beaten? I hoped the assailant wasn’t the man with her in the ambulance. That was never a good situation. "This patient also has abrasions and shallow lacerations to limbs, chest and abdomen. BP 145 over 95, pulse 125, with very tachy episodes up to 175. Temp is 94.2. Repeat 94.2 Patient appears to be in early labor. Copy that, Dawkins?"

"We copy," Anne said. She was writing furiously, but paused to glance over her shoulder at me and shake her head. I had heard the emergency medical technician correctly. She was pregnant and had been assaulted. Her body temperature was low and her heart rate was high – "tachy" was medic speak for tachycardia.

"Patients were immersed in Prosperity Creek for a number of hours and have swallowed a large amount of creek water. Possible aspiration of same. Copy all that, Dawkins?"

"Dawkins, you might like to have sheriff’s department on hand at hospital. They have not been notified. Unit 52 out."

"We’ll call them in," Anne said. "Dawkins 414, all clear." She replaced the mike and stood, grimacing at me. Neither one of us liked this. We had an assaulted female in labor with a six month fetus and no OB/GYN on hand. We were supposed to ship all pregnant patients out.

Anne was a medium woman: medium brown hair, brown eyes, medium build, middle age, medium height. But in an emergency, she was great. Already she had moved into the treatment room with the OB table/bed to pull out supplies I might need.

"Anne?" I called. When she stopped and looked back over her shoulder I said, "Call them back. Ask them if the road to Ford County is open. See if they can take both patients there."

I looked up at the dry tone and surveyed the cop standing there in a rain slicker and black combat boots. I hadn’t heard Mark come in. "72 is closed, two bridges out. I-77 is down for the next six hours at least, with accidents." Anne snorted and went on into the treatment room where I could hear the crackle of plastic being torn.

"We have three separate situations with tractor trailers flipped over," Mark continued. "Two on `77, one on highway 9 just outside of town. HazMat has been called in for the highway 9 accident, by the way. Guy was trying to head north through this wind carrying a load of sulfuric acid. Thought he’d drive around the mess on `77 and hit the interstate again up in Ford County. Bad decision."

"Lovely," I said. I hadn’t delivered a baby since med school. I wasn’t the maternal type. And if there were any burn victims from the acid spill, I would get them. With this wind, there was no way to fly anyone out to burn or trauma centers.

"Ain’t it?" Mark said. "Now it’s covering the road, running out of the ditch banks, and flowing toward the creeks. Fun time in the old town tonight."

I wasn’t sure if he was kidding or not; cops think the strangest things are fun. To Anne, I said, "Get me a mag sulfate drip. If we need to slow down contractions I want it ready." To Mark I said, "You’re dripping all over the floor."

He grinned, a drip of water sliding down his forehead, getting caught in his thick brows. "You gonna mop up after me?"

He laughed and leaned forward, stroked my head, his hand damp against my short, black hair. Mark didn’t believe in public displays of affection. Neither did I. "Have to hit highway 9 and see can I help out." He smiled broadly, as if he thought that standing around in a violent storm, surrounded by flowing sulfuric acid, would be a fine thing. "Be sure to call my deputies on your assault. But if you need me, call the dispatcher. I’ll come back."

I was touched, but wasn’t about to show it. Our relationship hadn’t made it to the point of sharing many vulnerabilities yet. Probably never would. "Yeah. Thanks. And by the way, you were right. I do need a truck to handle this kind of weather. It’s real nasty. Be careful out there."

Resigned, I followed him into the airlock, a big, burly, out-of-uniform-cop with a gun on his hip, a second one on his ankle beneath his jeans, and an ugly orange slicker still dripping with water, the word POLICE in huge capital letters on front and back.

Mark pushed against the outer doors and air sucked through, swirling leaves inside. Under the ramp, a branch swept past and the outer doors shook with wind and pressure changes. Without a word, Mark thrust the outer door open and shoved his body into the tumult. He was still grinning, green eyes gleaming, as he drove away in his dark green Jeep, and I knew he was having the time of his life. He un-bent enough to toss me a wave.

The sky was dark, ripped with purple clouds, lit with flares of lightning. Debris, tossed like failing kites, whirled along the ground, only half visible in the dying light. Rain slashed like warm butter knives, beating at the hospital’s brown stucco sides. A cat, drenched and miserable, ran into the covered breeze-way and shook herself. She crouched at the sight of me, wary, cautious. When I didn’t move, she relaxed and lifted a paw to lick away the rain. Her affected air of unconcern only partially hid the hyper-alertness caused by the storm.

From the road in front of the hospital, a pair of headlights turned into the lane, red lights flashing above. Wind rocked the ambulance from side to side. Even the heavy conveyance was too small to fight the storm. Engine roaring, it pulled up under the ramp and stopped beneath the covered ambulance bay. The cat scuttled back into the storm, tail down.

The driver door opened and Mick Ethridge hopped out, his wet hair slicked to his skull. He was just a kid, still too young to drink legally, but old enough to take the paramedic exam. Last I heard, he was still waiting for the test results.

I stepped through the inner doors and shouted back down the hallway, "Anne, Zack, get a wheelchair!" Not waiting to see if they heard, I went to the back doors of the ambulance. Wild wind grabbed my lab coat and tried to pull it from me. Horizontal rain wet my scrub suit and soaked through to my legs. An overweight EMT jumped down, wedging the doors open. I peered past him inside.

There was blood in the back of the unit. Quite a lot of it, pooled in the smooth floorboard. A man, his long, soaked hair draggling forward over his face, sat hunched in the corner seat, almost invisible in the poor light. Lying limp on the stretcher was a young woman, a waif-like thing looking little more than a child, her small belly pushing against her wet dress. Fresh blood ran in bright rivulets down between her legs.

"When did this start?" I couldn’t tell if Mick heard me or not, my breath whipped by the wind.

Zack came through the airlock doors, a wheelchair before him. He stopped, his face lit by flickering florescent lights and shadow. Black skin grayed by lightning. Huge eyes. "What a storm!" he shouted happily.

Mick nodded back, jumping into the unit and assisting the paramedic inside. "Started not more than two minutes ago, Doc. Pressure’s dropping."

The EMS crew transferred the woman first. She was covered in mud, wet to the bone, and was in heavy labor, bleeding profusely. "Vitals," I shouted as we moved to the airlock doors.

"BP dropping. Last time I took it, it was 90 over 45. Pulse 90. Pupils equal and reactive. They were in the water all day, Doc. Through the entire storm." The airlock doors gave, Anne holding the inner doors open for the stretcher.

Excerpt from the book Prescribed Danger by Gwen Hunter
A Rhea Lynch, MD. Novel
Mira Books - April 2002 - ISBN 1-55166-803-3 - ©2002Gwen Hunter
This edition published by arrangement with Harlequin Books S.A.

Gwen Hunter’s books have been sold in the USA, Italy, France, Germany, Holland, Australia, New Zealand, the Philippines, and the UK, where her best seller STOLEN CHILDREN (the UK title for the novel BETRAYAL) won the W.H. Smith award for best first novel. Gwen's latest book, GRAVE CONCERNS, is a lead title from MIRA BOOKS. Look for it in book stores January, 2004.