Chapter 11: Get Out of Here!

July 3, 1989, McKinley, Ohio

"Mike Loucks," I said.

"Mike, it's Melissa Bush. I'm sorry I haven't returned your call. What can I do for you?"

"First, tell me, how are you doing?"

"I'm a doctor, so that's a major plus. I split my time between the Internal Medicine ward and the ER. Eastern Kentucky coal country is not my idea of a great place to live, but it beats the alternative. I take it you're loving every minute of the Moore ER."

"This is my first full shift," I said. "I had a short shift on Saturday but took a delayed start so I could spend time with my wife and daughter before the full-scale insanity began."

"Why did you call?" she asked. "I'm positive you don't expect us to be friends."

"And there you'd be mistaken," I replied. "Again. Nobody is irredeemable, Melissa, and that includes your dad. I saw him about a week ago."

"He was in the hospital again?"

"No, I went to Southern Ohio Correctional Facility to visit him."

"What the heck?! Why would you do that?"

"There's this book that reminds us of how we're supposed to behave. I believe you've read it once or twice."

"It's all bullshit!"

"Not to get into a theological debate, but 'bullshit' accurately describes the Calvinist interpretation of the Scriptures. It's a good thing I don't buy it, and I never have. Sadly, though, your dad thinks he's on a Highway to Hell with no offramp available."

"Well, if such a place actually existed, I'd say that's where he belongs."

"You're no longer a believer?" I asked.

"I was fed a steady diet of that bullshit for twenty-five years, and it nearly wrecked my life. It certainly wrecked my mom's and did a serious number on my brother as well."

"And on your dad, too. Fundamentally, that's why he is where he is. I was going to suggest you get in touch with him, but now I'm not sure it's a good idea. He needs love and hope."

"And you thought I was brainwashed? He murdered your friend!"

"Yes, he did, but that does not make him any less a child of God. Misguided and sinful, but still a child of God, and in the end, not all that different from me."

"That's crazy talk."

"If I be a fool for Christ, that is a credit to me," I replied, quoting a monk. "Anyway, I did want to congratulate you on Matching, and I hope you're successful. The people of that area need good medical care."

"They need way more than that!" Melissa protested.

"I don't doubt it, but as has been said to me, we have our roles to play and our jobs to do, and we have to do them to the best of our ability and leave other things to others. It's not that we don't care, but neither of us is a social worker. What kinds of cases do you see?"

"Respiratory problems related to mining, poor nutrition, pregnant teenagers, and drug addiction."

"I suspect that's par for the course for a poor rural county."

"It is. How is your daughter?"

"Healthy and almost two," I replied. "I'm sure you heard I re-married."

"I did."

"Anyone special in your life?"

"Nah, just the usual Friday night hookups with unemployed rednecks at the local bar."

"Now, why don't I believe that?"

"What's not to believe? I'm not the same person I was a year ago."

Nurse Bonita tapped my arm and said, "Doctor Williams needs you in the ambulance bay."

"Sorry, Melissa, but there's an ambulance run. OK to call you again?"

"Suit yourself, but I'm not going to contact my dad."

"OK. Could I get your phone number?"

She gave it to me, and I wrote it in my address book. We said 'goodbye', and I hung up.

"Let's go," I said to Tom.

We gowned and gloved and went to the ambulance bay where Doctor Williams, Naveen, his two medical students, and two nurses were waiting.

"Two gunshot victims on their way in," Doctor Williams said. "One's a deputy with an arm wound, which you'll take. Naveen and I will take the guy he shot twice in the chest."

"Any idea what happened?"

"No. But you can expect half the Sheriff's Department will swarm the place, and they'll know. Kelly is with you."

An arm wound could be anything from grazing to a through-and-through with only soft tissue damage to a shattered bone. None of which were directly life-threatening and certainly not serious compared to a pair of .357 slugs in the chest. That might well be futile, but, as always, we had to try.

"OK," I agreed. "Kelly, I'll want a full trauma panel, no matter what. Tom, EKG and pulse oximeter, please. Beyond that, we'll see what we have."

The two EMS squads arrived in quick succession, and the victim with the two gunshot wounds to the chest was extremely critical, as expected. Doctor Williams and Naveen rushed him inside as the Sheriff's deputy was unloaded.

"Sam Kenseth, thirty-one," the paramedic called out. "Through-and-through small caliber gunshot wound to the upper right arm; tachy at 110; BP 110/60; PO₂ 99% on nasal cannula; IV saline TKO; morphine x1; awake, alert, and oriented times three."

"Take good care of him, Doc!" another Deputy who hopped out of the squad after the gurney.

"Best care anywhere!" I declared, quoting the sign for the 4077 MASH from the TV show. "Trauma 2!"

We quickly brought Deputy Kenseth into the trauma room and moved him to the bed, and Kelly connected the nasal cannula to the hospital oxygen system.

"Deputy Kenseth," I said. "We need to get your Kevlar off, and it's not going to be comfortable if we don't cut the straps.

"Don't cut it," he grunted.

"Tom, bandage scissors for the uniform shirt," I instructed. "Cut up the sleeve to the shoulder, then across the chest and down the other sleeve. Be cognizant of the wound."

He did as I asked, then hooked up the monitor while I undid the straps on the Kevlar vest. I had the deputy sit up so I could remove it without cutting the straps, and he grunted and grimaced, but his vest was intact.

"Tom, please cut away the T-shirt for an EKG," I said as Kelly moved to draw blood from the deputy's good arm.

I did a quick exam, and other than the gunshot wound and slightly depressed blood pressure, likely from the morphine, I found nothing amiss.

"What caliber bullet?" I asked Deputy McCallum, the one who had come in with the patient.

"A snub-nose .32," he said.

"Please tell me it wasn't a Walther PP," I said.

"James Bond, the scumbag ain't!" Deputy McCallum said. "But that pistol fits in a pants pocket."

"Deputy Kenseth, we'll get an X-ray, irrigate the wound, and probably throw in a couple of stitches on either side. You'll need a tetanus shot, and we'll give you antibiotics, but you should be able to walk out of here in a few hours."

"How's the dirtbag?" he grunted.

"He's next door with Doctor Williams and Doctor Varma. I'm sure they'll fill you in when they know something. Mind if I ask what happened?"

"Kid had a trunk full of weed and pills," Deputy McCallum said. "Sam pulled him over for speeding, and he came out blasting."

"That doesn't appear to have ended well for him. Tom, call for the portable X-ray, please, then get the blood to the lab."

"Yes, Doctor."

"Kelly, trauma kit with sutures times four."

"Right away!" she said brightly.

"How much time will I miss?" Deputy Kenseth asked.

"That's up to your boss," I said. "From a medical perspective, I'm not going to prescribe anything other than antibiotics. For pain, use over-the-counter Advil or Tylenol. You'll need to have the wound checked in a few days, but the duty nurse from the lockup can do that. On the other hand, if you want some time off, I can write that up for you."

Both Deputies laughed.

"I love all you docs," Deputy McCallum said. "You take good care of us. You're the doc who disarmed the asshole in your waiting room, right?"

"Yes."

"And you turned down the recognition award."

"Let's just say I don't want to draw attention to doing something bordering on foolish."

"Nah, you did the right thing in a room full of people. I heard you had a good wrist lock on the idiot."

"Karate training," I replied.

"Radiology tech is on his way," Tom announced, then left with the blood.

Five minutes later, I had the image on the screen.

"It's your lucky day, Deputy," I said. "No ligament or bone involvement and no major blood vessels impacted. Four sutures, antibiotics, and you'll be outta here. Have you had any negative reactions to anesthesia, including when you've had dental work?"

"No."

"Forget the drugs, Doc!" Deputy McCallum declared. "Just give him a bullet to bite on."

"There's bravery, and then there's stupidity," I replied. "The difference is minor!"

"I'll take the drugs, Doc!" Deputy Kenseth declared. "Pete can bite me!"

"Pass," Deputy McCallum retorted.

"Lidocaine times four, Kelly," I said.

Twenty-five minutes later, after the lidocaine, irrigation with saline, application of Betadine, and four sutures, I was finished.

"Your blood work will be back in about fifteen minutes," I said. "Once we see that's clear, we'll get you out of here. Kelly, would you administer the tetanus booster, please?"

"Right away!" she exclaimed.

I sat down at the table, wrote out the prescription for antibiotics, updated the chart, then went to the nurses' station to get the proper discharge form, which I filled out, then took everything to Doctor Mastriano, who, if I judged correctly, had not treated a single patient since her shift began. She once again reviewed the chart perfunctorily and signed off.

"What's wrong with her?" Tom asked as we walked back to the trauma room.

"No clue, but that's something for Doctor Gibbs or Doctor Northrup to handle."

Tom went to the lab to get the blood work results while I returned to the trauma room. I went over the discharge information with Deputy Kenseth and gave him the prescription. When Tom returned with the results, which were normal, I informed Deputy Kenseth he could go.

"What about the perp?" he asked.

"Emergency surgery, according to the board," I replied. "Someone upstairs can keep you posted."

"Powers and Green are with the perp, Sam," Deputy McCallum said. "I'm going to get you home to Nancy and the kids."

"She's going to kick my butt for not calling her."

"You're alive and not badly hurt," Deputy McCallum said.

"Not for long! You might see me again soon, Doc!"

I chuckled, "My advice is the next time you get shot at, don't get shot!"

"No shit, Doc! Fortunately, the little bastard was a lousy shot."

"That .32 wouldn't have penetrated the vest," I said. "But in the head, it would have ruined your entire day. Try to avoid showing up here with extra holes in your body, please."

"You know it, Doc!"

We shook hands, and Kelly helped him put on a scrub shirt so he didn't have to leave bare-chested.

"Be sure to have that checked and make sure you take the full course of antibiotics."

"Will do. Thanks for patching me up."

"You're welcome."

I left and went to find Doctor Williams, who was in the lounge.

"How bad?" I asked.

"Two to one, he doesn't make it," Doctor Williams said. "Missed his heart, but he lost a lot of blood, and he'll likely lose a lung if he does make it. Your deputy is an excellent shot — both center mass. How is he?"

"I just sent him home to a wife who might send him back because he didn't call her."

"The man has a death wish!" Doctor Williams said. "Treatment?"

"Irrigation, four sutures, tetanus shot, antibiotics, and over-the-counter NSAIDs for pain. I cleared him for work as soon as he wants to go back, though obviously that's up to his boss."

"You're really averse to pain meds, aren't you?"

I nodded, "Some docs are handing out opiates as if they were Skittles. I think that's a really bad idea. Obviously, I'll suggest them when absolutely necessary, but why exacerbate what's already a growing problem?"

"Good point, but expect some pushback."

"Story of my life so far in medicine," I chuckled.

"You are something of a maverick."

"While there is value in 'this is how we always do it', that's what led to the rejection of handwashing, though I'd like to think I'm not as much of an ass as Ignaz Semmelweis was reputed to have been."

"You'd like to think!" Doctor Williams said.

"OK, so I come across as an arrogant, egotistical prick at times, but am I wrong?"

"No. Just remember what my grandma always said — you catch more flies with honey than with vinegar."

"I prefer to keep the flies away, not attract them!"

"Get out of here"! Doctor Williams ordered.

I chuckled, and Tom and I left the lounge.

"That was weird," he observed. "Why say that about yourself?"

"Why not? It's not like I hide it! And in the few hours we've worked together, I bet you've noticed."

"I just figured it was a surgeon thing."

I laughed, "You figured right! That said, I do not have the bedside manner of a surgeon."

"Nobody does," Tom said. "They don't have one!"

I laughed, "Often, too true. Let's go see what Mary has for us."

"Naveen just took the beer can to the forehead," Mary said. "Nothing else at the moment."

"He waited a long time," I said. "Did you call Doctor Mastriano?"

"Yes, but she said she was busy, and he could wait for you or Doctor Varma."

Busy my ass, but I couldn't say that to my medical students.

"OK. I'm going to get some fresh air. Send a nurse to get me if anything comes in, please."

Mary acknowledged me, and Tom and I went to the ambulance bay. I was surprised when he pulled out a cigarette.

"Seriously?" I asked.

He shrugged, "It helps with the stress, and nicotine isn't on the prohibited list like alcohol or pot."

"Just remember, you're going to have to look patients directly in the eye and tell them to quit smoking. If you smell like smoke, you'll come off as a hypocrite."

"I hear you. And what's with Mastriano? Busy? She's sitting in the Attendings' office reading a book!"

I shrugged, "As I said, not my place to say anything to her, but I will mention it to Doctor Gibbs as soon as I see her."

Which would be Wednesday night when she, Bobby, Ghost, and Oksana would join us for dinner.

"Can I ask you something?"

"Always."

"You seemed to be sucking up to the deputies. Why?"

"I have great respect for firefighters and law enforcement," I replied. "While I have serious problems with the excesses of the criminal justice system, the patrol officers are not the problem. I wasn't sucking up, only treating them with the respect I think we owe to the men and women who put their lives on the line to keep us safe. I have several good friends who are firefighters or deputies."

"You've never dealt with a big-city police department, have you?"

"No. Where are you from?"

"New York City, where the cops are all on the take, totally corrupt, and only look out for themselves."

"I hope you've noticed our deputies and city cops aren't like that."

"It is a whole different world from Queens."

"I believe it. Doctor Nielson did his Residency at Cook County in Chicago and says it's night and day different from here. Doctor Taylor said the same thing, but he Matched here, which made him very happy. Are you going to try to Match back home?"

"Upstate New York or Eastern PA," Tom said. "Basically close to home, but not in the City."

"Mike?" Bonita said, coming out into the ambulance bay. "Mary needs you for a walk-in with facial contusions and lacerations."

"Stub out the cig, Tom," I ordered. "Duty calls."

We went to see Mary at the triage desk.

"Approximately twenty-two-year-old who appears to have been in a bar fight," she said. "He's clearly drunk, and his buddies dropped him off and left. He was at least somewhat awake but appears to have fallen asleep. No ID."

"Those are usually closer to closing time," I observed, accepting the proffered chart. "Tom, get a wheelchair, as I don't think our patient is in any condition to walk."

He left and returned a few seconds later with a wheelchair. We went out into the waiting room, and I tried to rouse the patient, whose name we didn't know. He was basically incoherent from the booze, the beating, or, more likely, a combination of the two, so Tom and I moved him to the wheelchair.

"Exam 2," I said.

Tom began pushing, and I went over to Mary.

"When the Law shows up, send them back."

"What makes you think the cops will show up?"

"Nobody gets this drunk, and this beat up in a bar without someone calling the cops."

"I'll send 'em back if they show up."

"Thanks."

I stopped at the nurse's station and asked Bonita to send in a nurse with a banana bag, then went into Exam 2. Tom and I were strong enough to get our patient onto the exam table. Nurse Becky came in with the banana bag, and I had her set it up.

"What do we do?" Tom asked.

"Trauma panel with EtOH, and wait for him to sober up. None of his lacerations are bleeding badly, so we wait. Go ahead and draw the blood and take it down to the lab. I'm going to do a quick physical to make sure he's not bleeding internally."

Once Tom drew the blood, I did a basic exam, checking for blood in his eyes, ears, nose, and mouth, then palpated his abdomen. His pulse and breathing were reasonable, given his inebriation, though I was concerned about aspiration if he vomited.

"Vitals are acceptable," I said. "No obvious internal injuries. Becky, please stay with the patient, and let me know when he comes to."

"Soft restraints, Doctor?" Becky asked.

"I see no need," I replied. "Let's see his EtOH level, then decide what to do next."

July 4, 1989, McKinley, Ohio

I left the exam room and went to check with Mary, but there were no additional patients, so I went to the lounge. I was just over halfway through my thirty-six-hour shift and still had plenty of energy. I'd done twenty-four-hour shifts and been OK, but those additional twelve hours looked to be tough, not to mention I had a concert gig to play on Tuesday afternoon — actually, later this afternoon, as it was after midnight.

Tom returned with the EtOH results about ten minutes later.

"0.19," Tom said.

"Take another in twenty minutes, please, and add a blood gas. Once those are back, along with the trauma panel, we'll decide what else to do."

"I'll take care of it," Tom said.

He left and about five minutes later, Nurse Peggy came into the lounge to let me know a Sheriff's Deputy was looking for my patient. I went to the nurses' station and saw Deputy Schmidt, whom I'd spoken with on several previous occasions.

"Overnight shift before a holiday?" I asked. "Who did you piss off?"

"Hi, Mike! Well, I guess it's Doctor Loucks now. And I traded similar to how you docs trade and it was a good deal."

"Doctor Mike, please. What can I do for you?"

"I hear you have Peter Firth in Exam 2."

"I have an African-American twenty-something John Doe who was in a bar fight, but we didn't find an ID. He's basically incoherent at the moment, and we have him on a banana bag, waiting for him to sober up before we treat him further."

"What injuries?"

"Contusions and lacerations consistent with a fist-fight, but no internal injuries were detected. I can't imagine he fought back, given how drunk he was."

"He was beaten up by four guys for talking to one of their girlfriends."

"White guys, I take it?"

"We got two of them, and we're looking for the other two. Can I see him?"

"Yes, though he's not in any state to question at the moment."

"I just want to get a record of his injuries, including a Polaroid."

He held up the camera.

"You assume he's going to press charges?"

"I hope so. Those guys have done this before and managed to walk. This time, though, the bartender swore out a complaint for disorderly conduct and property damage, so we can keep them cooling their heels at least until they see a judge on Wednesday."