“Thank you.” Lukas handed them to Carol. “Would you do the honors? Beverly, let’s get an IV established on this man immediately, and we need to get his clothes off and see where the blood is coming from.”
While they worked on him, the double-coverage nurse arrived. Lauren groaned when she saw Beverly. “We’ll be swamped.” Even as she spoke, the ambulance radio blared. She pulled her long, blond hair into a ponytail and fastened it as she sat down at the desk to take the call.
In fifteen minutes, the emergency room was nearly full. The man in exam room seven had a deep laceration in his right forearm from an industrial accident. Lukas called industrial accidents his “graveyard specials,” because they happened most often during the predawn hours when the need for sleep was at its highest. Lukas used them as an example when arguing against twenty-four-hour shifts for emergency room physicians. This patient had worked since midnight, having had no sleep the day before. Dangerous?
A high school track student in room two had a possible broken wrist. The E.R. staff was waiting for parental consent to treat, enduring endless telephone calls from classmates to check on the patient’s progress while the track coach searched for the completed consent form. Naturally the parents were out of town for the day.
A baby in room three had a red ear, and Lukas was still trying to decide if it was serious enough to treat with an antibiotic. The young mother had come in crying almost as loudly as her baby, and for a while no one had known which of them was here for treatment.
Two unwashed females stood out at the reception desk complaining loudly because they hadn’t been treated yet for their head lice.
“No, you did not ‘wimp out,’ Mr. Casey.” Lukas stood beside the bed of their first arrival, thirty minutes after they’d wheeled him in. The man still looked weak, although his color had improved. “You lost a couple of pints of blood. Your loving pet nicked an artery in your thigh.” He indicated Casey’s bare leg.
Lukas traced the stablike wounds on the inside of Casey’s right thigh. “That’s some cat.”
“This is just a love bite, Doc. My name’s Jake, or Cowboy, but don’t call me Mr. Casey.”
“A love bite?”
“Male African lion.”
“A pet?”
“Had him for four years, since he was a cub. I raise exotic animals for parks and zoos, but I kept Leonardo. He’s good company.”
“When he’s not eating various parts of your anatomy. You must live alone.”
“How’d you guess?”
Beverly entered the trauma room to recheck Cowboy’s vitals and help Lukas finish irrigating the wound.
Covered in nothing but a towel, Cowboy’s whole body blushed. “Uh, Doc, I’d be grateful if you could spare one of those skimpy hospital gowns. It’d cover a whole lot more.”
Lukas grinned at him. “I think that could be arranged.” He glanced at Beverly. He had already seen the way Cowboy looked at her—and the way she looked back. “Maybe I should help him dress.”
“You don’t have time,” Beverly said. “I hear the ambulance phone now, and we have a mom out in the waiting room with three children she wants to have checked out for sore throats and earaches.”
“How long before our surgeon arrives?” Lukas asked.
Beverly wrote down Cowboy’s vitals on a clipboard. “Any minute now, Dr. Bower. He laughed when I told him who it was. He says he’s had this patient before.” She grinned at Cowboy. “I hear you’re pretty adventurous.”
He returned her smile and blushed again. “The folks I work with aren’t always predictable. Dr. Wong took care of a gash I got in the head when a scared zebra kicked me.” He looked at Lukas. “But why do I need a surgeon for this bite? Can’t you just sew me up and let me get home? Leonardo will be hungry before long, and he’s probably worried.”
“Good,” Beverly said. “Let him worry. Maybe he’ll remember this the next time he confuses you with a beefsteak.”
“Sorry, Cowboy,” Lukas said. “Leonardo bit into a deep artery. That’s surgeon territory.”
“But you’ve stopped the bleeding.”
“With pressure. When we remove the pressure, we’ll be leaving an unstable wound that can burst open at any time. You’ve lost enough blood already. You can’t afford to lose more.”
“But, Dr. Bower—”
“Listen to your doctor.” Beverly laid a hand on Cowboy’s arm. “He knows what he’s doing. Besides, if you’re too eager to get out of here, we’ll think you don’t like our company.” She winked at him. “You never want to offend your local emergency department personnel. You can’t tell when you’ll need them.” She dug into her pocket and pulled out the set of keys she had retrieved from Carol. “I’ll make a deal with you. If you’ll let me drive your car and give me some instructions, I’ll go out to your place when I get off work and feed Leonardo for you.”
Both men stared at her.
“Uh, Beverly,” Lukas said, “you do realize we’re talking about an African lion.”
“I heard through the crack of the door. Besides, I’ve read the chart.”
“Sorry,” Cowboy said in his gravelly voice. “No way am I sending a pretty female out to do the job I should’ve done. Get a man to feed Leonardo, and you can drive him out there in my car.”
Lukas expected Beverly, with her obviously independent spirit, to spit fire. Instead, she gazed bemusedly at Cowboy and nodded. “I’ll see what I can do.”
Someone approached the trauma room entrance. “Dr. Bower?” It was Lauren’s voice.
“Oh, Doc, please,” Cowboy said. “I’m still practically naked here. Don’t give me an audience.”
Lukas slipped through the partially open door, leaving Cowboy his privacy. “Yes?”
“We have an elderly man in exam room one who has just been brought in unresponsive.”
“I’ll be right there.” He rechecked Cowboy’s wound, then crossed to exam room one, where Lauren was rushing through the vitals of an unconscious, toothless elderly man in his pajamas, who was already hooked to a monitor and a nonrebreather oxygen mask.
A worried-looking woman in her thirties stood at the patient’s side, her eyes puffy and red from crying.
“Hello, I’m Dr. Bower,” he said to the woman. “Are you his daughter? Granddaughter?”
“No, I’m Shelly, Frankie’s neighbor. My children go over to see him every day, and today they found him like this on the floor of his living room. I think he’d been trying to call someone, because the telephone receiver was off the hook and lying beside him.”
“Did you bring him in by yourself?”
“Another neighbor helped me get him into the van. We should have called an ambulance, but I just didn’t think. We only live four blocks from the hospital.”
Lukas adjusted his stethoscope and did a quick auscultation of the man’s chest. He had mild tachycardia and slow respiration. His skin was pale and cool to the touch. A quick check of his head and upper body revealed no signs of injury. Lukas didn’t smell alcohol.
“Lauren, let’s get a bedside glucose on him.”
“Yes, Doctor. We have a new patient in room eight who needs you next.” She lowered her voice. “It’s cancer. She’s a DNR.”
Lukas grimaced. Those were the hardest. “Okay, thank you, Lauren.” He checked Frankie’s eyes. The man had good papillary sparing.