Fatal Trauma

Endorsements

"Fatal Trauma asks big questions of faith, priorities, and meaning, all within the context of a tightly crafted medical drama."

—Steven James, best-selling author

of Placebo and Checkmate

Drug cartel assassin, malpractice lawsuits, and a murder allegation: Dr. Mabry ratchets up the conflict and keeps us turning the pages. Medicine, suspense, and a hint of romance—℞ for a memorable read.

—Candace Calvert, best-selling author

of the Grace Medical serie

Grab your heart meds! This medical suspense is guaranteed to raise your blood pressure.

—DiAnn Mills, author of Firewall and Double Cross

Title page

Copyright

Fatal Trauma

Copyright © 2015 by Richard L. Mabry

ISBN-13: 978-1-68299-885-4

Published by Abingdon Press, P.O. Box 801, Nashville, TN 37202

www.abingdonpress.com

All rights reserved.

No part of this publication may be reproduced in any form,stored in any retrieval system, posted on any website,or transmitted in any form or by any means—digital,electronic, scanning, photocopy, recording, or otherwise—without written permission from the publisher, except for brief quotations in printed reviews and articles.

The persons and events portrayed in this work of fiction are the creations of the author, and any resemblance to persons living or dead is purely coincidental.

Macro Editor: Teri Wilhelms

Published in association with Books & Such Literary Agency

Library of Congress Cataloging-in-Publication Data

Mabry, Richard L.

Fatal trauma / Richard L. Mabry, MD.

pages ; cm

ISBN 978-1-63088-116-0 (binding: soft back)

I. Title.

PS3613.A2F38 2015

813'.6—dc23

2015004764

Unless otherwise indicated, all Scripture quotations are taken from the Holy Bible, New Living Translation, copyright © 1996. Used by permission of Tyndale House Publishers, Inc., Wheaton, Illinois 60189. All rights reserved.

Scripture quotation on page 54 is taken from The Authorized (King James) Version. Rights in the Authorized Version in the United Kingdom are vested in the Crown. Reproduced by permission of the Crown's patentee, Cambridge University Press.

Printed in the United States of America

Dedication

For the two wonderful women with whose love God has blessed me: Cynthia, who will never be forgotten, and Kay, who makes my life worthwhile.

Acknowledgments

It may not be evident, but I—like almost all my author colleagues—suffer from what we call the Imposter Syndrome. We’re surprised when we get our first contract, even more when additional opportunities for publication come our way, and absolutely floored by honors and awards for our novels. Well, that’s the story of my writing career, and all I can say to each of you who continue to read my work is, Thank you.

I appreciate my agent, Rachelle Gardner, and my editor at Abingdon Press, Ramona Richards. Thanks for believing in me. The final version of Fatal Trauma is much better than it might have been thanks to the suggestions and support of my first reader, severest critic, and biggest fan—my wife, Kay Mabry. Teri Wilhelms took my manuscript and edited with just the right touch. The cover design by the Anderson Design Group was perfect. And, to top it off, Cat Hoort and her staff made sure people knew about the book.

None of this would happen without the dozens of authors who unselfishly shared their time and talents to teach me the craft. My family was kind enough to believe in me and encourage me in my writing. And God has continued to bless me with opportunities. I’m not sure what’s around the next corner, but I can hardly wait to see.

As I have done in the past, I’ll close with the words with which Johann Sebastian Bach and George Frideric Handel signed their work: Soli Deo Gloria—To God alone be glory. Amen.

Chapter 1

1

Dr. Mark Baker swept his straw-colored hair away from his eyes, then wiped his forearm across his brow. He wished the air-conditioning in the emergency room was better. Patients might complain that it was cool, but if you were hurrying from case to case for eight hours or more, it was easy to work up a sweat.

Nobody move!

Mark spun toward the doors leading to the ER, where a wild-eyed man pressed a pistol against a nurse’s head. She pushed a wheelchair in which another man sat slumped forward, his eyes closed, his arms crossed against his bloody chest. Dark blood oozed from beneath his splayed fingers and dropped in a slow stream, leaving a trail of red droplets on the cream-colored tile.

Behind them, Mark could see a hospital security guard sprawled facedown and motionless on the floor, his gun still in its holster, a crimson worm of blood oozing from his head. Mark’s doctor’s mind automatically catalogued the injury as a basilar skull fracture. Probably hit him behind the ear with the gun barrel.

The gunman was in his late twenties. His caramel-colored skin was dotted with sweat. A scraggly moustache and beard framed lips compressed almost to invisibility. Straight black hair, parted in the middle, topped a face that displayed both fear and distrust. Every few seconds he moved the barrel of the gun away from his hostage’s temple long enough to wave it around, almost daring anyone to come near him.

The wounded man was a few years older than the gunman—maybe in his thirties. His swarthy complexion was shading into pallor. Greasy black hair fell helter-skelter over his forehead. His face bore the stubble of several days’ worth of beard.

I mean it, the gunman said. Nobody move a muscle. My brother needs help, and I’ll kill anyone who gets in the way.

Mark’s immediate reaction was to look around for the nearest exit, but the gunman’s next words made him freeze before he could act.

You the doc?

Now the gun was pointed at him. Mark thought furiously of ways to escape without being shot, but he discarded each plan as fast as it crossed his mind. Yeah, I’m the doc.

The gunman inclined his head toward the man in the wheelchair. He’s . . . he’s been shot. He snatched two ragged breaths. I want you to fix him, pull him through. He punctuated his words with rapid gestures from the pistol. If he dies . . . if he dies, I’m going to kill everyone in here. The gunman turned back toward his hostage. Starting with her.

Mark’s eyes followed the gun as it traversed once more from him to the nurse pushing the wheelchair. To this point his attention had been focused on the gunman, but now that he recognized the hostage, he knew the stakes were even higher. Although her red hair was disheveled, her normally fair skin flushed, there was no mistaking the identity of the woman against whose head the gunman’s pistol lay. The nurse was Kelly Atkinson—the woman Mark was dating.

***

Kelly gritted her teeth against the pain of the gun barrel boring into her temple. Her stomach clenched and churned with the realization that her life was in the hands of this crazed gunman. Her lips barely moved in silent prayer.

Mark’s voice seemed remarkably steady to her, considering the circumstances. I can see that he needs help, and I’ll give it, but stop waving that gun around. He nodded toward Kelly. First of all, I’m going to need some assistance, and the nurse certainly can’t help me with you holding that pistol against her head. Why don’t you put it down and step away? You can wait over there, and I’ll let you know—

Shut up!

Suddenly the pressure on Kelly’s temple was gone. Out of the corner of her eye she saw the gunman turn his weapon and his attention once more to Mark. If she was going to act, now was the time. She looked down at the man in the wheelchair and put all the urgency she could muster into her words, Doctor, I’m not sure he’s breathing! He may be in arrest.

Ignoring the gunman, Mark took several steps forward and squatted in front of the wheelchair. He touched the wounded man’s neck with two fingers, then placed his stethoscope on the man’s chest. In a few seconds, Mark pulled back his bloody hand, straightened and said, We need to get him into one of the trauma rooms. Right now!

Ignoring the gunman, Kelly started pushing the wheelchair toward trauma room 2. What will you need? she asked over her shoulder.

She hoped Mark’s reply would communicate the urgency of the situation and further distract the gunman’s attention. He didn’t disappoint her. I need to intubate him and start CPR. Start a couple of IVs with large bore needles so we can push some Lactated Ringer’s into him until the blood bank can cross-match him for half a dozen units.

After an emphatic gesture from her, Bob, one of the ER aides reluctantly fell in behind Kelly. Bob’s ebony skin couldn’t show pallor, but he was sweating profusely. As he followed Kelly, he murmured under his breath, What does the doctor think he’s doing?

Kelly’s answer was a hoarse whisper. I think he’s trying to save everyone’s life.

***

Hold it right there, Doc, the man with the pistol said. You don’t move unless I tell you to.

Mark watched as the gunman’s finger tensed on the trigger of his weapon. He fought to keep his voice steady. Every second you keep me standing here makes it less likely I can save your brother’s life.

The gunman gestured at the door through which Kelly was disappearing with the wounded man. Okay, but I’ll be right behind you. He glared, his brown eyes seeming to bore a hole through Mark. And remember—if my brother dies, everyone in that room dies—the nurse, you, the aide—everyone.

Out of the corner of his eye, Mark saw the curtains flutter at the ER cubicle he’d recently left, and a faint spark of hope arose in him. To set this up, he had to move. After a split-second’s hesitation, he strode swiftly to the open door of the trauma room where Kelly and the aide were already moving the wounded man onto the treatment table.

Despite the sweat that poured out of him a few minutes ago, now Mark felt a chill that went deep into his bones. He probably had one chance to make this end well, but to make that happen, everything had to work perfectly. Otherwise, he and several other people would die.

Start some oxygen, Kelly said to the aide. I’ll get IVs going.

Help him, Doc, the gunman snapped.

Mark, at a shade over six feet and a hundred seventy pounds, was larger than the gunman. But the pistol in the man’s hand was a great equalizer. Besides, when he looked into the brown eyes of the man holding the gun, Mark saw a fire that was due to zeal for a cause or the effect of drugs or maybe both. It took every bit of courage he had to keep his own eyes from showing the emotion he felt—fear.

Mark turned to the gunman and said, I’ll help him, but we need some space. If you’re determined to watch, at least step back. He jerked his head to the side. Stand there by the door. You can see everything, but you’ll be out of the way. I need to start CPR on this man.

But—

Mark’s voice carried all the authority he could muster. Move! Now!

The pistol came up, and Mark felt his heart drop as he waited for that trigger finger to tighten one last time. Then the gunman shrugged and backed up until he was against the door. Okay, but remember—I’m watching. His pistol traced a circuit from Kelly to Mark and back. Get cracking.

Mark reached down even further for courage he didn’t know he had. Okay. He moved to the side of the wounded man, where his fingers felt the neck for the carotid pulse. He took a deep breath and looked up at Kelly. Got those IV lines in yet?

Just finished one, she said. About to start on the second.

No time. Let it go, Mark said. When you started the IV, did you get some blood to send to the bank for T&C?

She patted the pocket of her scrub dress, producing a glassy tinkle. T&C for six units, stat hemoglobin and hematocrit, everything. Got the tubes right here.

Bob, take these to the lab—

Nobody leaves the room! the gunman snapped.

Mark started to argue, but decided it would be fruitless. I’m going to start chest compressions now. He glanced at Kelly. Hook him up to the EKG so I can see if there’s any activity. We may have to shock him.

Mark looked down at the man on the treatment table. The aide had cut away the patient’s shirt, revealing three puckered entrance wounds where bullets had pierced his chest. They were grouped tightly right above the man’s left nipple, close enough together that a playing card could cover them all. Now the bleeding had completely stopped.

Why wasn’t he here by now? How long would it take? Mark had to keep going. I’m going to start CPR now. He put one hand over the other, centering them on the patient’s breastbone. He wasn’t sure how long he could keep this up, though. Come on. What are you waiting for?

The door crashed open, sending the gunman staggering forward onto his knees.

Police. Drop the gun! The policeman held his service pistol in a two-handed grip. On the floor! Now!

Instead, the gunman, still on his knees, twisted to face the policeman, his own pistol extended. The next seconds were filled with gunfire.

When he heard the first shot, Mark reached across the patient and shoved Kelly to the ground. Get down, he screamed.

It seemed to Mark that the gunfire went on for a full minute, but he knew better. It always seemed that time either sped up or slowed to a crawl in emergency situations like this. His ears were still ringing when he raised his head and looked around. The gunman lay sprawled on his back, open eyes unseeing, his gun a foot away from his outstretched hand. Mark had seen enough death to know the gunman no longer presented any danger.

The policeman was crumpled in the doorway, one hand clenched over his abdomen, a fountain of blood issuing from between his outstretched fingers. The other hand still clutched his service pistol. He was breathing, although his respirations were labored.

Mark took in the scene in less than a second. He jumped to his feet and called to Kelly, We need a gurney. We have to get him to the OR, stat. To the aide, he said, Stick your head out the door. Have them call for help. Alert the OR I’m coming up.

He looks familiar. Who . . . who’s he? Kelly asked.

Sergeant Ed Purvis. He brings patients here sometimes. I’d just finished with one when all this started. Mark moved to the side of the wounded policeman. Now help me get him onto a gurney.

What . . . what about the wounded man already on the table? Bob asked over his shoulder as Kelly and Mark slid their hands under the fallen officer.

Don’t worry about him. He was dead by the time Kelly wheeled him into the ER.

Chapter 2

2

In the operating room, a germicidal solution splashed on Ed Purvis’s abdomen by the circulating nurse turned the pale skin bronze. The scrub nurse hurriedly placed sterile green sheets around the operative area. While the anesthesiologist was still injecting medication into the patient’s IV line to relax him, Mark, now clad in a sterile gown, reached out a gloved hand for the scalpel and made a vertical incision that opened Purvis’s abdominal cavity wide.

Is one of the surgeons on the way? Mark asked.

We’ve put out a call, the circulating nurse said.

Guess it’s up to me until one shows up, Mark said. He looked to the anesthesiologist at the head of the table. Can you give me more relaxation?

Dr. Buddy Cane nodded. Coming up. You’ve got a pretty good head start on me, you know.

Mark worked on, assisted by the scrub nurse. His attention was riveted on the operative field when a husky contralto voice from across the room said, Tell me what we’ve got.

Dr. Anna King stood in the doorway, dripping hands held high in front of her. The scrub nurse turned away from the table to help the surgeon gown and glove.

For a moment, Mark had almost forgotten that Anna was a surgeon. In his mind, she was an attractive blonde he’d dated occasionally. Of course, he’d heard rumors . . . Never mind. He wanted help and now he had it. Multiple gunshot wounds of the abdomen, he said. In a few sentences, he related how Purvis had been shot. He’s hanging on by a thread. I think we need to—

I’ve got it, Mark. Thanks. This was a different Anna King from the one with whom Mark had shared dinner just a week ago. That one was funny, easy-going. This one was, in every sense, the surgeon. The attitude was I’m in charge, and Mark had the feeling that if he crossed her, he’d regret it. He was already wondering what a long-term relationship with her would be like. Never mind. He’d deal with that later.

Within less than a minute, Anna was gowned and gloved. She moved to stand at the patient’s right side, and Mark slid around to a position opposite her. Anna readjusted the self-retaining retractor and held out her hand. Let’s get some suction in here. Adjust that overhead light.

For a few minutes, the OR was quiet except for the murmured conversation of the surgeon and assistant as they bent over the operative area. Once, the circulating nurse darted in to mop Anna’s brow with a cloth. When she eased up behind Mark, he shook his head and she backed away.

How many units of blood? Mark looked toward the head of the table.

The anesthesiologist checked his notes. Six. He paused. More coming. But his vitals keep slipping.

Mark’s deep breath resonated inside his surgical mask. Let’s—

Mark, you called for help. I’m here. Let me be in charge, would you? There was no anger in Anna’s words, just a simple statement of fact.

Mark nodded, but didn’t reply. He’d have to be careful not to cross Anna while she was in this mode.

His mind moved from the Anna he’d known socially to the surgeon, Anna King. So far she seemed to be doing fine. There were too many smells in the operating room for him to pick up any scent of alcohol drifting through her surgical mask. Still, Mark wondered . . .

Anna spoke without taking her eyes from the operating area. Mark, I know you feel responsible for this patient, but you did your part by getting him up here as quickly as you could. Now it’s my responsibility. She held out her hand and the scrub nurse slapped a hemostat into it. We’ll do our best. But we can’t save every patient.

I got him into this, Mark said, clamping off another bleeding point. It’s my fault he got shot.

No, Anna said. Like every police officer, he knew the risks the first day he put on that uniform. You took the only chance you had to save the lives of three people.

And it cost the life of another one, Mark said.

Not yet, Anna said. Now, if you’re going to assist, don’t focus on assigning blame. Just help me.

***

Anna King pushed her surgical mask down to hang beneath her chin. She stripped off her latex gloves and tossed them in the designated waste receptacle, then turned around so the nurse could unfasten her surgical gown. I’m sorry, Mark. She balled the gown into a mass and threw it after the gloves. We did what we could. We just couldn’t save him.

Mark opened his mouth, then decided he had nothing to say, so he simply shook his head. Let her assign whatever meaning she liked to the gesture.

Anna paused with one hand on the operating room’s swinging door. I’ll see if his family’s here yet.

No! Mark hadn’t meant to bark the word, but, considering the state of his emotions at this point, he wasn’t surprised at the way it came out. No, he said more softly. Let me go out there and talk with them. They need to know more than that he was shot dead. He swallowed hard. I need to tell them that he saved my life.

Mark, you can’t take this personally. You see gunshot wounds in the emergency room all the time. Some of those patients we can save, some not. What’s so different about this one?

Mark knew what was different, but he wasn’t prepared to say the words. Not yet. Instead, he snatched the surgical cap off his head and held it in front of him like a penitent presenting an offering. When they come into the ER—makes no difference which side of the law they were on when the bullets hit them—when they reach the ER, they’re mine. I’m going to do my best to save them. Some I do, some I don’t. I accept that. He looked at the body of Ed Purvis, now covered by a sheet. But this wasn’t someone who showed up with a gunshot wound. This was a man I knew—admittedly, not well—a man that I literally asked to put his life on the line to save mine. Mark bowed his head.

Anna put her hand on Mark’s shoulder, probably the closest she could come to a gesture of tenderness in this situation. And he responded the way you hoped he would. He did what law enforcement officers do every day in this country. He did what he’d signed up to do, and in doing so he saved your life. She opened the door. Come with me if you like. I know his family would appreciate it. But don’t take the responsibility for his death on yourself. And don’t think you have to spend the rest of your life making up for it.

***

Thanks for doing this, Steve, Kelly said. The adrenaline from what happened has about worn off, but I just couldn’t be alone . . . not for a while, at least. Besides, I . . . I think it might help if I sort of talked this out, and you’re a good listener.

Before he took a seat in the booth opposite her, Steve Farrington, pastor of the Drayton Community Church, handed Kelly one of the two steaming cups he’d obtained from the service counter at this all-night fast food establishment. No problem, Kelly. He blew across the surface of his cup. When I heard about the gunman in the ER, I headed for the hospital. I found out you were one of the hostages, and after you were freed I stuck around to see if you needed anything. He took a sip of coffee. But, to be clear, did you want me here because I’m your pastor or your friend?

Both, I guess, Kelly said. So you can wear whichever hat you want . . . so long as you stay here with me for a while.

I’m happy to sit and talk with you, but don’t you need to call anyone else? Family, maybe?

Kelly thought for a moment. No. My family wouldn’t understand or even care.

He looked into his coffee cup but didn’t drink. Why don’t you tell me about it?

Kelly leaned across the table. "I was at the triage desk in the emergency room tonight when a man came in, supporting a gunshot victim. I was about to call for an aide to get a gurney for the patient when the first man grabbed a wheelchair and told me to push