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Fatal Trauma

By Richard L. Mabry

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FATAL TRAUMA
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 were 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 two. “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 IV’s 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 friend’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 IV’s 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.”

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