Critical Judgment (1996) Page 7

  "No! You stay out of this. Quinn can handle it. There's no need for you to rush all over the valley playing hero wherever you go."

  "Jesus." Abby turned to a husky man with tattooed deltoids, standing to her right. "Excuse me," she said. "I'm Dr. Dolan from the emergency ward. There's a big gray backpack over there near the picnic table. My medical supplies and bandages are in it. Could you bring it here for me, please?"

  "Sure thing, Doc," the man said, sprinting off.

  Abby half expected her lover to chase the man down and tackle him. Josh was entering the irrational, nasty phase of whatever was eating away at him. The pressure cooker was boiling and the safety valve was stuck. Sometime between now and late afternoon he would blow. Well, she was near boiling point herself.

  "All right, everyone," Quinn was saying. "You all know that Angela has this problem. It doesn't help to stand around gawking at her. Go on. Get your kids out of here and get back to the picnic."

  Immediately, the crowd dispersed. It was as if the onlookers had wanted to go but had needed someone to break the stranglehold of lurid fascination. In seconds there were only fifteen or so remaining, mostly men, who seemed ready for action.

  Pointedly ignoring Josh, Abby moved next to Quinn.

  "I have first-aid supplies in my backpack," she said softly. "A man's bringing it over."

  "Oh, Angela's okay," Quinn replied, clearly annoyed with the woman and frustrated that he could not simply end the matter with a frontal assault. "Just nuts. She's been doing things like this for months--smashing her head against the wall until she's a bloody mess, cutting herself. We're all getting a little sick of it. I just want to make sure no one but her gets hurt."

  "She's cut an artery in her arm. I think we should be trying to stop the bleeding soon."

  "Someone went to call the police and rescue." Quinn risked another step forward. "She'll be all right. People get arms and legs cut off and survive."

  "Not always," Abby said sharply. Could anyone really be that callous?

  She moved up next to him. They were now about ten feet away.

  "Stop it!" Angela screamed, slashing the air in their direction, cutlass style. "Stop it! Let me die! I deserve to die!"

  Her eyes were wild. Tears washed through the blood smeared across her cheeks. The ground at her feet was becoming sodden.

  "Damn her," Quinn muttered.

  A woman hurried up to Quinn on the side opposite from where Abby stood. She had short graying hair, tortoiseshell glasses, and a Save the Planet T-shirt.

  "Lyle, I've called rescue and the police," she said breathlessly. "They're at an accident at Five Corners. It'll be another ten or fifteen minutes."

  "Jesus."

  "Poor Angela. This is worse than I've ever seen her. After I spoke to Sergeant Brewster, I called her mother. She'll be right over, but she lives in Green Gables."

  "Oh, great, Kelly," Quinn snapped. "The last thing we need is another hysterical member of the Cristoforo clan."

  "Sorry."

  "Look, call Brewster back. Tell him I want a cruiser and two men here in five minutes or less."

  The woman nodded quickly and left.

  Panting, the large man arrived with the backpack and set it beside Abby. Without taking her eyes off Angela Cristoforo, Abby withdrew her medical case and the plastic bag with the bandages and dressings she had leftover from treating Ives. There were at least two sets of rubber gloves inside. She was relieved that she didn't have to deal with the healer's dilemma of whether to treat someone in the field if it meant touching her blood without protection.

  "Angela, I'm Dr. Dolan from the hospital," she said. "I want to help you. I want to stop the bleeding and fix those cuts."

  At that moment Abby caught a flicker of movement--a man--through the trees behind Angela. She could tell that Quinn saw him, too.

  "The doctors at the hospital hate me," Angela sobbed. "They hate the sight of me. The nurses laugh at me."

  Abby was careful not to dispute what the woman believed, and what might very well be true.

  "I'll make sure nobody ever does that again, Angela. I can do that. I promise."

  Angela began singing a children's song, jabbing the point of the huge knife in rhythm against her chest. From somewhere out in the valley, Abby could hear sirens. She hoped that the commotion that was about to descend didn't push Angela Cristoforo the final inch. Nobody wanted to believe that a woman could bleed to death in plain sight of dozens of people. Abby knew better.

  The man in the trees was now no more than five feet from Angela. Abby tried not to give his presence away with her eyes. He was tall and dark, wearing light jeans and a tan work shirt.

  "Who is that?" she whispered, struggling to keep her eyes focused on the woman.

  "A maintenance man from the plant. Willie Cardoza. He's kind of a flake, big practical joker. I don't know what in the hell he thinks he's doing."

  "Too late to stop him now," Abby whispered.

  She took a pair of rubber gloves and pulled them on. Then she held up a roll of gauze bandage.

  "What are you trying to pull?" Angela shrieked. "Stop right there! I mean it! I mean it!"

  She raised the hunting knife to her throat.

  "Angela, please--don't!"

  Willie Cardoza took one step out from the cover of the trees. If Angela whirled now, there was no way he could escape being slashed. To Abby the seconds that followed were slow motion. Willie made his move at the instant Angela began to turn. He was taller than she was by six inches or more, but she was considerably bulkier.

  "Angela!" Quinn shouted.

  The distraction was just enough. Willie grabbed her right wrist from behind and brought his left arm around her neck. She struggled ineffectually as he braced his legs behind hers and pulled her down backward on top of him.

  "Angie, it's me, Willie," he said, holding fast to her wrist, his lips next to her ear. "It's Willie. Angie, you've got to stop. It's over."

  For one frozen moment, Angela Cristoforo's body went rigid. Then, with a final, pathetic wail, she released the knife. Lyle Quinn quickly moved forward and kicked it aside.

  Willie Cardoza gently rolled her off him and onto her side.

  "Angie, you let them take care of you now," he said. "You just rest and let them take care of you."

  The sirens approached, then were cut off as the first police cruiser pulled onto the ball field.

  As Abby knelt beside the wounded woman, her gaze met Cardoza's. His long, narrow face, weathered and creased, had the look of having seen hard times. But his eyes were kind.

  "That was a very good thing you just did," she said.

  Cardoza's smile was self-effacing.

  "She would have done the same for me," he replied. "We company grunts have to stick together."

  He pushed himself to his feet, turned, and left without a word to Quinn.

  Abby assured herself that Angela's pulses were intact and strong, and that none of her wounds was immediately life threatening. Then she began to tend to the individual cuts. She had two of them bandaged when the rescue squad arrived. After a brief report she turned matters over to them. When it came to first aid, nobody did it better than an EMT.

  "How long has this been going on?" she asked Quinn.

  "I don't know. Six months, maybe. She's spent a lot of time in mental hospitals over that period."

  "And before?"

  Quinn shrugged.

  "She was--what was the word Cardoza used?--a grunt."

  Abby packed up the knapsack and watched as the EMTs finished inserting an IV and prepared Angie for transfer to the hospital.

  She put the pack on and buckled the support straps, realizing with dismay that she had blood on her arms, legs, and clothes. She would wash it off as quickly as possible. With a terse good-bye to Lyle Quinn, she walked away.

  The barbecue was now in full swing, with a dozen aproned chefs--according to Josh, the officers in the company--serving steak and chicken to their em
ployees. But Josh was not among them, though he had told her he would be. She checked the picnic area and the path to the lake. Not there. Then she walked to the parking lot. The Jeep was gone.

  She waited for five minutes but knew he was not coming back. The debate about approaching Lyle Quinn for a ride home lasted only moments. Abby found a pay phone and called a cab. She was feeling as frustrated, worried, and angry as she had at any time since moving to Patience.

  Josh would get help or she was moving out.

  She glanced back just as the ambulance began its trip to the hospital. There was something surreal about the scene--the magnificent mountains, the perfect ball diamonds, the shimmering emerald grass, the smoke rising from the barbecue pits, the laughter. And at one edge of the perfect scene, an ambulance carrying a woman slashed by her own hand--a woman consumed by the most virulent hatred imaginable. Hatred directed inwardly ... at herself.

  CHAPTER EIGHT

  Abby parked her three-year-old Mazda in the doctors' lot and entered the hospital through the ambulance bay. For seven-thirty in the evening the ER was busier than she liked it, but still a notch or two from utter chaos. It was just as well, she thought. A few hectic hours would help keep her mind focused on work.

  Five days had passed since the Colstar family outing. For Abby they had been days of tension and turmoil at home, sandwiched around relatively uneventful shifts at the hospital. Shortly after returning by cab from Colstar Park, she had moved her things into the small guest bedroom. And there she had stayed despite Josh's daily assurances that he would never behave so irrationally again.

  Getting away from the stress at home wasn't the only reason she was pleased to be at the hospital tonight. The day-shift doctor she would be replacing was Lew Alvarez. Their paths hadn't crossed since the evening of Bill Tracy's resuscitation. But on her shifts Abby had managed to draw a nurse here or a doctor there into conversation about him. She could not, in all honesty, deny that she found Alvarez intriguing and attractive. But she refused to admit to herself that she had anything like a crush on him. The deteriorating situation with Josh was simply opening her eyes to other people. That was all.

  What she did learn about the man only intrigued her more. He had been at PRH for just over three years and was now a partner in the ER group. Despite George Oleander's curious irritation with him, not one nurse had anything negative to say, except for the backhanded compliment that because he spent so much time with each patient, the ER tended to get jammed up during his shifts.

  He was most definitely single. And although one nurse was certain he was involved with a woman, another felt equally certain he was gay. Abby knew enough of hospitals to be sure there was almost no way an attractive single physician--male or female--could be involved with anybody for long without some colleague getting wind of it. So she labeled him, unofficially and in pencil, heterosexual and unattached. In addition to his ER job he had a small working farm in the hills west of town, frequently moonlighted as the attending physician at the state mental hospital in Caledonia, and coached Little League soccer. His teams hardly ever lost.

  Abby skirted the patient area and went directly to the on-call suite--a good-sized office, sleeping room, and bathroom. She changed into a pair of blue scrubs and her clinic coat, and then, as she routinely did when starting a shift, stopped to get centered. She rinsed her face with cold water, headed to the door, then stopped again and returned to the sink. Almost in spite of herself she adjusted the band holding back her hair and put on a dash of lipstick.

  Alvarez caught sight of her as soon as she entered the ER, made a theatrical display of looking at his watch, and gave her two thumbs up.

  "It's been like this since we had a code at three this afternoon," he explained. "Seventy-five-year-old guy with a massive anterior MI."

  "Make it?" Abby sensed the answer to her question even before Lew shook his head. "Sorry.... Well, listen. Why don't I get started on that chart rack? Maybe together we can outflank them."

  "I'll stay until the place is cleaned out," he said.

  "You don't have to do that."

  "You didn't have to come in early."

  The first patient Abby dealt with was another of the I don't know what's wrong with you group. He was a thirty-eight-year-old father of three with profound fatigue. In Abby's experience fatigue and headaches were two of the most difficult complaints to evaluate and diagnose. And she had seen a significant number of both since starting at PRH. There was an almost limitless number of causes for each symptom, with perhaps the most common of those being stress--psychosomatic illness. Abby had never doubted the power of the human mind to cause or cure disease. The problem was that psychosomatic illness was a diagnosis of exclusion, to be made only when all other reasonable possibilities had been systematically ruled out. To assume an emotional etiology for a symptom like fatigue was asking for trouble.

  Abby sent off what she considered to be a reasonable battery of tests and was launching into her "I don't know ..." speech, when the nurse, Bud Perlow, motioned her over to the minor trauma room and handed her a chart. The patient's name was Hazel Cookman. She was eighty-four years old and a widow. Her presenting problem read simply, "Fell."

  "I know you've got about ten things going on at once," Perlow said, "but I just needed you to take a quick look at her arm and tell me if you want films. I don't think they're necessary. You'll love her. If she wasn't a schoolmarm, she should have been."

  The woman, propped up on the stretcher, wore a navy-blue short-sleeved cotton dress with a lace collar. She had on pearls and an extravagant amount of rouge, and overall looked as if she were dressed for a church social. The glint in her eyes and the set of her jaw were defiant.

  Abby introduced herself.

  "I assume you are well qualified to fix my arm, young lady," Hazel said, her voice strong.

  "I am. Could you tell me what happened?"

  "Why, I fell. Doesn't it say that there?"

  "It does. But how did you fall?"

  "I just fell. Nothing complicated about it. I was cooking some chicken and I fell. I think I must have hit the edge of my kitchen table. I checked my arm in the mirror and knew that I would need some stitches." She eyed Abby sternly. "Now, Doctor, I would like you to tend to my injury and let me get home. I left my house in such a lather that I forgot the chicken simmering on the stove."

  "How did you get here?"

  "Why ... why, I drove, of course."

  "Of course," Abby said, smiling toward the nurse.

  Hazel Cookman's injury was one common to older people with "tissue paper" skin. Just below her elbow a flap of delicate skin had peeled back. It would need to be stretched out again and tacked in place with some fine stitches and Steri-strips.

  "Well?" Hazel asked. "Can you fix it?"

  "I can."

  "And?"

  Abby was checking the left and right carotid-artery pulses in the woman's neck as she kept two fingers on the radial artery pulse at her wrist.

  "I'd like to examine your heart and check over your nervous system," she said. "And I think you should have an electrocardiogram and a blood count."

  "My lord, it's just a cut arm. I simply have no time for all this rigmarole, young lady."

  "Mrs. Cookman, I may be a young lady to you, which is fine. I'm pleased you think me one. But I am also a doctor. And I worry a lot about missing things in my patients. Right now I'm very worried that you don't know precisely why you fell. Now, these tests won't take long. And I promise as soon as they're done, we'll fix your cut."

  "But--"

  "Thank you." She turned to the nurse. "We'll need postural blood-pressure checks, lying, sitting, and standing, but not until I've seen the EKG." She waited until they were out of earshot, then added, "I don't know why, Bud, but something doesn't feel right. I don't think she just tripped. I think she lost consciousness and fell. In fact, before you do anything else, hook her up to the monitor."

  "She'll bite my head off."
r />   Abby patted him on the arm.

  "Charm her with one of those great faces you use to win over the kids."

  Abby saw one more patient, a straightforward splinter removal, then met Lew by the chart rack. There was no question that together they were getting ahead of the backlog.

  "Anything interesting?" he asked.

  "Not really. A cute LOL with a flap of skin pushed back off her forearm. Listen, Lew, why don't you go on home?"

  He glanced about at the beds, which were still almost all filled.

  "Another half hour, forty-five minutes. All I had planned for tonight was paying bills. The more tired I am, the easier that job is to take."

  Not a team player? Abby wondered what could possibly have gone on between Lew and George Oleander to put off the medical chief so.

  "Dr. Dolan!" Bud Perlow shouted from Hazel's room.

  Abby charged to the doorway with Lew close behind. Hazel Cookman was drifting into unconsciousness. Her monitor showed a heart rate of ten.

  "She's in complete heart block," Abby said instantly, her own pulse pounding. "Lew, call a code. Bud, get a line in her. I'll pump. As soon as we have another pair of hands, I want five-tenths of atropine IV."

  She kicked a low metal stool in place next to the litter and stepped up on it to give herself enough leverage for effective CPR. At that moment Hazel's complete heart block reverted to a normal rhythm and rate. Abby checked both carotid-artery pulses and felt them easily. In seconds Hazel moaned. A few seconds more and she was wide-awake.

  "Bud, get cardiology in here stat," Abby said. "She needs a pacemaker. Do we have an external pacer?"

  "Sure thing."

  "Set it up just in case."

  Abby's suspicions about the woman's fall were confirmed. Hardening of the arteries into Hazel's heart was causing a blockage to the spread of electricity from her body's natural, inborn pacemaker--the spot in the right atrium chamber where heartbeats are normally initiated. The result of the blockage was a pulse rate too slow to generate an effective blood pressure, and the pressure drop had caused her brief faint. For the moment the blockage kept reverting to normal. But that situation could change, quite literally, in a heartbeat.