LITMIR.BIZ

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and wash again. You can buy this at your local pharmacy.”

      She stared at the note in his hand. “No prescription?”

      “You don’t need a prescription for this. The two of you can share a bottle.”

      “But we’ll have to pay for it.”

      Lukas felt his skin tingle with growing irritation. He inhaled slowly, counting to ten as he placed the note on the top of a trash can nearby. It had suddenly become a stressful day, the worst he’d had in a long time. He couldn’t blame it all on these two misguided souls.

      He turned and opened the heavy glass door. “Ladies, the shampoo costs less than a pack or two of your favorite brand of cigarettes.”

      “But we have Medicaid cards,” the smoker called after him. “We can report you for refusing to treat us!”

      He stopped midstride and slowly turned back toward them. “Feel free,” he said, keeping his voice calm. “I feel I should warn you, however, that when a card carrier tries to use the card in the E.R. for nonemergency care, she can lose her card. It’s called Medicaid abuse. I think you’ll find that shampoo works very well as long as you follow the directions.” He stepped inside and let the door close silently behind him.

      There were other Medicaid cardholders—for instance, the little baby in exam room three—who needed treatment today, not next week, and Lukas saw to it that they received good care. Lots of Medicaids used the emergency room here because many family practitioners refused to take assignment. Those who did still limited their patients. Medicaid paid so little that a physician who took too many could go broke. The system didn’t work. Many times the people who behaved with integrity got left out entirely—both the honest Medicaid recipients and the honestly compassionate physicians. Greed was the culprit on all sides. Lawmakers spent their time writing more laws because people kept figuring out ways to take advantage of the system. It was frustrating. Lukas had to keep reminding himself not to blame the patients who sometimes misunderstood the constantly changing rules.

      Lukas glanced around at the emergency department. He liked this little ten-bed setup. The exam rooms surrounded a large central station. Each room was well equipped. Five of the ten rooms had excellent cardiac equipment. There was a separate ambulance entrance and two physician call rooms.

      Mrs. Estelle Pinkley, the hospital administrator, had done a remarkable job when she’d convinced the county to pay for this upgrade. Lukas had jumped at the chance to receive a dependable salary with benefits so far away from the congestion and stress and corruption of the city. Yes, he knew corruption was everywhere, but right now, with specific, damaging events so fresh in his memory, Kansas City represented everything painful.

      Carol met Lukas as he entered the E.R. proper. “Dr. Bower, Mrs. Conn is getting worse. Lauren said to notify you.”

      “Thanks, Carol. Please call Dr. Richmond back.”

      “Lauren already did so.”

      “Get ready to call a code if necessary.”

      “Dr. Richmond will have a fit about that, you know.”

      “Maybe she can do more about it than I was able to.”

       Chapter Three

       M ercy Richmond ran the block from her medical office to the hospital, not bothering to remove her lab coat. Mom had promised to call when the time came, but she hadn’t done so. Instead, Lauren had been the one to break the news.

      Shoving open the glass doors into the emergency room reception area, Mercy barely slowed her stride. “Carol, where’s Grandma?”

      “She was in exam room eight, but they called a code and moved her to trauma room one.”

      Mercy stopped and wheeled back. “What? There’s not supposed to be a code!”

      Carol shook her head in sympathy. “I’m sorry. Dr. Bower called it. He had to.”

      “We’ll see about that.” Mercy swung back on course. First, administration had arbitrarily decided to bring in a full-time E.R. doc from Kansas City, and now this hotshot doc had decided to ignore a perfectly legal DNR request. Perhaps he’d never learned to read.

      She pushed through the swinging double doors that pretended to lend privacy to the open emergency room. A secretary manned the central station. All other hands were gathered in the trauma room, six people altogether, including Grandma’s frail, still body on the bed. Others worked with quick efficiency, responding without question to the soft-spoken commands of a slender, brown-haired man in green scrubs. He knew the drill well.

      “Get me a blood gas…. Push the epi now, Lauren…. Any pulse…? Continue CPR.”

      Mercy stopped just inside the doorway as a nurse from upstairs pushed methodically against Grandma’s chest and another bagged her.

      “What’s going on here?” Mercy demanded. “Doctor, what are you doing to my grandmother?”

      He looked up, his blue eyes behind gray-framed spectacles holding her with gentle concern. “You must be Dr. Richmond. I’m sorry, but as per your mother’s request, we are attempting resuscitation.” He turned back to the table.

      “Stand clear,” he called as he prepared the paddles to send a jolt of electricity through Grandma’s chest. He placed one paddle above her right breast, and the other paddle he placed to the side below her left breast.

      Mercy stood in stunned horror as the frail body jerked, arms flying out, legs up. Mercy had done the same procedure herself many times during her shifts in E.R. but not on someone she loved like Grandma.

      “Check pulse,” Dr. Bower said.

      Lauren gently felt the carotid artery for a moment, then shook her head. “Nothing, Doctor.”

      “Continue CPR. Prepare more epi, and I need lidocaine, 1.5 milligrams per kilogram. What’s that blood gas?”

      “Not back yet, Doctor.”

      Mercy stepped toward him. “Dr. Bower, I’m her granddaughter. Stop this code.”

      He was barely taller than her five feet eight inches, but his expression held calm authority. “As I said, Dr. Richmond, your mother—”

      “I heard what you said, but my grandmother signed a DNR form weeks ago. Surely that has some bearing on this case.”

      “You know that form does me no good. Believe me, I wish it did.” Dr. Bower’s voice betrayed frustration. He lowered his voice. “Your mother showed me her papers for legal power of attorney. Her order is to resuscitate.”

      “Forget that order. As a fellow physician—”

      “I can’t break the law, Dr. Richmond.”

      “Don’t abuse this patient any more than she has already been abused!”

      Dr. Bower grimaced at her words, sighed and shook his head. “I’d love to comply, but I can’t. If you want to sway the decision, please talk to your mother. I tried.” He turned back to the table. “Stop CPR.”

      The monitor showed an irregular, sawtooth pattern. Grandma’s heart was in ventricular fibrillation. Mercy hoped it would not change back.

      “Where is my mother?” she asked, her voice heavy with frustration.

      “She was in the private waiting room when I left her.” Dr. Bower shook his head at the monitor. “No change. We need to shock again.”

      He charged the defibrillator to 360 joules. “Clear.”

      Mercy stepped back and almost turned to leave, but she couldn’t. A sort of morbid amazement held her there, watching the scene of horror play out before her. She gripped the door frame. A loud pop and flash preceded the stench of burned flesh. An electrode had blown. Lauren and Dr. Bower checked for signs of life while another nurse replaced the electrode.

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