Oath of Office

CHAPTER 17

“Oh, Jesus! My thumb! My thumb!”

In an instant, blood was everywhere, spurting into the air from within the tattered rubber glove and cascading across the wooden chopping board onto the floor.

Lou vaulted over the counter and past the waitress, whose expression gave no indication that the startling event had even registered. He slammed into the chaos of the kitchen through a swinging door with an eye-level porthole as a crush of customers and staff closed in behind him.

“It’s Joey!” someone cried out. “Joey’s cut his finger off!”

Lou’s powers of observation were immediately heightened. Seconds passed as minutes. The world around him began moving in slow motion. His tone became firmer, but his speech slowed. What might have been dozens of factors were analyzed and synthesized at once.

Crunch mode.

“I’m a trauma specialist from Eisenhower Memorial,” he heard himself announce calmly. “Please give me room. Give me some room. Someone call nine-one-one and tell me when you’ve done it. One of you bring over some rubber gloves. The rest of you, back away, please.”

Incredibly, the boy was still on his feet, staring down at his hand with what appeared to be little comprehension. Blood had sprayed across his white apron like a macabre piece of spin art. The blade had crunched through the bone just above the metacarpo-phalangeal joint-the knuckle separating the digit from the hand. It had been a vicious cut, requiring almost unimaginably intense force.

The bone had been splintered more than sheared in two. Some soft tissue remained intact at the base-a piece of good fortune that would enable optimum anatomical alignment in preparing the boy for transport. Still, as things stood, two bloody tendons and a bridge of skin were all that kept the digit from dropping into the stack of blood-soaked carrots.

If this were a single finger other than the thumb, it seemed quite possible the hand surgeon would opt simply to complete the amputation. But this was the thumb-the digit that, because it could be pressed against the pads of the other four fingers on the hand, created the opposition that, in essence, separated primates from other animals. Writing, grasping, fine motor skills. For life to go on as it was for this youth, meticulous reimplantation was critical.

And preserving anatomical relationships and circulation had to be Lou’s mission. But first, there was the matter of the kid himself.

Lou grabbed a towel and laid it over the boy’s hand. Instantly, the white cloth became soaked in crimson.

“Joey, is that your name?” Lou asked, supporting him by the shoulders.

“Joey,” the kid managed. He began shrieking again and raised his hand to eye level. Heavy drops of blood fell from beneath the towel.

“He just stuck his hand in there!” the chef cried out, the heavy, blood-covered blade still in his hand. “I never saw him. Jesus, Joey, what in the hell were you thinking?”

Joey’s fair, freckled complexion was ashen-one of the early changes of shock.

“All right, Joey,” Lou said, “I’m going to lower you down.”

“Here you go, Doc,” someone said.

A box of disposable rubber gloves appeared on the high bench where the accident had occurred. From his earliest days in the hospital, Lou had to battle against the intense urge to dive right in and help whenever there was an open, bleeding wound. Then articles began appearing in the literature reporting the surprisingly large percent of HIV-positive patients found in sequential testing in both inner city and suburban emergency wards. And finally, conversion to positive happened to a fellow moonlighter who didn’t follow protocol, in a small, affluent community hospital, fifty miles outside of D.C.

“Please, no one come near the blood without having gloves on,” he said, donning a pair and quickly backing it up with another. “One of you roll an apron under his neck and someone else get his legs elevated with something under his knees and ankles. The higher, the better. If there’s a blanket around, put it over him. And I need towels. Lots of towels.”

He brought his mouth next to Joey’s ear.

“Joey, my name is Dr. Louis Welcome. Call me Lou. Hang in there with me and we’ll get you fixed up. Okay?” He took a clean towel and slid it in as a replacement for the blood-soaked one. “Do you have any allergies to medications?… Any past surgery…?”

He craned his neck back until he made eye contact with his father. Then he pulled his car keys from his pants pocket.

“Ask that guy over there in the green plaid shirt to get my medical bag from the trunk of my car,” he ordered the chef nearest to his left. “Then get me a large bowl of ice water and some dishwashing soap. Dove, Palmolive. Anything you have is okay.” The circle of people gathered around them began to close in. “You’ve got to back up!” Lou said firmly, applying gentle pressure. “Give us more room.”

Blood flowed from the wound in thick spurts. Hemostasis? Ice? Cleansing?

He evaluated the pluses and minuses of each maneuver.

Stop bleeding.… Get alignment.… Sterilize.… Protect any microscopic arteries that might still be intact.…

Lou made decisions while talking to the boy almost continuously. A single rolled apron had been placed under Joey’s neck, and stacks of towels were now elevating his legs from the knees down.

Lou rested the damaged hand palm down on a clean towel, gently adjusting the thumb into an anatomically correct position.

“Okay, Joey … listen to me now.… Everything is going to be just fine.… I’m going to help.…”

“Help me,” Joey answered back meekly. “Please help me.”

“Someone give me a scissors, please.”

Lou pulled one of the towels from the pile and cut off a long three-inch strip. Next, he wrapped the strip twice around the middle of Joey’s forearm and tied it off. The bleeding began to slow. To add torque, Lou slipped a wooden cook spoon under the strip and turned it until the bleeding began to slow even more. He made note of the time, 12:50. There may have been as much as two hours of wiggle room to keep the tourniquet on before there was tissue damage, but he had no desire to cut things that close.

“Here you go, Lou,” he heard Dennis say.

Lou’s heavy black leather bag materialized on the floor beside his knee. A number of states had enacted Good Samaritan laws to protect doctors who offered help in an emergency from being sued. But many of those laws were vaguely constructed, and some had even been challenged in court. As a result, there were docs who went out of their way to avoid involvement in trauma or medical emergencies-an aspect of his profession Lou had never been proud of. Instead, he had chosen to make himself better prepared. He carried a well-equipped medical bag in his trunk, and at one point, had actually participated on a committee that helped the airlines to design a sensible and useful emergency first-aid kit that could be placed on planes.

“You still with me, Joey?”

“Yes … I’m with you, sir.”

The physical evidence of shock had already begun to recede, and some strength had returned to the youth’s voice. Bleeding had been reduced to an ooze.

“I need that icy dishwashing soap now,” Lou called out.

Given that the ambulance would be there soon, there was little in Lou’s emergency bag that would be of major help. But there was gauze and a great splint-thumb-sized, three-quarters of an inch wide, pliable aluminum, backed with foam rubber. And just as important, there was a pair of shears that could shape it. Years had passed since he had put the splints and shears into his kit. Who knew?

He irrigated the wound, carefully wrapped the laceration, measured off a piece of splint well more than twice the length of the thumb and twisted it into a U that held the fracture in an anatomically perfect position, with three inches of aluminum extending across the wrist and onto the hand, front and back. Then, again from the kit, he snapped open a chemical ice pack and set it on the bandage. By the time the cold was gone, Joey would be undergoing treatment. Lou finished the job with heavy cotton batting up to the tourniquet and two ACE bandages.

“You’re doing great, pal,” Lou said to him. “You’re one tough customer, I’ll tell you that. You are really something.…”

Lou checked the youth’s blood pressure. One hundred.

Reasonable.

He continued the stream of encouraging banter.

“You’re doing just great, Joey … just great.…”

“Out!.. Out! Okay, back off, everyone. Please.” Millie Neuland came rushing through the crowd. If she had aged since any of the dozens of photographs of her were taken, Lou could see no evidence of it. Gray, tousled hair, round wire-rimmed glasses, bright blue eyes, rouged cheeks, finely painted eyebrows, and a nearly perfectly round face. Her gingham dress, frilly half apron, and single strand of pearls completed the picture.

The quintessential grandmother.

Lou had begun wiping off the boy’s pallid cheeks.

Millie knelt next to him, mindless of the blood. “The ambulance is on the way,” she said to no one but Lou, a genteel Southern lilt in her speech. “If you’re not a doctor, son, you dang well should be. I’m Millie Neuland.”

“I guessed. Lou Welcome. I’m an ER doc at Eisenhower.”

“Lucky us. Oh, Joey! Can you hear me, baby? You got a doctor right here with you.”

Joey’s eyes fluttered open. “Hi … Ma.”

“Your son?” Lou asked.

“Might as well be. His name’s Joey Alderson. Been here at the restaurant for years. Looks twelve, but he’s near twenty-five.”

“Ma, I really messed up this time,” Joey managed in a hoarse whisper.

“How bad?” Millie asked Lou. There was emotion in her voice, but her tone was that of a woman used to being in charge and dealing with crisis.

“He put his hand under a knife that was chopping carrots. My father, the guy over there in green, and I were sitting just a few feet away.”

“How bad?” the restaurateur asked again, encouraging no mincing of words.

Lou glanced down at Joey, who appeared to have drifted off. “Reimplantation,” he said, sensing the word was one that the youth was unlikely to completely understand. “We have some wonderful hand surgeons at Eisenhower Memorial. I can make some calls and we can get him over there.”

“I don’t know you, and I don’t know any of the doctors at Eisenhower Memorial,” Millie replied, “but since you work at one of the big hospitals in the city, you might know that many folks out here consider a referral to there tantamount to a death sentence. We’re very proud of our hospital here. My restaurant is one of its biggest supporters. In fact, the surgical suite is named for me and this place. Joey’s a little … limited in some ways. He may frighten easily. The doctors at DeLand know him well. They know how to be sensitive to his needs.”

“I understand,” Lou said, now measuring every single word carefully. “The metropolitan hospitals in cities like D.C. all have the reputation you spoke about-mostly because people who are referred in are usually quite ill.”

From the distance, they could now hear the siren of an approaching ambulance. Lou knew that, assuming his concerns about DeLand Regional were on the mark, time was running out on his chances to get Joey Alderson into the city.

A frontal assault seemed to be his only option.

With the approaching siren getting louder, he met Millie Neuland’s gaze with his, and held it. “Millie, I promise to explain my feelings later,” he said, “but I have my reasons-very strong reasons-and I am begging you to allow me to bring Joey into Eisenhower Memorial.… Begging you.”

The woman, clearly nonplussed by the force behind Lou’s words, studied his face.

The siren, now in front of the restaurant, cut off. Moments later, they could hear the voices and commotion from the direction of the main entrance.

Lou felt his heart sinking. There was nothing more to say.

“Well,” Millie said finally, “if Joey’s going to be trucked into the city, then I’m going with him.”