did what?” Her dark eyes flashed, and fatigue tightened the tension in her voice.
Lukas blinked at her helplessly. This was not going well. She was clearly, and understandably, irrational from lack of sleep. There had to be some way to make her see, without becoming too graphic.
“I specifically delayed calling my daughter because I wanted to put her through as little heartache as possible,” Ivy said. “She’s been through enough. You had no right to call her.”
“I’m sorry you feel that way, but Mrs. Conn’s condition is getting worse. I felt family needed to be here.”
“Not yet!” She paused with a gasp, placing a hand on her chest.
He stepped toward her. “Are you okay?”
“I’m fine.” Lowering her hand, she took a deep breath and held his gaze. “I don’t care what the DNR form says. I have durable power of attorney, and I want you to do everything for my mother. She’s not ready to die. She’s not…”
“I didn’t mean for this to be so difficult.” Lukas kept his voice gentle, resisting the urge to ask if he could examine her. He’d seen this kind of family reaction before, during his oncology rotation, when a caregiver was so exhausted that they became confused and combative. They often blamed the physician for the pain of their dying loved one. “I will contact Mrs. Conn’s family physician and clarify the matter.” He turned to leave.
“You don’t believe I have power of attorney?” she challenged, her voice rising a decibel.
He paused with his hand on the door. Lord, give me compassion.
But what about Mrs. Conn? She would suffer even more pain if they managed to resuscitate her.
He turned back to face Ivy, and he tried to keep his voice gentle. He knew his words were not. “What I believe is immaterial, Mrs. Richmond. For instance, I believe that to impose heroic measures onto a patient suffering the last stages of advanced carcinomatosis is not only transferring much-needed care from the living to the dying, it is inhumane to the dying.”
“Only if you don’t believe in hell.”
“Mrs. Richmond—”
“Ivy! My name’s Ivy!”
“I’m sorry, Ivy. I do believe in hell. I also believe that your mother is at peace about this. She told me she was ready to go.”
“What do you mean, she told you?” Ivy snapped. “Mother hasn’t spoken in days. What are you trying to pull here?”
Be gentle. Be patient. But what about Mrs. Conn? “Ivy, to try to resuscitate your mother at this stage would only cause greater, unnecessary suffering. And for what? A few more minutes or hours for the family to say goodbye? What about your mother’s feelings? She’s made her decision already.”
There. He’d done it again, him and his bad habit of stating his opinion to the wrong people at the wrong time. But if there was the slightest chance Ivy would listen…
She bent her head, her eyes closed for a moment. He watched her hopefully.
She reached into the right back pocket of her jeans and drew out a folded three-page form. “I had hoped it would never come to this.” The strength had left her voice. She unfolded the papers and held them out with shaking hands. “I have the power of attorney. Are you satisfied?”
Beverly caught up with Lukas as he reentered the E.R. proper. “That Mustang’s mine!”
Lukas struggled to work up some enthusiasm. “Don’t tell me you cajoled Dr. Wong—”
“Nope.” She jingled Cowboy’s keys. “Sweet-talked one of the new EMTs to help me. Buck likes animals.”
“Yes, but did you tell him this wasn’t a gerbil?”
She grimaced. “He knows it’s a big animal.”
“Horses are big animals. How will you feel if your helper comes back in here on a stretcher?”
“Awful.” She shrugged. “Dr. Wong’s finished with Cowboy. Got any patients for me?”
“Have I ever.” He gestured toward the charts at the desk. “Enjoy.”
He left her staring at the sudden overload and stepped back into exam room one to check on Mr. Verris. Shelly still sat there beside his bed, and Lauren entered behind Lukas, as if geared to his location by radar.
“Any change?” Lukas asked Lauren.
“Test results are in.”
Lukas checked the printouts. Nothing. Everything was normal. Even the drug screen was not helpful, because all it showed were benzodiazepines, and that was to be expected for someone who occasionally took them to sleep. Lukas could have done a quantitative drug screen, but that would have taken too long.
“BP’s gone up just a little, but not much,” Lauren continued. “Pulse and respiration are the same. They’ve called from upstairs to let us know they’re coming to take him to ICU.”
“Let’s make sure they know he still needs a CT scan.” Lukas did his own assessment. Was it his imagination, or was the man breathing more deeply? As he watched, Frankie’s head moved a fraction of an inch.
Lukas looked up to see if Lauren had noticed. “Has he moved like that before?”
“I don’t think so.”
He watched a moment longer. It was probably just a stimulation of the limbic system, a common event in a coma patient.
Lukas did an auscultation of Frankie’s chest one more time, then shook his head. With a nod at Shelly, he left the room. He was feeling more and more frustrated as the day progressed.
Lauren stepped out of the room behind him. “Dr. Bower? Some of the staff are getting together after this shift over at the cantina across the street. Want to join us?”
“Uh…sure. Yes, I’ll be there. Thank you for asking.” Lukas nodded and continued down the hall, knowing he would be kicking himself tonight when it came time to show up at the cantina. He would be starving when he got off, as usual, and since he always ate out anyway, this would be a good way to get better acquainted with the people who worked here. Unfortunately, he knew that by the time he arrived at the restaurant, he would be feeling so awkward about meeting with a group of near strangers, he would have lost his appetite. Almost.
Moving to a new place was lonely business, especially for him. Funny, he could face patients and coworkers all day long with no problem, but when his time was not regimented, he had trouble forcing himself to reach out to others. It wasn’t that he didn’t like people, because he did. The youngest of three boys in a loving Christian family, Lukas was the only shy one in the bunch, and he had often been teased about it. The teasing had only made him more self-conscious, turning him inward, and now his family despaired of ever seeing him married. But this was a new place, and no one here knew about his shyness. It was time to dig himself out of the rut—or pray that God would move him out.
He took Mrs. Richmond’s papers to the secretary. “We’ll need copies of these, Carol. Please call Dr. Richmond back and tell her that she needs to be on standby. Her grandmother is holding her own at the moment, but she could deteriorate fast, and she’s now a full code.”
“Yes, sir.” Carol grabbed the papers from him, dark eyes glowering as she spun around to the copier. She muttered something under her breath.
Lukas watched the characteristically cheerful secretary in surprise. “Carol, are you okay?”
She put the first sheet into the copier and pressed the button. “Fine, just fine,” she mumbled. “We’re swamped, we’ve got patients dying back there, and all I hear are complaints that we’re not seeing people fast enough.” She indicated the waiting room. “Griping because you haven’t looked at their scalps yet. They’d