Master Key

By Illya

Doctor Rachael Lord is near the end of her thirty-six hour tour, in the Emergency Department at Beekman Hospital, when a male trauma victim rolls through the doors. The man has no identification, and looks as though he had just been tortured. As Doctor Lord desperately fights to save the mans life she discovers a key embedded in his intestines. The key is unusual in appearance, but Doctor Lord is too busy to notice. After stabilizing the mystery man she absentmindedly pockets the key and heads north to spend some time with her aging parents. Four days later she returns home to her apartment only to find it ransacked. Having nothing but the clothes on her back, and a car thats over ten years old, she calls the police. The police are less then helpful and even less optimistic about finding the culprits. With no other place to turn, Doctor Lord returns to work, but it isnt very long before she discovers an interesting series of events that had taken place in her absence.

• Language: English
• Publisher: Xlibris US
• Release date: Sep 5, 2000
• ISBN: 9781469121468

Illya

David Liebowitz is currently a Registered Critical Care Nurse in the Dialysis Unit of the Dartmouth-Hitchcock Medical Center in Hanover, NH. His formal training includes a Baccalaureate in Business Administration from Western New England College, in Springfield, Massachusetts, and an Associate degree in Nursing from Greenfield Community College, in Greenfield, Massachusetts. He currently lives the quite life with his seven-year-old daughter, Cathy, and enchanting wife, Susan in rural New Hampshire.

Book preview

CHAPTER 1

The telephone on the nightstand rang with a vengeance as the mind of the occupant in the nearby bed scrambled to consciousness. Two, three, four rings, and still the individual’s brain resisted. The air in the overly cramped room where the occupant lay smelled ripe with the aroma of old sweat, stale pizza and disinfectant, but the occupant didn’t mind. In fact, they were comforting reminders. They were the smells of home.

On the sixth ring the figure in the bed reached out for the receiver on the phone. The room was completely devoid of light and its tenant liked it that way, especially on the tail end of a thirty-six hour shift. The phone should have been difficult to find in the oppressive dark room, but it wasn’t, for this was a never-ending routine. The stirring figure had endured four long and tiring years of interrupted catnaps.

The phone’s receiver was more then seven inches away from its recipient’s ear when the yelling started, Doctor Lord, are you there. Come on damn it, wake up!

Doctor Lord, Doctor Rachael Lord, calmly said, Yes, yes, I’m awake. What is it now?

The voice on the other end of the phone frantically said, between gasps of air, We have an incoming trauma. Estimated time of arrival four minutes.

Doctor Lord didn’t even have to ask who was on the other end of the phone. She knew. The raspy breath, frantic tone and thick masculine accent reeked of Thomas Boldman, a.k.a., Emergency Department ward clerk. He weighed in at a neat two hundred and seventy three pounds, plus or minus a pound or two of old sweat. His hair always looked greasy and his breath smelled of cheap cigars. At age thirty-nine he was the epitome of disgust, but the Emergency Department couldn’t run without him. Rachael knew this and so did her fellow co-workers. She also knew Mr. Boldman was on the fast track to an early death if he didn’t quickly change his bad habits. She had taken it upon herself to make it her personal crusade to remedy that. So far she had had little luck.

Doctor Lord brought the phone’s receiver to her cosmetic free lips and replied, Hold your shorts on Tom, I’m on my way and page Larry, will you?

Doctor Lord nearly always called Larry Maxwell, MD wannabe, and medical student of the year to her side when she worked in the Emergency Department. The two worked as a symbiotic pair. She was the brain and he was the workhorse. If there was nauseating work to be done, Maxwell did it, no questions asked. Of course, he did plenty of griping, but then again, what medical student didn’t? Still, it was a give and take relationship. Doctor Lord tried to teach him the finer points of medicine and in return he did all of her scutt work.

Mr. Boldman typed Maxwell’s pager number into the hospital’s paging system as he said, Sure thing Doctor Lord, consider it done. By the way, the nurses say this in-coming is a real train wreck.

Doctor Lord pulled on her drab gray lab coat that had been sparkling white just thirty-six hours ago and said, Aren’t they all? before hanging up the phone.

She arrived in the Emergency Department; thirty seconds later, just as the gurney from the ambulance burst through the inner double swing doors. One attendant pushed the stretcher while the other feverishly pumped on what appeared to be the chest of the victim. Both attendants were covered in bright red blood despite their protective garb. Doctor Lord ran to the side of the stretcher and involuntarily winced at the sight. A nurse in the periphery of the action yelled, Trauma Two is open, and someone call the blood bank!

The two ambulance attendants shifted to the right as they steered towards the empty trauma room. Doctor Lord confidently said, Alright, give me the lowdown, as she snapped on two pair of extra thick latex exam gloves. She had learned double gloving from her previous instructor. It was really a pretty neat trick. If the first pair of gloves got too slippery to work with, she simple peeled them off and she’d be back in business. She chose extra thick gloves because during a previous trauma she had been cut by a piece of stray glass floating around in a jumbled mass of mangled intestines. Thankfully the patient tested HIV and Hepatitis negative.

The EMT at the head of the stretcher said, You won’t believe it. The guy just ran out right in front of our ambulance. We had to practically pry him out from under our wheels. Shit, it was really wild.

Doctor Lord looked at the EMT for the first time. He was just a kid. He couldn’t have been older than twenty-one. She couldn’t help but wonder if he was even old enough to drive. One thing was for certain, he knew very little about Emergency Department reporting. Doctor Lord was about to say as much when the other EMT spoke up.

Sorry about that Doc, he’s only been on the job for three weeks. We have a Caucasian male, approximately forty-five years old, and one hundred and eighty-five pounds. He took a crushing blow to his chest and right arm.

Doctor Lord interrupted, Your ambulance I presume?

The EMT doing the chest compressions responded, Yes, but here’s the strange part. He’s got multiple lacerations all over his body and his abdomen is completely eviscerated. That couldn’t have happened from the accident, could it?

Doctor Lord looked up from her initial survey of the patient and said, I don’t know, how fast were you going?

The EMT at the head of the stretcher said, I was driving, but it was right in the middle of rush hour traffic. The kid was obviously nervous, and the quiver in his voice proved it. Honest, I wasn’t going that fast. The kid paused to wipe the sweat from his forehead with the back of his hand. He still wore his green industrially thick forearm high rubber gloves so when he brought his wrist across his face he left a long trail of wet blood behind.

Sandy, one of the two circulating nurses, took pity on him and said, Let me take over bagging so you can wash up.

The young EMT looked up at his partner with sorrowful eyes, as if to say, ‘I’m sorry I let you down.’ Sandy gently removed the young mans hands from around the Ambu bag as she said, I’ll take it from here. You did a great job.

His partner ended another cycle of chest compressions and said, Yeah, Randy, great work. I’ll be out in a few.

Randy removed his eye shield, peeled off his bloody gloves and quietly walked out of the room.

Doctor Lord knew by her quick once over that the man’s chances were small, but nonetheless, with luck and a good team he might pull through. Thankfully, she was working with an experienced team. Sandy was bagging the patient and Linda, the other circulating nurse; had already started two large bore intravenous lines. She had also placed the patient on a cardiac and oxygen saturation monitor. Ordinarily she would have immediately taken over the chest compression from the EMT, but a staffing shortage made that an impossible luxury.

At the end of the EMT’s compression cycle, Linda checked the cardiac rhythm on the monitor and she felt the patient’s carotid artery for a pulse. Both showed nonproductive heart activity. The monitor glowed with a fine dull green wavy line and the artery felt like a piece of overcooked spaghetti. She quickly moved into position next to the EMT and said, I’ll take over from here. Thanks for all your help.

The EMT sunk back, shook her tired arms and said, Sure thing. Let me know how it turns out, alright?

Linda replied, No problem. Go get yourself some coffee on me.

The EMT threw back her hair with a flick of her head and said, You’re on, as she took off her gloves and walked out the door.

Doctor Lord started at the beginning. She glanced at the patient’s oxygen saturation rate on the monitor and grabbed a seven point five millimeter Endotracheal Tube from the trauma table as Sandy hyperventilated the downed man’s lungs. Everyone in the room knew that an oxygen saturation of seventy-two percent was not compatible with life. Sandy moved out of the way as Doctor Lord daftly eased the firm plastic tube down the patient’s windpipe. The procedure took less than thirty seconds, which was good, since every second might mean the difference between the man’s life and death. Sandy placed the Ambu bag’s connector to the end of plastic tube and resumed bagging.

Doctor Lord placed her stethoscope over both sides of the patient’s lungs and said, We are in business. I hear bilateral breath sounds.

Linda looked up at the oxygen saturation monitor and said, His Sat’s up to eighty-nine percent.

Doctor Lord was about to comment when the Trauma Room’s doors flew open with a bang. A winded, disheveled looking, Mr. Maxwell burst through the opened doors, followed by two very well dressed men. Mr. Maxwell stammered, Sorry, ah, I was right in the middle of something. He tucked in his dragging shirttails and pulled on his gloves, both pairs. Just like his teacher had showed him.

Doctor Lord looked at the two suited men, but before she could say anything the taller of the two pulled out a shiny badge and yelled, FBI, hands off, this man is our prisoner.

Doctor Lord turned her attention back to the man beneath her hands and calmly said, Get out, without missing a beat in her next medical step. She reached for the paddles of the external defibrillator and called out, Clear! Linda stopped her cardiac compressions and Sandy sank back from the patient’s head. Two seconds later Doctor Lord had the defibrillator’s paddles against the unconscious man’s naked chest, and a second after that, the man’s body jerked from the two hundred joules of electricity. Doctor Lord looked up and saw the Electrocardiogram on the monitor and said, Mr. Maxwell, what do you see?

Mr. Maxwell cleared his throat and said, Hum, fine ventricular tachycardia.

Doctor Lord called out, Clear, as she increased the defibrillator’s output to three hundred joules. The defibrillator’s speaker shrilled a ready tone and Doctor Lord squeezed off another bolt of juice into her patient. The Electrocardiogram showed a half of a second blip before reverting back to its original rhythm. Doctor Lord increased the defibrillator to its highest setting, three hundred and sixty joules. She turned towards Mr. Maxwell and said, Well, Mr. Maxwell, what do you plan to do about it?

Mr. Maxwell rubbed his hands together as he said, Hum, well, re-shock at three hundred and sixty joules. Doctor Lord did just that, and the patient beneath her shuddered for the third time. Mr. Maxwell looked at the monitor, and seeing no change said, Resume CPR Linda checked for a pulse, shook her head and resumed chest compressions. Sandy stepped forward and bagged air into the patient’s lungs. Mr. Maxwell looked questioningly at Doctor Lord and hesitantly said, Hum, give one milligram of Epinephrine IV push. Doctor Lord nodded and Sandy injected the drug into the clear plastic tubing that ran into the downed man’s arm. Maxwell wiped the sweat from his brow and said, OK, let’s zap again at three sixty.

Doctor Lord charged the defibrillator to three hundred and sixty joules, called out, Clear, and discharged the paddles into the man’s chest. Everyone turned to the cardiac monitor. The Electrocardiogram jumped once before breaking into a sinus tachycardia rhythm. Mr. Maxwell’s face beamed with an expression of relief. The rest of the team knew from past experience that they had just begun.

The tall suited man saw the relieved expression on Maxwell’s face and said, All right, we’ll take over from here.

Doctor Lord looked at Linda as she asked, What’s our BP?

Linda said, Seventy over forty. She then rechecked the man’s BP by pushing the button on the automatic blood pressure monitor. She had wisely placed the device on the man’s left arm after hearing the EMT’s report about a right arm injury. It read, ‘Sixty-five over thirty-eight.’

Mr. Maxwell looked at the man’s bloody abdomen and tentatively said, Abdominal bleeding.

Sandy let out a barely audible, Duh?

Doctor Lord glared at Sandy over her protective goggles as she said, Very good Mr. Maxwell let’s see what we got, but first let’s open up our IVs and hang a couple units of blood.

The tall man in the suit stepped forward, placed a hand on Doctor Lord’s shoulder and said, That’s enough. We have it from here.

Doctor Lord instinctively spun around and placed a well-aimed knee into the suited man’s groin. The man didn’t know what hit him. One minute he was standing with a firm goal in his mind and the next he was retching in pain. The second suited man made a move closer, but before he could take a step Mr. Boldman was on him. The little man struggled against Mr. Boldman’s weight, but it was useless. Boldman had saved many nurses from strung out drug addicts, and he knew how to restrain a man. Less then five minutes later, security had the two men under lock and key.

When the commotion was over Doctor Lord turned her attention back to her patient. Six precious minutes had gone by, but her team hadn’t failed her. Three units of blood had been set up on the rapid infuser, the patient’s blood samples were in the lab, and a portable X-ray film was on the view box. Doctor Lord examined the X-ray and raised an eyebrow in surprise. The lower part of the patient’s intestine clearly showed an outline of a key. Doctor Lord had seen many a thing in the lower part of the intestine during her years of practice as a ED Fellow, including a light bulb, but a key in an adult male intrigued her. Adults didn’t usually swallow inanimate objects indiscriminately, that activity was reserved for the children.

Doctor Lord undressed the bulky blood saturated bandage that held the man’s abdomen together in the hopes of finding the severed artery that kept dropping the man’s blood pressure. The bright red blood seeping around the abdominal packing was like a calling card that screamed, ‘Ruptured Artery.’ Even a first year medical student would have picked up on such a clue, and Doctor Lord was no student. The gauze gave way easily and so did the blood behind it. The cardiac monitor was the first to alarm and the blood pressure monitor and oxygen saturation machine soon followed it. Doctor Lord didn’t have to look up at the monitors to know what was going on. Her patient was bleeding out and rapidly. She quickly slipped her hand into the man’s open abdominal cavity and felt her way along the anatomical structures that would lead her to the offending artery. It took her less than five seconds to find her target. The abdominal aorta had a small tear on its dorsal side.

Doctor Lord grasped the injured area between her index and middle fingers to slow the bleeding as she said, Give me a pair of Kelly’s.

Linda placed the Kelly’s in Doctor Lord’s left hand. Doctor Lord tried to bring her left hand along side her right, but there just wasn’t enough room. Mr. Maxwell seeing the problem came to Doctor Lord’s aid. He pulled the entire dressing to the side and slipped his hands under the man’s mesenteric membrane. This had the effect of lifting the bowel up and out of the way. Doctor Lord tried again, and succeeded. She clamped the Kelly across the aorta tear and the majority of the bleeding stopped. As her left hand retracted from the blood filled cavity it scraped across something hard and sharp. Doctor Lord’s first thought was a broken bone, given the patient’s trauma, but the object had hit the top of her hand, and only soft tissue lay above it. She turned her hand over to investigate and her fingers immediately came in contact with something short and skinny.

Doctor Lord looked in the direction of Linda and said, Linda, can I have another Kelly?

Linda said, Sure thing, as she placed the other clamp in Doctor Lord’s right hand.

Doctor Lord brought the clamp up and under her other hand with ease. Mr. Maxwell was doing an exceedingly good job of holding the man’s guts out of the way. It took a little finesse, but Doctor Lord managed to grasp the unidentified object. With the Kelly clamp firmly secured around the object she pulled downward with a twist. The object came free with little resistance.

Doctor Lord held the Kelly up, along with its entangled object, to the air and Mr. Maxwell asked, What is that? A key?

Doctor Lord shook her head and said, Yeah, we find the darnedest things don’t we? Alright Sandy, we did our part let’s send him to the OR. Sandy walked over to the phone on the wall as Doctor Lord opened the Kelly clamp that held the blood-covered key. The key dropped into a saline filled basin with an unusually loud metallic clink.

Sandy hung up the phone just as two large male orderlies came into the trauma room. Sandy bagged the patient’s lungs with the Ambu bag and said, OK, let’s move. They’re waiting for us upstairs.

Doctor Lord peeled off both pairs of gloves as her patient was wheeled out of the room. Mr. Maxwell did the same. Linda picked the key up from the basin of saline, dried it off with a piece of gauze, and tossed it to Doctor Lord as she said, Souvenir for you Doc. Another good save per your usual.

Doctor Lord caught the key, winked, and said, Well, I can’t lose them all, now can I? After all, I have a reputation to think about, not to mention the permanent staff position I’m gunning for.

Linda laughed out loud and said, You’ve got my vote, for what’s it worth.

Doctor Lord replied, It’s worth a lot. You nurses carry more clout then you realize.

Linda laughed again, but