Oath of Office Read Online Free PDF Page B

as he was. Next to Prichap was a tray with bloody sponges and instruments piled on it.
    No bullet.
    On the bed, barely visible in the crowd, was John Meacham. His trachea had been intubated through his mouth, and he was being ventilated mechanically by a state-of-the-art machine that occupied most of the space the crush of bodies did not. A tall man—six feet or so—Meacham looked lost, almost diminutive. He appeared to be unconscious. His eyes were taped shut, and his head had been shaved on the right side. The bullet hole, just above his right ear, seemed to have been widened. On the wall view-box were anterior–posterior and lateral skull films showing a deeply embedded slug, fragmented into one small and two larger pieces, none of which were easily accessible to the entrance wound itself.
    Dr. Schwartz, the hospital-employed intensivist, was apparently off with other patients. Why hang around for a plain old everyday gunshot wound to the head?
    Lou introduced himself to Prichap, and received an uninterested nod in return. No handshake. Then, without a word, the neurosurgeon drifted into the background as Lou conducted a quick visual scan of Meacham. What he saw immediately disturbed him. There were two intravenous lines—one inserted in the elbow crux of Meacham’s left arm, and the other at the wrist of the right. The line at the elbow was barely running, despite a blood pressure reading on the monitor screen that demanded fluids and pressor medications—eighty over forty. Surrounding the spot where the catheter had been inserted was a large swelling. The line was infiltrated, and rather than pouring life-supporting fluid into the circulatory system, it was pooling fluid in the tissues.
    Careless, dangerous medicine.
    “Sara, that needs to be replaced,” he said, pointedly ignoring Prichap, who, at that moment, was looking rather pleased with himself for whatever reason.
    The Sara Turnbull he remembered would never have allowed a critically traumatized patient to have only one working IV. Perhaps in the chaos, she simply had not noticed. In seconds, she was taking down the dressing and preparing to replace the IV line—this time at the wrist.
    Lou glanced up again at the perilously low blood pressure reading, which had dropped from a systolic of eighty to seventy-four. Unless the cause could be identified and reversed, John Meacham was heading out. Quickly, Lou began mentally ticking through the possibilities. It took only a few seconds to connect with the right one.
    Stunned at what he was seeing, Lou worked his stethoscope into place and listened to Meacham’s chest. There were no breath sounds on the right side. The exam was not really necessary. All the information he needed was visible in the distension of the jugular veins along the sides of the man’s neck, the slight bowing of the trachea toward the left, the persistently low oxygen saturation, and the asymmetrical hyperexpansion of the right chest.
    A tension pneumothorax—collapse of the right lung due to a tear, probably caused by excess pressure from the ventilator. Air was being forced by the vent through the ruptured lung and into the chest cavity. The midline structures including the heart, esophagus, aorta, and other great vessels were being pushed to the left. The absence of breath sounds on the right merely confirmed the diagnosis.
    Lou noted that the vent pressure was dangerously high and turned it down. From beside the machine, the respiratory tech—a tall, pencil-necked man in his late twenties—stood smiling at him blandly.
    Did you do this on purpose? Lou wanted to shout. Did you?
    “Everyone, please, listen to me,” he called out, louder than he’d intended. The commotion immediately stopped. “I’m Dr. Lou Welcome from the ER at Eisenhower Memorial. This man has a rapidly expanding tension pneumothorax. We need to dart his chest immediately to get the air out of there. Then we’ll get a chest tube in. I need an IV angiocath in