Fatal (4 page)

Matt slid a thin plastic catheter through the needle and into what he hoped was the pericardial space. Then, carefully, he withdrew the needle and fixed the catheter in place with a single suture through the skin of Teague’s chest. Blood oozed from the catheter opening and soaked an expanding stain into the sterile drape. For several seconds there was nothing but a tense silence.

“Pressure’s still zero,” Lee reported at the moment Robert Crook charged into the room.

A rotund, ruddy-faced man, Crook had dense, sandy-gray brows that always looked to Matt like giant woolly caterpillars about to do battle. Along the margin of his left jaw were several fresh clots from where he had nicked himself shaving, as well as a tiny, bloodstained flake of tissue paper. His response to the emergency at MCRH had clearly been to charge into the bathroom and break out his razor and shaving mug.

“Rutledge, what’s going on?” he demanded.

Matt shrugged.

“He lost his blood pressure and I couldn’t figure out why. I decided he had a pericardial tamponade, so I tapped him.”

“You . . .
tapped
him?”

“Still no pressure,” Lee called out.

“Be sure the dopamine is open all the way,” Matt ordered.

“It is.”

“Did you see pericardial fluid on his echo?” Crook asked, ignoring the sterile field and the thin catheter in order to listen with his stethoscope.

“I . . . wasn’t able to get an echo. No time.”

Crook erupted.

“Jesus Christ! How can you be sure you’ve stuck that needle into his pericardial space and not into his friggin’ heart?”

“I did what I thought was right,” Matt responded as steadily as he could manage. “I did what I thought was needed, and I did it the best I could.”

“The best you could? Rutledge, you’re not a doctor. You’re a goddamn cowboy. A loose cannon. And I want you to know that I fully intend to report your actions to—”

“Wait,” the nurse cried out. “I hear a pressure. It’s loud and clear at sixty. . . . No, now it’s eighty. It’s eighty.”

At that moment, Darryl Teague lifted one arm and turned his head.

 
CHAPTER
3

“
MORNIN’, KIM, MATT SAID TO THE EFFICIENT, 
empathetic clerk of the ICU.

“Good morning, Doctor” was the chilly reply.

Matt considered confronting the woman. Kim West had always been at least cordial to him, if not downright friendly. But there was no sense in singling out her rudeness. The Belinda Coal and Coke Company was the lifeblood of the valley. In one way or another, all of Montgomery County was linked to it. Over the three days since he saved the life of Darryl Teague, the coolness toward him on the streets of Belinda had grown increasingly unpleasant. Teague had never been a favorite son of the town, and now two young men were dead because of him. And because of Matt, he wasn’t. The gas station, Scotty’s Diner, the dry cleaner—wherever he went, there were whispers and tension, even in the hospital, where people should have known better about the choices doctors should and should not be making.

Within hours of the incident in the ER, Robert Crook had sent a memo to the entire hospital staff decrying Matt’s behavior and judgment. He even speculated that poor technique in doing the pericardial aspiration had placed the man in as much jeopardy as had the accident itself.

Teague was officially Crook’s patient, and the cardiologist had gone out of his way to involve an internist other than Matt in his care. Still, Matt had made it a point to visit Teague twice a day since the disaster. Helping to save a person’s life forged a connection only those who had been in that situation could completely understand.

Ignoring the distasteful glare from one of the older nurses—a miner’s mother, Matt recalled—he went directly to room 6. The lights were out, save for a dim fluorescent over the bed. Teague, his monstrously deformed face battered and bruised, lay on his back breathing shallowly and irregularly on a ventilator. He was unconscious, as he had been since shortly after his transfer up from the ER. From what Matt could tell, there was no decent explanation for his lapse into a coma. Initially, blunt head trauma was the likely suspect, and that certainly remained a possibility. Still, there had been no order for an MRI or CT scan, or even for a consultation with the neurologist. Robert Crook certainly wasn’t going to win any Doctor of the Year award for his attention to this case, although he might well receive a good citizen medal from the townsfolk.

Matt stood in the gloom, looking down at Darryl Teague.

What happened to you, Darryl?
he asked silently.
What did you and Teddy Rideout inhale? What did you drink? What did you rub onto your skin?

Matt took Teague’s wrist and checked his pulse, which was quite strong. The torn vessel that had caused the nearly lethal cardiac tamponade had clotted, and the narrow drain, which had been placed under the pericardial membrane, had been removed. Now, to all intents, Teague’s mysterious coma was all that was standing between him and a transfer out of MCRH—probably to some prison hospital. Matt did a brief neurological check. Nothing alarming—no focal signs that would suggest a slowly increasing hemorrhage between the skull and brain. He reached up and gently touched the hard, fleshy lump above Teague’s left eyebrow, then the one on his chin. Had the man ever bothered to see a doctor for this bizarre condition, or did his rapidly progressive mental illness prevent him from acting rationally?

“What’s the deal, Darryl?” Matt whispered. “Come on. Wake up and tell me. . . . What’s the deal?”

He picked up the bedside phone, hesitated, then called the pathology lab. In seconds his uncle was on the line.

“Hal, how’re you doing?”

“Well, I don’t have half the town wanting to tar and feather me for just doing my job, if that’s what you mean.”

“There’s a nurse right outside who’ll be happy to smear the first glob on me. Listen, Hal, I’m here in Teague’s ICU cubicle. You may already know this, but he’s been in a coma since right after he was moved up here from the ER. I’m wondering if someone’s medicating him.”

“Why?”

“First
if
, then
why
. Is there any way you could have one of your techs draw an extra tube and run a drug screen on it?”

“Without telling Crook?”

“That’s the idea. I would draw it myself, but there would be hell to pay if a nurse walked in on me while I was doing it.”

“I’ll do it, nephew, but I expect a pouch of premium tobacco next Christmas. No more ties.”

“You sure? I think I still have three or four left in my closet.”

“I’m sure.”

“Okay, no more ties. Thanks, Unk.”

MATT

’
S OFFICE OCCUPIED 
the first floor of a shingled old two-family just off Main Street, near the center of town. He parked his Harley by the garage in back and entered through the rear door. The moment he stepped inside, he could hear an animated exchange coming from his waiting room. The voice, a woman’s, was strident and shrill. Responding to her, evenly, civilly as always, was Mae Borden, his office manager and receptionist.

“Now, Mrs. Goodwin,” Mae was saying, “I’m not trying to convince you not to switch doctors, but I do think you owe it to your husband to think things through.”

Matt stopped just short of the door to his office and leaned against the wall in the hallway.

“Charlie’s the one who made me come,” the woman said. “He’s very upset about what happened in the mine.”

“You mean Dr. Rutledge saving that boy’s life?”

“Yes. The two men Teague killed were friends a Charlie’s. An’ the mine’s been closed for three days now because a the damage Teague did down there. That’s money outta everyone’s pockets.”

“I understand. Tell me something, Mrs. Goodwin. If your husband had been the one driving that equipment that night, would you have wanted Dr. Rutledge to do all he could?”

“Well, I . . . I suppose I would.”

“And has Dr. Rutledge always given you two the best of care?”

“A course he has.”

“And you want to switch doctors?”

“Well, I—”

“Mrs. Goodwin, supposin’ I keep your records here until Charlie comes in and speaks with me—or better still, with Dr. Rutledge. I’m not supposed to say this, but I know for a fact that the two of you are among his favorite patients. He’d hate to lose you.”

“Well, the truth is, I’d hate to lose him, too.”

“So?”

“Mrs. Borden, I was really hopin’ you’d talk me outta this. I’ll tell Charlie if’n he wants to go through with it, he’s got t’ come in an’ face Dr. Rutledge hisself.”

“I suspect he’ll be relieved you didn’t do it.”

“I think he will, too. Thank you. Oh, thank you so much.”

Matt heard the front door open and shut.

“It’s okay, Matthew,” Mae called out. “She’s gone. You can come in here now.”

Matt entered the modest waiting area and kissed his office manager on the cheek.

“I have some Eskimos I want to sell refrigerators to,” he said. “I think you’re just the woman for the job.”

“No thanks. I can’t stand the cold.”

“Bless you for saving my practice.”

“Oh, it’s not been that bad,” Mae replied in her melodic, Alabama drawl. “Six attempted defections so far, only three successful ones.”

Mae had been Matt’s office manager since the day he entered practice. She was in her fifties, but her silver hair and conservative manner and dress added a decade to that. Over the years, the two of them had become bound by their differences as well as by a total devotion to the practice and their patients. In addition to making the best pot of coffee in town, Mae was a wizard at squeezing in any patient who needed to be seen, and at “adjusting” a bill for anyone who couldn’t pay.

“I’m afraid this Teague business has made me a few enemies around town, Mae,” Matt said.

“Correction, sir, people in town like you and respect the kind of doctor you are. Many of them sympathize with you because of the losses you’ve endured. But they’re losing patience. Since you came back here to practice, your attempts to get the mine fined or even shut down for safety violations have already rankled a whole bunch of people. It’s made you an irritant in some quarters and the butt of jokes in others. Saving Darryl Teague has merely pushed the envelope.”

“Mae, come on, now. Stop mincing words. What do you
really
think?”

Mae smiled in spite of herself.

“Very funny,” she said. “But it’s not so funny when people won’t come to see the best doctor in the valley because they think he’s always crusading to take away their livelihood.”

“I’m not crusading to take away anyone’s livelihood. It’s just that—”

“Matthew, open your eyes,” Mae cut in. “Ever since Ginny died, you’ve had blinders on. You were already writing letters to the mine safety people and trying to make every injury in the mine a federal case. After she passed away, you just haven’t let up. And what have you got to show for it? Nothing.”

“Ah-ha!” Matt said. “Now, that’s where you’re wrong.” He raced into his office and returned with a stack of magenta paper. “I have these to show for it, fresh from the copy store.”

He set the sheets on Mae’s counter and passed one over.

WANTED

INFORMATION ON ILLEGAL TOXIC WASTE

DUMPING OR STORAGE AT ANY MINE IN

MONTGOMERY COUNTY

$2,500 REWARD

FOR INFORMATION LEADING TO MSHA OR EPA ACTION

COMPLETE CONFIDENTIALITY GUARANTEED

REMEMBER, IT’S YOUR HEALTH

The Healthy Mines Coalition

“Lord,” Mae groaned. “‘Healthy Mines Coalition’?”

“I thought that sounded better than Matthew Rutledge, M.D.”

“Matthew, when are you going to see the light? You can’t hurt these people. They have more money than we could ever dream of, and more influence in high places than they need to brush off a fly like you. Going against them, you can only hurt yourself.”

“Mae, Ginny died of a type of cancer that only shows up one in a million times in female nonsmokers her age. Now along comes two cases of a totally unusual syndrome in two men who both just happen to be miners. How can you not believe that BC and C is responsible? Do you have any idea how many barrels of toxic petrochemicals they generate converting coal into fertilizers or paint, or especially coke? Where are they?”

If nothing else, Matt had done his homework. The production of coke, the derivative of coal that was essential to the production of iron and ultimately steel, was, to his mind, a major culprit. With enough plant space, equipment, and technology, certain types of coal could be utilized nearly 100 percent. But various by-products of production—creosotes, tars, pitches, and many other hydrochemicals—if not generated in sufficient quantities to be commercially valuable, had to be disposed of safely, or else stored. It was in this area that Matt believed the powers at BC&C were cutting their most dangerous corners.

Shaking her head more in frustration than disapproval, Mae handed the fliers back to him.

“You have five minutes before Jim Kinchley,” she said. “I sent him over to the lab for routine bloods and an EKG.”

“Perfect. Mae, don’t worry. We’ll do fine.”

Mae smiled thinly and returned to her business.

Matt repaired to his office and began working his way through the pile of lab reports and charts on his desk. As usual, Mae made sense, he was thinking. When was the last time one of his letters to the editor had actually been published? And what about the abortive town meeting he had held where there were only seven attendees, including his mother, uncle, and two homeless people who were clearly there for the coffee and cookies?

He looked up just as a scarlet tanager alighted on a branch of the white oak outside his window. For a minute, maybe even longer, the magnificently colored little songbird perched there, motionless, looking, it seemed, directly at him.

Ginny?

The bird remained fixed in its spot.

Ginny, is that you?

From the doorway, Mae Borden cleared her throat discreetly.

“Matthew, are you okay?”

“Huh? Oh, sure. I’m fine.”

He glanced back at the tree, but the tanager was gone.

“You were thinking about your wife, weren’t you?”

“No, I mean yes. Yes, I was.”

“I thought so.”

“You know, Mae, it’s been almost four years and the feelings haven’t really changed inside me at all. If anything, I miss her more than ever. First it’s a cloud that reminds me of her, then a scene in the woods, or the way a woman on the sidewalk looks from behind. Just now it was a bird—a tanager. Only this time it didn’t just remind me of her, Mae, I had this powerful feeling it
was
her. No matter how hard I try, I can’t seem to get my brain around how long forever is. I keep thinking that some director’s going to walk into the room, clap his hands, and announce that this scene is over and we get to move on to the next—the one where she’s waiting at home to tell me about her day with the kids at school.”

Mae crossed the room and set her hand on his shoulder.