wound to the abdomen. Blood pressure is one-ten and dropping. His name is Jon LeFrenz.” The paramedics helped transfer the moaning patient from the ambulance cot to an emergency-room cart. They ran alongside as the Charity Hospital E.R. employees rolled it through East Hall to triage.
“Room four is open,” Dr. Shae O’Riley said to her colleagues. Then she addressed the closest paramedic. “How’re his sounds?”
“Lungs are clear. But we had trouble stopping the bleeding. That’s the third pressure dressing. We already gave him a unit of O negative. He’s lucid and responsive.”
Nodding, she said, “Okay, thanks.” She left the ambulance crew behind as the cart was rolled into the tiny trauma cubicle. The area was jammed with people and equipment. Drawing the curtain to separate the area into two separate compartments left barely enough room to move. “Okay, Jenna, type him and get a couple of units of blood ready.” The lab tech nodded, reached for the patient’s hand.
Shae looked up, saw the lines the ambulance crew had put in to replace fluids. Both IV bags were nearly empty. “Let’s get another couple of bags in him. How’s his blood pressure doing?”
The emergency room RN looked at the screen. “One hundred over sixty.”
Not dangerously low yet, but dropping. “Roll him to his side.” Shae leaned in and lifted the dressing used to staunch the bleeding on the abdomen. The bullet had torn through the flesh, leaving a relatively small entry. She looked up at Boyd DuBois, the emergency-room resident. “Is there an exit?”
He lifted the dressing on the man’s back and nodded. Shae moved around the cart and looked at the angry gaping hole, which was oozing sullenly. “Wessels and Lyndstrom still on duty in surgery?”
DuBois checked his watch. “I think so.”
Shae looked at the triage nurse next to her. “Could you give them another call, get someone down here for a consult?”
“I called as soon as we heard he was coming in.”
“But no one’s here yet, are they?”
The woman shrugged and headed to the phone on the wall. The consultation would be merely a formality. Virtually all gunshot wounds to the abdomen had to be explored.
Shae turned her attention back to stabilizing the patient. The paramedics had cut his blood-soaked T-shirt up the center, baring his chest. He was awake, his face sheened with sweat. No more than twenty, she guessed, although it was difficult to tell for sure with pain and shock twisting his surprisingly innocent features. Leaning down, she shone a flashlight into each eye, noting normal pupil reaction.
The patient turned his head from the light, raised his hand to knock the flashlight away. “Get that outta here.” The oxygen rebreather mask the paramedics had placed on him made his words difficult to make out, but his meaning was clear enough.
“You’re in Charity Hospital, Mr. LeFrenz, and we’re going to help you.” She put a stethoscope to his chest to check his sounds. “You will probably require surgery. Do you have any family you want us to call?”
“No,” he muttered, turning his head back toward her. His eyelids fluttered open and he stared fixedly at her. Then he reached up and dragged down the mask. “Must be alive. Ain’t no angels where I’m going.”
Shae pushed it back into place. “We’re stabilizing you now, and a surgeon will come to assess your condition.” As she spoke, she pressed lightly on the skin surrounding the wound, watching his face carefully for signs of increased pain. When he flinched and moaned loudly, she said to Boyd, “Slight swelling to the upper quadrant.” She probed the area a bit longer. The belly was hard, rigid, indicating possible internal bleeding. “Let’s do a DPL and see what’s going on in there.”
She stepped aside to allow the RN to prepare an area on the skin where they could insert the catheter. Moving back up to the patient’s head, she spoke evenly, pitching her voice above the man’s loud moaning. “Mr. LeFrenz, we’re going to do a test that will let us know the extent of the bleeding in your abdominal cavity. The discomfort will be minimal, but one of us will let you know what we’re doing every step of the way.”
“No! Just patch me up and let me go!” He’d pulled his mask down again to scream the words. Then he spewed a stream of obscenities as he rolled from side to side, grimacing in pain. Boyd made a grab at him, but not before one of his flailing arms had knocked Shae back a step.
With no more than a look she directed two of the staff to restrain the man. Preparing the plastic catheter, she performed the direct peritoneal lavage and withdrew the catheter, handing it to the RN. “Get that to the stat lab and have them do a cell count.” The woman nodded and exited. It was only then that Shae noticed the man leaning against the far wall.
Her first thought was that he was a family member. She immediately realized her mistake as second and third impressions followed on the heels of the first. She didn’t need the gold shield hanging around the man’s neck to identify his occupation. There was cop in his eyes, in the cold steady way he was regarding her.
“Detective Cade Tremaine,” he said by way of an introduction. “I need to talk to him. Is he lucid?”
“Pressure’s dropping, Doctor. Ninety-eight over sixty.”
Shae acknowledged the resident’s words with a quick nod, but never looked away from the detective. “He’s as lucid as anyone would be with a bullet in his belly. Did you put it there?” She wasn’t even certain where the note of censure had come from, but she heard it in her voice.
If it had any effect on him, it didn’t show in his expression. “Yes.” He brushed by her, took up a stance next to the patient. “Hello, Jonny.” The patient abruptly stopped struggling. Tremaine turned to look at Shae. “Does he need that mask on?”
It was on the tip of her tongue to assure him that the man did. To tell him in no uncertain terms to get out of her trauma room and wait as long as it took for his little talk. But that urge sprang from the personal side of her, not the professional. So instead, she stepped in next to him, took out her stethoscope and listened to the patient’s breathing. It was shallow, but still even. Without a word, she reached up and pulled the man’s mask down.
“Sorry it took so long.” Jenna appeared around the edge of the curtain, holding two units of blood. “The lab was pretty backed up.”
Shae looked up at the monitor again. The pressure was still dropping. “Use a power infuser to transfuse him.” The device would warm the blood and deliver it far more rapidly than an ordinary infuser.
“You gonna keep protecting him, Jonny? What the hell for? You don’t see him here asking after your health, do you?”
The conversation between the detective and her patient diverted Shae’s attention as she flushed the wound of particles of fabric and dirt. There was no doubt in her mind which of the pair was the more dangerous. Tremaine’s six-foot-plus frame seemed overly spare, his unshaven angled face just shy of gaunt, as if he’d recently been through his own trauma. But the aura of quiet menace that radiated from him effectively quelled any sympathy his appearance might have elicited.
“I got nothing to say to you. Angel Eyes, get him away from me.” LeFrenz grasped her fingers.
Shae gave Boyd a sharp glance and the resident
