and Medicaid and health plans were making it harder to practice medicine with the good of the patient in mind instead of the glorified buck. Health-care providers often found themselves in a Catch-22 situation. Doctors and hospitals were under increasing pressure to eliminate “unnecessary” tests, yet were provided no protection from litigation if omission of one of these “unnecessary” tests resulted in a missed diagnosis. It was crazy. And medical costs were still on the rise. If Lukas were in charge of the insurance programs, he wasn’t sure what he would do about it.
He picked up the receiver. “Yes.” His voice was clipped as he imagined Dorothy Wild on the other end of the line.
“Doctor?” It was an unfamiliar woman’s voice, shaky with tears, and Lukas immediately regretted his curt tone. “You’ve got to help us. Our little boy just swallowed some stuff, and I don’t know how much—” her words tumbled over themselves, threatening to spiral out of control “—and we don’t know what to do, and we’re too far away to—”
“Hold it, wait, calm down.” Lukas kept his own voice soft. He glanced toward the entrance to see if the ambulance had arrived yet. The bay was still clear. He turned back. “What did your little boy swallow?”
He heard the muffled sound of a hand over the receiver, heard the woman’s panicky voice, and then the sound cleared as the hand was removed.
A man’s voice, high-pitched with near panic, as well, came across the line. “Hello? This is Craig Chapman. My wife’s not doing too well right now.” He stopped and took a breath. “I was winterizing the car out in the garage, and our three-year-old drank some of the antifreeze while my back was turned. It was dripping from his chin when I caught him.”
Some of Mr. Chapman’s tension transferred itself to Lukas. This could be bad. “Do you have any idea about how much he swallowed?”
“No. I hadn’t used the stuff for a few months, and I didn’t pay any attention. I tried to get him to throw it up, but nothing worked.”
“Where do you live?” Lukas asked.
“We’re out by Old Well. You’re the closest hospital.”
Lukas grimaced. Old Well was almost an hour’s drive into the hills over rocky dirt roads.
“What can we do?” Mr. Chapman asked, panic once more filling his voice. “Will this stuff hurt him?”
“It depends on how much he drank, Mr. Chapman. I need you and your wife to stay calm so we can discuss this and help your son as quickly as possible.” Old Well…what was it Lukas remembered about that place? “Do you have any liquor in the house?”
“No, we don’t drink.”
“How about your neighbors? Are you close to a liquor store?”
“We don’t know our neighbors around here yet. We just moved in from Kansas.” The man’s voice grew tighter and higher. “Tell me what to do!”
“Do you have any cooking extracts? Any vanilla?” If there was enough, vanilla extract could save the child’s eyesight due to the high percentage of alcohol. It could even save his life.
He heard the man put the phone down and ask his wife, heard her frantic reply and a small clatter of bottles, and then suddenly remembered who else lived near Old Well. Yes!
Chapman came back on the line. “We’ve got half of a little bottle of vanilla, Doctor. Is that enough? Will that help?”
“Give it to him, but you’ll need more.”
“He’s not showing any symptoms yet. He isn’t acting sick.”
“The symptoms won’t show up for twelve to twenty-four hours.” And then it would be too late. “Mr. Chapman, do you know Emmet and Ruby Taylor? They live out in the hills near you at the edge of Mark Twain National Forest, about two miles from the cemetery by the church at Old Well.” He should know. Ruby Taylor had almost died of lead poisoning from her still a few months ago. The still had been destroyed since then, but Lukas knew Ruby. “Take your son over to their place. Tell them I sent you, and ask for a bottle of their best. They’ll have liquor somewhere.” He prayed that the Taylors were there. They usually were, with their teenage boys and dairy farm, pigs and chickens and rusted-out tireless cars sitting in the front yard.
“You want me to get my little boy drunk?” Chapman asked, a hint of indignation in his voice, as if it had suddenly dawned on him what Lukas was saying.
“I want you to get enough grain alcohol down him to counteract the effects of the antifreeze,” Lukas said. “About three tablespoons of Ruby’s stuff ought to do it, but you don’t want to overdose him, especially since we don’t know how much he’s ingested. Mix some orange juice or something with it so he’ll drink it. Maybe some sugar will kill the taste. Then get him here as fast as you can.”
“Won’t the alcohol interfere with the antidote?”
“In this case, the alcohol is the antidote. Mr. Chapman, the effects can kill him if you don’t treat.” He didn’t want to be cruel, but the man needed to be aware of the serious risks. The sound of a siren echoed through the doors, then the reflection of ambulance lights bounced against the bay entrance. “Are you okay with that?”
“Yeah, Doctor. We’ll get him there.”
“Good. I’ll see you then.”
Lukas hung up and got up to walk out to the ambulance bay just as the EMT threw open the back doors of the van. He stepped over to the foot of the first cot that was pulled out.
The patient was a female in a nonrebreather mask, fully immobilized on a long spine backboard with head blocks. She had a large bore IV in her right arm, and blood splattered her clothing. Blood also concentrated in a dark, thick stain that had seeped through a bandage over her right lower leg, where her jeans had been cut free, and a Harris long traction splint held firm.
“Is this the worst?” Lukas asked.
“Sure is. She looks pretty bad.” The EMT gestured to the other patient, who was still inside the van. “That’s her husband in there.”
Lukas didn’t like the looks of the patient’s right foot—almost white from lack of circulation. She moaned, but her eyes remained closed.
The paramedic stepped out of the back of the van. Connie was a muscular, seasoned professional with short boy-cut blond hair and a chronically serious expression. “Hi, Dr. Bower. This is Alma Collins, forty-five years old. First responders had to free her from between the car and the concrete balustrade of the courthouse.” Her voice remained monotone, a habit she practiced when she worked with patients to keep from alarming them. “She was unconscious on scene, but she’s been coming around since we’ve been en route, and she’s in a lot of pain. She has an obvious open tib-fib fracture, badly mangled leg, no pulse on the foot. Vitals initially on scene, heart rate 115, BP 90 over 60, respiratory rate rapid, with slight improvement following a liter bag of normal saline wide open. She’s received 700 cc’s so far. A lot of bleeding on scene from right lower extremity, but we managed to control it some after we placed the splint.”
“What about the other patient?” Lukas gestured toward the cot still in the van.
“That’s
