Fatal (2 page)

 
CHAPTER
2

THE ER AT THE MODERN, 120-BED MONTGOMERY 
County Regional Hospital had a patient capacity of twelve, including rooms specially equipped for orthopedics and pediatrics, as well as room 10, the “crash” suite for major medical or surgical emergencies. Two surgeons and a GP were waiting by the nurses’ station when Matt arrived, but he knew there were at least two or three more clinicians around, plus a radiologist. In addition, almost certainly poised over in the lab, was Hal Sawyer, the chief of pathology and Matt’s uncle. Hal, part mountain man, part community activist, part playboy, all scholar, was Matt’s mother’s brother, his godfather, and the major reason he had decided on a career in medicine. Over the twenty-two years since the cave-in of Tunnel C-9, Hal had been as close to a father as Matt had.

Matt hadn’t been in the ER more than a minute when a pickup screeched into the ambulance bay bearing the first casualty. He waved off the other docs and accompanied two nurses to the truck. If the miner, muddy from a mix of limestone, coal dust, dirt, and perspiration, was any indication of the carnage in the mine, it was going to be a long night. His bloodied leg, fairly effectively splinted between two boards, had an obvious compound fracture of the femur. A grotesque spike of bone protruded through a tear in his coveralls midway up his thigh.

Matt followed the litter to the ortho room. Out of the corner of his eye he saw mine safety officer Blaine LeBlanc, dressed in pressed chinos and a hundred-dollar shirt, speaking to the driver of the pickup while making notes on a clipboard. Too late for Matt to avoid eye contact, LeBlanc turned toward him. His face was pinched and pallid. Matt flashed on what the humorless mine officer might be thinking.

Oh, no, here we go again. Another goddamn crusade by Dr. Do Little. Well, go ahead and try causing us more trouble, asshole. No one pays any attention to you anyhow. . . .

LeBlanc shook his head derisively, and Matt responded with a cheery thumbs-up. As long as Matt continued his efforts to make BC&C own up to its safety shortcomings and corner-cutting, they would be enemies.

Brian O’Neil, the orthopedist on team B, reached the cast-room door simultaneously with Matt. At six-three, O’Neil was two inches taller than Matt was, and a couple of years older. He had added two or three dozen pounds to the hard-nosed linebacker he had been at WVU, but at forty he was still a hell of an athlete. He was also a top-notch surgeon and Matt’s closest friend on the medical staff.

“You first,” Matt said. “I take enough of a pounding from you under the hoop.”

“Since when did Gunner Rutledge ever mix it up under the hoop? You’d need a map just to show you where under the hoop is. Get a line in please, Laura. Normal saline. Usual bloods. Type and cross-match for six units. Portable films of his chest and leg. As soon as Dr. Gunner here has finished examining him, give him seventy-five of Demerol and twenty-five of Vistaril I.M.”

“We’re on it,” Laura Williams replied, unflappable as always.

“You know, pal, Laura and some of the other nurses were betting that you’d sleep through this one.”

“They may still be right. Seeing you here on time makes me think I might be dreaming.”

Together, they moved to the bedside and assisted the nurse in cutting away the young miner’s clothes. He might have been nineteen or twenty, with reddish hair and wide, feline eyes. His narrow face was etched with pain, but he forced his lips tightly together and took the jostling to his shattered leg without a sound.

“I’m Dr. O’Neil, the orthopedist,” Brian said. “This is Dr. Rutledge. He’s a veterinarian, but he’s a damn fine one. We’re going to take good care of you.”

“Th-thanks, sir,” the young man managed. “I’m Fenton. Robby Fenton.”

“What in the heck happened down there, Robby?” O’Neil asked as Matt began a rapid physical assessment.

“It was Darryl Teague, sir. He . . . he went berserk. He’s been actin’ a little tetched for a while, but tonight he was operatin’ the C.M. an’ he jes went off. You know what a C.M. is—a continuous miner?”

“That monster machine that scoops up coal and puts it onto the conveyor belt?” Matt said.

“Exactly. Twelve ton or more every minute.”

“You never cease to amaze me, Dr. Rutledge,” O’Neil said. “No wonder you don’t date even though people tell me you’re the prime catch in the region. You scare all the women away with your vast knowledge.”

“Don’t pay any attention to him, Robby. He’s lucky he’s a darn good bone doctor, or no one would even talk to him. Go on.”

“Well, early on in the shift Teague got into a shovin’ match with one of the guys, Alan Riggs. I don’t know what it was about. Teague’s been like that for a while—pickin’ fights, complainin’ that people were out to get him, that sort of thing. Well, a bunch of us broke it up between him and Riggs. Then, a little while later, Teague goes after Riggs with the C.M. He runs right over him, I mean right over him. Then he goes on an’ takes out maybe half a dozen supports. That’s when the roof caved in. How are the rest of the guys?”

“We don’t know yet, Robby. You’re the first arrival.”

“Alan’s got to be dead. You shoulda seen it. Blasted Darryl Teague. I don’t usually wish nobody no harm, but I hope he got hurt but good.”

“Dr. Rutledge, we need you,” Laura Williams said from the doorway.

Matt had been so mesmerized by Robby Fenton’s account that he had completely forgotten about the deluge that was about to hit. Now the ER was in beehive mode. Six of the beds were occupied by miners in varying degrees of distress and pain. Technicians, nurses, and physicians were in constant movement, but the chaos seemed organized and nothing looked out of control.

“We don’t need your internist skills right now,” Laura said, “but we sure could use your ER talent. There’s a lac in three. A beauty. I’ve ordered skull films, but they’re going to take a while. He’s low on the triage totem pole.”

Matt stopped in the on-call room and quickly changed into scrubs. He was on his way to room 3 when Blaine LeBlanc intercepted him. A New Yorker with a dense accent, LeBlanc was a fit fifty, just an inch or so shorter than Matt, and broader across the shoulders. His thick, jet hair was slicked straight back and held in place with something from a tube. His trademark white stripe, an inch and a half across, glistened beneath the fluorescent overheads.

“What did that kid in there tell you?” he asked.

“Nice of you to inquire after the lad, Blaine. He has a compound fracture of his femur. That’s when the ol’ thighbone is sticking out through the skin. He won’t be pushing coal for you for a while.”

“Back off, Rutledge. What did he tell you?”

Matt met LeBlanc’s icy stare with one of his own. The man was potentially dangerous. Of that, Matt had no doubt. It was possible that before Ginny died, he had held his contempt for LeBlanc and BC&C in better check. But with her gone, he simply didn’t care. A lifelong health nut and nonsmoker, Ginny had no family history of lung cancer. She was only thirty-three when the diagnosis was made, and her tumor was an unusual cell type—the kind of unusual cell type that might,
might,
have been caused by some sort of toxin.

No one could deny that BC&C’s coal processing plant was awash in carcinogenic chemicals. Whether they were handling and disposing those toxins in a safe, legal manner was another story. Matt had plenty of theories and some hearsay about illegal dumping or storage, but no proof. There was never any proof. Still, he was certain that if there were shortcuts in any aspect of mine safety or toxic waste disposal, the directors of BC&C would choose to take them. It had been that way when his father was killed, and Matt felt certain it remained that way today.

Over the years he had kept up a steady stream of letters to MSHA—the Mine Safety and Health Administration—demanding investigations and spot inspections. Once, two years ago, they had actually responded to his demands by sending a man in. Nothing—absolutely nothing except some minor maintenance log omissions. Now his credibility was at an all-time low. The folks at the agency either refused to return his calls or, when they did, as much as laughed at the notion of acting on his “information” with another surprise intrusion.

Despite his contempt for Blaine LeBlanc, Matt could see no reason why the safety officer shouldn’t know what had happened in his mine.

“Fucking Teague,” LeBlanc said when Matt had finished the account. “Stupid fucking Teague.”

Mickey Shannon, the miner Matt had been sent in to suture, was fifty-four—positively ancient for mine work. In fact, he actually remembered working the coal face with Matt’s father.

“Good man . . . Real good man . . . Stayed one of the guys even after they made him a foreman.”

A sharp chunk of rock from the tunnel roof had glanced off Mickey’s forehead right below the hairline. Three-quarters of an inch higher would have meant a direct hit on his skull, and his name might have been added to the list of fatal mine casualties kept on the wall of The Grub Pit Bar and Grill. Instead, the rock had peeled a five-inch-wide flap down over the bridge of his nose and across his eyes.

“I’m going to put some novocaine in to numb this thing up,” Matt said.

“Don’t bother, Doc. Just sew me up an’ get on to someone who needs your help more’n I do.”

Matt knew from experience that this was no false bravado. Mickey Shannon and the rest of the miners had been dealing with physical punishment and pain nearly every day of their adult lives. Caring for them and folks like them was one of the main reasons he had returned home to do medicine. It was the rugged, scramble for every dollar, help your neighbor even though you hardly ever have time to speak with him type of mountain people who made up much of his practice.

“Hey,” Matt said, “you handle the mining, I’ll handle the doctoring.”

“If you say so. People round these parts speak real highly of you, Doc. I been thinkin’ lately of gettin’ me a doctor, and you’re the one I ’uz gonna call.”

“Do that,” Matt said, dreading what an X ray of the man’s chest might reveal.

He numbed the margins of the huge wound with 1 percent Xylocaine, prepped the area with Betadine, clamped a set of sterile drapes around it, and carefully lifted the flap back in place. There was going to be a scar. There always was when skin had to be sutured. The question was whether to do a meticulous, microscopic closure with tiny sutures that might pull out if tested by Mickey’s going back to work too soon, or a quicker job using thicker suture material, guaranteed to hold under almost any circumstance.

“What’s the deal with your qualifying to collect disability?” Matt asked.

“We get full salary so long’s we have sick time available. Then it’s a month waitin’ period before the disability kicks in. With a doctor’s note sayin’ the problem is work-related, we start collectin’ disability immediately with no loss of sick time. But I’m—”

“Shhhhhhh.”

Matt selected dissolving sutures for a careful, layered closure, and fine, 6-0 nylon for the actual skin. Then he donned magnifying goggles and a new pair of gloves. Mickey’s lined, weathered face showed every day of three decades in the mine. But there was no way he was going to leave the ER with anything but the thinnest of scars from this one.

“You’re out for two weeks,” Matt said. “I’ll give you the note. In fact, make that three weeks. And if you have any kind of a headache, any kind at all, we’ll tack on a few weeks more.”

Twenty minutes later, he was halfway done with a closure that would have satisfied a movie star, when Laura Williams, breathless, called to him from the doorway.

“Matt, Dr. Easterly needs you right away in the crash suite. You’ll have to finish in here later.”

Matt placed some saline-soaked gauze over Shannon’s wound and set the sterile drapes aside. Then he stepped back from the table, flexing some of the tightness from his neck.

“Mickey, you hear that?” he asked.

“Don’t worry about me. Who’s he got to see, miss?”

“A man named Darryl Teague,” Laura replied. “Some sort of heavy equipment fell over on him.”

“Let ’im die!” Mickey Shannon snapped.

CONSIDERING THAT EVERY 
bed in the ER was occupied and most of those patients were being attended to, there was quite a crowd working in room 10. One glance at the overhead monitor told Matt why. Heart rate 140. Blood pressure 80/40. Oxygen saturation only 89 percent. Jon Lee, the nurse working beside the gurney, caught Matt’s eye and made a brief thumbs-down sign. It seemed as if Mickey Shannon’s and Robby Fenton’s prayers were being answered. Somewhere beyond the wall of technicians, nurses, and GP Judy Easterly, Darryl Teague was on the verge of checking out.

“What’s up?”

Startled, Judy Easterly swung around, then came over to him. Not the most energized or enthusiastic of doctors under any circumstance, she was currently in her seventh or eighth month of pregnancy, and looked as if she would have chosen to be anyplace in the world at that moment other than where she was.

“This is the guy who caused all this,” she whispered.

“I know,” Matt whispered back. “Is he bleeding somewhere?”