The bottom line was this: They had no way of quickly focusing their search.
Dr. Baker’s day had begun nearly eight hours ago with a SIDS baby who had arrived by ambulance, unnecessarily, as it turned out. The baby had likely been dead for hours, already showing signs of lividity and rigor mortis when he was transferred from the ambulance cot onto the gurney in the ER. Even the medics had known that there was no hope, but they weren’t paid to deliver that kind of news to frightened, desperate young parents. As medical director, that was Baker’s job.
Life and death were his business, and this was neither the first nor the last time that he would hold the hands of sobbing adults, as he sewed his own emotions together with a thin suture of professional aloofness. Still, it was a shitty way to start a day.
As of twenty minutes ago, however, the world had been brought back into balance as he delivered a very fortunate young man into this world via emergency cesarean section. Not one to show emotion on the job, he was self-conscious of the tears in his eyes as he handed the wailing infant over to his grateful mother. Somehow, it was easier to let the emotions go on the good news than on the bad. For Tad Baker, it was what had kept him coming to work every day for the past eight years.
Between the day’s two momentous events was an endless stream of broken bones and sliced flesh, all of which had to be handled in due course, prioritized in order of the injuries’ threat to the longterm health of their owners. As he slipped a set of x-rays into the clips on the viewer, he frowned, instantly regretting the decision of the triage nurse to put this case at the end of the line. Ordinarily, broken fingers were, on the ER’s scale, a low- priority injury, but this guy was the exception. The ghostly white hand on the screen before him was more than just broken; it had been mangled. The pain must have been excruciating, Tad thought. How odd that he would have sat so patiently in the waiting room for—he referred to the admissions chart—four hours! Cringing at the potential liability an event like this posed to his hospital, he made a mental note to follow through on it later. It was, after all, not the sort of note one would want to have in writing, in case Mr.—he referred to the chart again —Bailey turned out to be the litigious sort.
Putting on his best clinician’s face, Dr. Tad (as he was called by his staff) slid back the curtain and addressed for the first time the occupant of Bed Four. “Good afternoon, Mr. Bailey,” Tad greeted his patient. “I’m Dr. Baker. I see by your chart that you’ve had an accident. Hand injury, huh?” Mr. Bailey looked awful. He was drawn and pale, like someone who was fast approaching the limit of his pain tolerance.
Mark jumped at the suddenness of the doctor’s entrance, mustering only a wan smile in response to Baker’s clinically cheerful greeting. The intense throbbing in his hand had transported itself all the way back to his shoulder blades now, and lighthearted conversation was no longer in his repertoire.
Tad reached gently out toward his patient. “May I see it, please?” he asked, nodding toward the hand. The look he received as his reply told him that Mark Bailey had no plans to let anyone within five feet of his injury. Tad softened his voice nearly to a whisper. “I promise I won’t move anything around, okay? I’ll be very, very gentle.”
Mark studied the doctor’s face for a few seconds, then gently passed his right hand over, carefully supported by his left. “It really hurts, Doc,” he said.
“I bet it does,” Tad agreed. “I’ve seen your x-rays. It’s really quite a significant injury you’ve sustained. How did it happen?”
The first time that question had been asked, by the triage nurse, Mark had been caught off guard, and he had stammered clumsily through the poorly formulated lie. In the ensuing hours of his wait, he had worked through most of the details, actually practicing the answer out loud once, albeit at a whisper. “I was changing out the brakes on my car when the jack slipped,” he explained. Smooth as silk, he commended himself.
Tad winced at the thought. “Didn’t have it up on blocks, huh?”
“Nah, I was too stupid to do that,” Mark said. “You know. I was in a hurry; took shortcuts. Same old story I guess you guys hear every day.”
Tad smiled noncommittally, knowing right away that the story was a lie. First of all, the fingers were still on the hand; a highly unusual outcome for that particular scenario. For another, the angulation of the fractures was all wrong. An impact from a single heavy object should project a uniform force more or less perpendicular to the plane of the body part being injured. In Mark Bailey’s case, the displacement of the bone ends was longitudinal in the case of the first digit, and lateral in the case of the fourth.
The fact that patients lied to him—and many of them did—was typically not a source of great concern to Tad. Quite often, he had to admit that if he were in the position of the patient, he, too, would probably try to float a story in hopes of mitigating the embarrassment. Nine times out of ten, he played Mr. Gullible. People had the right, after all, to live their lives any way they wanted to, and it wasn’t his place to interfere with their fantasies, so long as they weren’t harmful to others.
But harmfulness was the key. In the medical world, as in the legal, the good of the many outweighed the privacy of the one. When a gunshot case or a case of suspected child abuse came to him, he was legally bound to report it to the police, even over the objections of the patient. The same was true for knife wounds and other acts of criminal brutality, but only when there was clear, irrefutable evidence that such acts were the source of the injury. While few doctors argued the spirit of the law, the way it was crafted put them in a very difficult position, because the burden of proof ultimately fell on the physician. Overreacting and reporting a case based merely on one’s supposition of foul play would place a doctor in violation of the Hippocratic Oath if his or her suspicions proved groundless. On the other hand, ignoring a bona fide criminal act would place a doctor in violation of the criminal statutes of the Commonwealth of Virginia. In either case, the doctor’s license to practice medicine would be at stake.
There was no doubt that Mark Bailey’s injuries were the result of something other than the causes described by the patient. In Tad’s judgment, these fingers had been broken intentionally, by someone who seemed talented at doing such things. This judgment was not something he could prove, however; nor could he ignore his suspicions. He needed to delve a little further into the details—not because the law required it, but because it was the right thing to do. Finger-breaking was not a talent he preferred among his neighbors.
“So your hand got caught under the wheel itself?” Tad asked as he gently turned the hand over in his own, trying for the sake of argument to match the purported mechanism of injury with the damage done to Bailey’s hand.
“Sure did:’ Mark said, his body tense and ready to take back his hand if the doctor broke his promise not to hurt him.
Tad noticed his patient’s uneasiness and smiled kindly, tenderly resting the injury back on Mark’s chest. “Relax:’ he urged softly. “The last thing I want to do is to hurt you.”
Now that he was back in sole control of his pain, Mark did, indeed, relax. “You’re right, Doc:’ he said. “You didn’t hurt me a bit. Kinda nice, for a change.”
Interesting turn of phrase, Tad thought. “Oh, really? How do you mean?”
“How do I mean what?”
“You said it was a nice change that I wasn’t trying to hurt you. I was just curious what you meant.”
Mark was exhausted, mentally and physically. He didn’t even remember saying that, but now he had to come up with something to cover it. “Did I say that?” he stalled.
Tad pretended to be distracted by Mark’s chart. “Mm-hmm. Somebody been hurting you, have they?”
Mark laughed at the very thought of it. “Nobody but myself, Doc. I guess I meant doctors. You know, even when they’re trying to help you it still hurts.”
Tad nodded and smiled. “Really no such thing as a painless shot, is there?” He finished jotting his note on the chart, and flipped it closed. “Here’s what we’re going to do with that hand,” he explained. “We’re going to put you under a light general anesthetic, and we’re going to have to set the bones. Looks like somebody might have already tried to do that, but made a bit of a mess of it.” He looked to Mark for a reaction, but none showed.
Tell me about it, Mark thought. His stomach turned all over again at the memory of sitting there on the filthy floor of the Hillbilly Tavern, grinding his own bone ends together as he brought the fingers back into alignment. It was the only way to even begin to walk out of there. Despite the initial agony, his efforts had reduced the sharp, electric pain to the dull throb that currently wracked his entire body.
“Once we’ve got that taken care of,” Tad continued, “we’re going to put you in a soft cast for a couple of days just to make sure we’ve got the swelling under control, and then we’ll do a hard cast for probably ten to twelve weeks. How’s that sound?”
