bedside.
Beau Robillard, lying nude on the trauma room litter, was disheveled, covered with cuts and abrasions, and even worse off than Zack had anticipated. Comatose… respirations shallow, minimally effective… barely responsive to deep pain… tight pupil, two millimeters, left pupil, five millimeters, sluggishly reactive… 'Was he ever awake, Wilton?'
'Absolutely, ' Marshfield said. 'He was awake when the police found him, and moaning and incoherent when he arrived here. Then he seized.'…
Some purposeless movement on the left side, no movement on the iight..
.. Babinski reflex absent both sides… deep scalp laceration left paiietal region… 'Could I have a pair of gloves, please. Size eight.
Also, get set to intubate him. Number seven point five tube. Wilton, can I see his films?'
'We haven't had a chance to get them, what with your father coming in first and this creep looking a helluva lot better than he does right now. Do you know who he is?'
'Yeah, yeah, ' Zack said. 'I know.'
'When this… this thing here was a boy, ' Marshfield said, 'He and his cronies beat up on my nephew so many times that my brother finally ended up having to send the kid to St. Michael's Academy. I'm telling you, he was really a creep. So were those two older. Robillard boys.'
Zack explored the deep scalp gash with his gloved fingers, and felt the distinctive click of bone fragments. 'Well, I don't care if he's the reincarnation of Jack the Ripper and Attila the Hun rolled into one,' he said. 'He's got a subdural or epidural hematoma expanding on the left.
He needs Burr hole drainage, and quickly. Also, see if you can get Greg Ormesby in here just in case something's going on in his abdomen.'
The nurse set a tray of equipment by Zack's right hand. He hunched over the head of the litter, positioned the steel blade of the laryngoscope against Robillard's tongue, and in seconds slid the polystyrene breathing tube through the man's vocal cords into his trachea.
'Hyperventilate him, please, ' Zack said, connecting a breathing bag to the tube and turning it over to the respiratory technician. Burr holes!
An hour in the operating room. More if there was trouble. Zack backed away from the bed, a stranglehold of indecision tightening about his chest. Both Beau Robillard and the Judge needed surgery that, of those at Ultramed-Davis, he was by far the most qualified to perform. From a purely medical perspective, there was no dilemma, no doubt about the priorities of the moment. Without immediate intervention, Robillard would die. It was that simple. But thanks to Judge Clayton Iverson, it wasn't that simple at all.
'Keep bagging him, ' Zack mumbled, rubbing at the ache that had suddenly materialized between his temples. 'Be sure there are two teams available for the O. R. I'll be right back.'
He glanced into room 8. It was still empty. Please, he was thinking as he headed toward the X-ray department. Let that chunk of metal be just below the skin. Let it be someplace where anyone with a scalpel and a little training can get it out. Suzanne was standing by one of the department's banks of view boxes, studying the films. Even from a distance, Zack could see that the position of the metal fragment was trouble. 'How's he doing? ' he asked. 'Okay. He's complaining of some heaviness in his legs, but I think you might have put that symptom in his head. Your mother's here. Frank's got her in the quiet room, I think. That metal's not in such a good spot, huh?'
'It's in near the cord, if that's what you mean. See right here how it's chipped the edge of the vertebral transverse process?
Removing it should be reasonably straightforward, but it certainly won't be any smash and grab. The area's got to be explored to be sure there's no bleeding around the cord. Damn, but I wish this wasn't happening.
That Robillard is going out. A Burr hole procedure now is his only chance, and not such a huge one at that.'
'Are you going to do it?'
'Suzanne, I don't have any choice. Of course I'm going to do it. Did you find out who's on for orthopedics?'
'Sam Christian's the only one around, but he's in the O. R. over at Clarion County. Apparently he just started an open reduction.'
'Damn. Well, listen, keep your eye on the Judge, okay? I'm going to call John Burris in Concord. He's an excellent neurosurgeon, and with that Beechcraft of his, he can be up here in an hour or less.
Meanwhile, go ahead, call in the radiologist and get a CT scan of the area. See if we can assess the extent of bleeding. This day is really the pits, do you know that?'
'Zack?'
'What?'
'The Judge and Frank told me what kind of a person this Robillard is. If he's really as bad off as you say, maybe you should accept the inevitable and devote your energy to making sure your father's all right.'
'Suzanne, I can't believe you're saying that.'
'Really?
Well, what if it were me lying in there with a piece of metal up against my spinal cord? Zack, this is your father we're talking about.'
'Suzanne, that man in there's dying.'
'You know, there are such things in this world as love and loyalty. they're allowed. According to some people, they're even worthwhile virtues to have.
Even physicians are allowed to be human. That man you want to operate on steals and beats up on people, Zachary. That's what he does. The police say that the cab of his pickup was littered with empty beer cans…'
Zack glared at her. 'I can't believe you're saying that. I just can't believe it.' He turned and stalked into the room where his father lay beneath the X-ray camera. 'Dad, how're you doing?'
'My back aches, and my legs feel a little heavy.'
Zack tapped his reflex hammer against the Judge's Achilles' tendons, documenting once again through the reassuring flick of each foot that the ankle to spinal cord and spinal cord-to-ankle circuits were intact.
'Wiggle your toes, please… Good. Other foot… good.'
'What's the story? ' the Judge asked. 'Well, your wrist is broken, but it will keep until Sam Christian gets done at Clarion County. However, that piece of metal in your back ought to come out soon.'
'I thought so. You going to do it?'
Zack hesitated, and then shook his head, triggering a jackhammer pain between his eyes. 'No, Dad, ' he said. 'I've got to do that man first or he's dead. Besides, we're not encouraged to operate on our own family if we can avoid it. I'm going to call John Burris up from Concord.'
'I want you.'
'Judge, please, don't make this any harder. You're quite stable right now. Robillard's dying.'
'Let him die.'
'I can't do that. Clayton Iverson stared stonily at the ceiling. In the silence, Zack became aware of others in the room. He turned. Frank and Suzanne stood just inside the doorway, watching and listening. 'Suzanne, please arrange the CT scan, ' Zack said, trying to ignore the disapproval in her eyes. 'I've got to call Burris and then get into the O. R. I can see by your face what you want to say to me. Don't bother.
I'm doing the one thing we are taught always to do-I'm doing what I think is right… Judge, I love you, and I'll be keeping track of things. With luck, by the time Burris gets here I'll be done with what I have to do, and I can assist him. Meanwhile, just hang in there.'
He turned and left, brushing past Suzanne. She followed him for several steps, but then, shaking her head in resignation and frustration, headed for the radiology office. 'Ma's here, ' Frank said, approaching the bed.
'Judge, I'm sorry. I tried to help him see reason.'
'Forget it, Frank, ' Clayton Iverson said. 'Just leave me alone.'
'But Judge-'
'Dammit, Frank, I said leave me alone.' Nothing felt normal or comfortable. The room, O. R. 4, seemed far too warm, the surgical team far too quiet. The blades and scissors and drill bits were too dull, the hemostats and needle holders unacceptably stiff or loose. Zachary struggled to ignore his throbbing headache and his sodden scrub
