Circle of Influence (A Zoe Chambers Mystery) Page 18

  The sirens she’d heard earlier were louder now, closer.

  Earl placed one gloved hand on McBirney’s shoulder, the other on his hip and rolled him toward them enough to reveal four small holes in the back of his blood-soaked shirt.

  “Bullets?” Earl aimed his question at Pete.

  He shook his head. “Looks to me like he was stabbed.” He pointed. “See that tear? Looks like the weapon hit a rib and slipped.”

  “Hard to tell for sure with all that blood,” Kevin commented.

  “Either way, we have to get him out of there,” Zoe said.

  Earl released his grip on their patient and dug into the jump kit, pulling out a packet of plastic tubing and a mask. “I’ll get him started on O2. One of you guys give Zoe a hand with the gurney.”

  Pete fell into step with her as she jogged to the back of the ambulance.

  “Are you okay?” he asked.

  She couldn’t afford to think about McBirney beyond what was needed to treat him. “I’m fine.”

  “Uh-huh.” He sounded doubtful.

  As they reached the ambulance, another police vehicle screeched into the parking lot, roaring toward them. Unlike Vance Township’s cruisers, this one was black with gold reflective lettering. Monongahela County Police. Pete muttered something too low for Zoe to understand. But from the narrowing of his eyes and the set of his jaw, she had a strong idea of what he was saying.

  She threw open the back doors of the patient compartment. Each taking a side, she and Pete rolled the gurney out and set it on the ground. She yanked the backboard from its slot beneath the bench seat and a cervical collar from one of the cabinets, and tossed them both on the cot. “Go,” she said.

  As they arrived back at the Malibu, Earl was adjusting the oxygen to the non-rebreather mask he’d placed on McBirney. Kevin held a stack of sterile gauze squares and a roll of tape, but appeared lost as to what to do next.

  Zoe wiggled her fingers into her Latex gloves and snatched a handful of the squares. She ripped the paper covering from the first one. “Tear off some lengths of tape,” she told the officer.

  He shot her a quick grateful smile and peeled off a foot-long piece.

  “Whoa, cowboy. Not that long.” She indicated half that length with both her index fingers.

  “Oh. Okay.”

  Glancing up from her work, Zoe noticed Pete charging toward the new arrival and recognized Detective Baronick climbing out of the car.

  Earl grabbed scissors and cut open the back of McBirney’s shirt. Zoe broke the seal on a bottle of sterile saline solution and poured some of the liquid onto a stack of the 4x4 squares. The rest, she dumped over McBirney’s back, washing away some of the partially congealed blood. She tore into another stack of the squares and dabbed his skin as dry as she could. Blood poured from the wounds as fast as she wiped it away.

  Bleeding meant his heart was pumping. He was still alive.

  For a moment, she questioned whether or not that was a good thing.

  “Zoe.” Earl’s words sliced through her reverie. “Tape.”

  Kevin held out a perfect length of the stuff. Earl pressed a wad of bandaging to one of the four holes and taped around it. Zoe did the same. Once all the wounds were dressed, Zoe said, “Let’s stabilize him and get him out of there.”

  Zoe fitted the cervical collar around McBirney’s neck without looking at his face. Earl and Kevin positioned the gurney and backboard against the Malibu’s back bumper.

  Pete and Baronick were engaged in a loud, animated conversation. They were far enough away that Zoe couldn’t make out more than a few words. She looked at Kevin. “Give us a hand?”

  “Yup,” he said.

  “Okay, kiddies.” Earl worked to get a grip on McBirney’s shoulders. “Let’s make this as smooth as we can.”

  Zoe maintained traction on McBirney’s head and neck. “On three,” she said and counted. “One. Two…”

  Earl maneuvered the patient’s shoulders. Kevin guided his legs. In unison, they muscled McBirney’s limp body out of the trunk. Earl secured the patient to the backboard with the straps.

  “Grab the O2,” Zoe barked at Kevin.

  He snatched the small green cylinder of oxygen and handed it to Zoe who positioned it between McBirney’s legs.

  “You two take him,” Earl said. “I’ll grab the kit.”

  Kevin and Zoe wheeled the gurney back to the unit and guided it into the patient compartment. “Is he gonna make it?” Kevin said.

  “No one dies in our ambulance,” Zoe said. “Earl and I both need to work on this guy. Mind driving?”

  “He’s on patrol duty,” Pete’s voice boomed from behind them. “I’ll drive.”

  Zoe caught a glimpse of a muscle popping in his jaw as he stormed past her to the front of the ambulance. She looked over her shoulder at McBirney’s car. Detective Baronick and another officer leaned over the open trunk with flashlights aimed inside. The faint wail of distant sirens bounced off the hillsides. Apparently, County had once again taken over.

  Kevin pressed his lips together hard in silent communication. Like Zoe, he obviously realized now was not the time to question the chief.

  She climbed in beside her patient and flipped the switch for the heater onto high. Earl slid the jump kit into the side door and climbed in, too. Pete claimed the driver’s seat. Kevin slammed the back doors and then circled around to slam the side one.

  “You’re good to go,” he shouted, and the ambulance lurched across the parking lot.

  Like a well-choreographed dance, Zoe and Earl went about their work, switching McBirney from the portable oxygen tank to the ambulance’s supply, slapping the leads for an EKG onto his skin, getting a new set of vitals, listening to the lung sounds. In the bright light of the patient compartment, the grayish blue of McBirney’s skin couldn’t be dismissed as an aberration created by the poor illumination in the trunk.

  Earl touched the patient’s neck and met Zoe’s gaze. “Pneumothorax,” he said.

  Zoe took the seat at McBirney’s head, the clipboard in her lap. She stared at his face. The left side was puffy and showed signs of bruising. She recalled swinging Windstar’s bridle earlier that afternoon and the thunk of steel striking flesh. With a shudder, she picked up the radio phone. “Brunswick, this is Medic Three.”

  After a brief pause, a voice responded, “Go ahead Medic Three.”

  “We have a male, age forty-six, with multiple penetrating injuries to his upper back resulting in severe blood loss. Patient is unresponsive. B.P. is sixty-eight over forty. Pulse is one sixteen and weak. Respiration is twenty and labored. Lung sounds are absent on the right side. He has distended veins in his neck and is cyanotic.” Zoe knew her words translated into bad news made worse by the presence of a collapsed lung.

  Earl had pulled out a bag of normal saline even before the doctor at Brunswick ordered them to start the I.V. and do a needle chest decompression. He plugged the tubing into the bag while Zoe repositioned herself at McBirney’s side. She tied the rubber tourniquet around the patient’s arm and felt for a good vein. Damn it. He’d lost so much blood, there was no way this was going to be easy.

  “Can you get it?” Earl asked.

  Zoe didn’t reply. A bead of sweat tickled her forehead, and it wasn’t from the blasting heater. On her third attempt, a red droplet appeared inside the needle. “Bingo,” she said.

  Zoe finished taping the I.V. catheter in place, and Earl pulled supplies from one of the cubbies to start the needle chest compression.

  “Radio Control to let them know we’re en route,” Zoe shouted to Pete as the ambulance pitched along the potholed road.

  Over the roar of the engine and the clanging and banging of equipment swaying around them, she heard Pete’s voice giving the information to the EMS disp
atcher.

  “Ready?” Earl asked.

  “Not really.” Inserting a needle into a patient’s chest was nerve-wracking enough without the added challenge of performing the procedure in a moving vehicle.

  “Do you want me to try?”

  Zoe shot a look at her partner. They had worked together long enough to know each other’s strengths and weaknesses. Sticking a patient with a needle was not one of Earl’s strong points. “I’ll do it.”

  “Okay.” Earl swabbed McBirney’s upper right chest with Betadine and then leaned back. Zoe inserted a needle between the second and third rib, careful of the angle. She felt a slight give. “I’m at the pleural cavity,” she announced. Drawing a deep breath, she advanced the needle further. A whoosh of air escaped. “Got it.”

  She slid the 14-gauge catheter over the needle and removed it. Earl handed her a Heimlich valve and tubing to finish the procedure.

  “Good job,” Earl patted her on the back.

  “Ha. You’re just glad you didn’t have to do it.”

  “You know me too well. Want me to secure it?”

  Zoe flopped back onto the bench seat. “Knock yourself out.”

  The I.V. tubing and bag swung like pendulums inside the patient compartment as the ambulance careened along the dark country road. Zoe braced one foot against the gurney and the other heel against the base of the bench. She clutched the cot’s side rail and stared at her patient as Earl finished taping the valve and tubing to his chest.

  It had only been a matter of time before someone tried to kill Jerry McBirney. But who?

  No. She couldn’t allow herself to think about that. The man on the cot was just another critical patient. Do your job, Zoe. Keep him alive.

  Earl moved to the seat at the head of the gurney. Zoe leaned forward to check the flow of the normal saline through the tubing. She clipped her stethoscope into her ears and placed the pad on McBirney’s arm, pumping the bulb of the blood pressure cuff. She listened for the weak thub, thub, thub as the needle descended the gauge. Nothing. The cardiac monitor showed a rhythm. Rapid and irregular, but a rhythm. She pumped up the cuff again and let the air out slow. Listening. Watching. Where was it? The needle slipped below seventy. The fluids should be helping by now. Saline might not be a good substitute for blood, but it should at least stabilize his pressure. The needle dropped below sixty.

  The cardiac monitor screeched, no longer showing a rhythm. Earl jumped.

  “V-Fib,” Zoe said.

  Earl yanked the defibrillator from its compartment and set it up. Zoe ripped the non-rebreather mask from McBirney’s face and placed her ear near his mouth. “No respiration,” she reported before grabbing a CPR mask, sealing it over his face, and administering four breaths. She listened again, watching his chest for movement. Nothing.

  “Clear,” Earl said. Zoe leaned back.

  The electrical shock caused the body to buck against the restraints. But the monitor showed no change. No steady blip blip blip.

  Earl charged the defibrillator again. “Clear.”

  Again, the shock provided nothing beneficial.

  Zoe’s own words rang in her ears. No one dies in our ambulance.

  “Start chest compressions,” Zoe ordered as she rummaged through the storage compartments for the laryngoscope and blades.

  After sticking a needle into McBirney’s chest, intubation was relatively simple. With the endotracheal tube in place, she attached the bag-valve mask and oxygen.

  Breathe, you bastard.

  “Let me shock him one more time,” Earl said.

  Zoe knew the defibrillator wasn’t going to help. She suspected he did, too. While her partner charged the paddles, Zoe hung a second bag of saline, ready to make the switch when the first one ran dry.

  “Still V-fib,” Earl announced.

  Zoe leaned toward the front of the ambulance. “He’s in full arrest,” she called to Pete.

  In response, he flipped on the siren. The ambulance lurched as it accelerated.

  Earl staggered and grabbed for a handrail.

  “Here,” Zoe said. “You bag and contact Brunswick. I’ll do compressions for a while.”

  He nodded, and they squeezed past each other. He perched on the edge of the seat at McBirney’s head, pressing breath into their patient with the bag and reaching for the radio phone. “Brunswick, this is Medic Three.”

  Zoe braced her feet against the gurney and the bench. She jammed one shin into the cot’s side rail and pressed the top of her head against the cabinet above McBirney to steady her. CPR in a speeding ambulance was no easy feat. And Brunswick Hospital was still more than twenty minutes away.

  EIGHTEEN

  Pete leaned against a low, brick wall outside Brunswick Emergency Department’s ambulance entrance, his breath frosted into a cloud in front of him. Medic Three sat silent, a few feet away. At least by driving the ambulance, he had a head start on Baronick, who’d dismissed him back at Rodeo’s Bar. Fine. Let the cocky young detective deal with processing the crime scene in sub-zero temperatures.

  He was beginning to wonder why he stayed on in this low-budget rural township where he had little choice but to turn over the big cases to County who had the funding and the lab facilities to properly investigate them. Why the hell didn’t he ditch this rural police chief gig and go back to Pittsburgh? The only reason he’d moved here in the first place was because Marcy wanted to live in the country.

  Marcy.

  Pulling out his cell phone, he turned it over and over in his gloved hand. He considered calling her to break the news. But he shoved it back in his pocket. Baronick could handle that, too. There wasn’t much Pete could do to protect her at this stage anyway. She was the victim’s wife. Automatic suspect number one.

  He pushed away from the wall and moved toward the automatic doors, which swung open at his approach. Inside, the emergency department smelled of antiseptic and bleach mingled with the faint aroma of body fluids. Somewhere, an alarm beeped, demanding attention it wasn’t getting. A child’s unmistakable wail echoed down the hallway.

  Pete had helped Zoe and her partner unload McBirney and had watched as they whisked him through the doors, disappearing into the organized chaos. He hadn’t followed. Give them time. He’d just be in the way, anyhow. But his curiosity nagged at him. What was going on? Was McBirney dead or alive? He hadn’t looked good with the two paramedics working frantically over him the whole trip and then as they rushed him into the hospital.

  Pete had no clue where they’d gone. He tugged off his gloves and stuffed them into his coat pockets. Drifting down the hall, he took a glimpse in each room he passed. In one, a young man in baggy jeans held a grungy, bawling child as a sallow-skinned woman reclined in the bed. So that was the source of the wailing he’d heard. Next door, a boy held an icepack to his head while a woman—Pete presumed his mother—paced. The curtains were drawn on the next two, and a pair of Brunswick city police officers flanked the doorway of another room. Pete exchanged a nod of acknowledgement with them.

  Medical personnel crowded into the central nurses’ station. Two nurses sat, scribbling notes onto records. A lanky male in pale green scrubs squeezed into the space as a petite brunette in white scurried out. A doctor stood in the adjoining glass-enclosed office frowning as he spoke on the phone. Zoe’s partner, Earl, stood on the far side of the station, engaged in jovial conversation with an older man wearing dark-rimmed glasses and a white lab coat.

  Pete circled the station. Earl spotted his approach. “Hey, Chief. Thanks again for driving.”

  The bespectacled older man clapped Earl on the shoulder. “I have to get back to work. Take it easy, you hear?” With a nod to Pete, he hurried away.

  “Any word on your patient?” Pete asked.

  “Nothing new that I’m aware of. He’s in room elev
en if you want to check on him.”

  Pete thanked the paramedic and headed down the hallway, dodging harried medical personnel and checking room numbers as he went.

  A nurse carrying two I.V. bags of deep red blood bustled past Pete, heading in the same direction, but at a much quicker pace. She ducked into the last room on the left. Room eleven. The curtains were drawn in there, too, but they moved and swayed, indicating some action behind them. Pete paused in the doorway and noted several pairs of feet visible where the curtain failed to meet the floor. The feet shifted and maneuvered around the concealed patient. Grim voices exchanged information in tones too low for him to comprehend the words. But he discerned a sense of urgency in them.

  Pete knew better than to enter. He hesitated. Glanced around. The hall cut to the right with more patient rooms on its left. Across from those cubicles, an ambulance cot sporting clean linen was parked. Zoe squatted next to it, her back against the wall, elbows on her knees and face in her hands. Her blonde hair was more disheveled than usual, sticking out on the sides, but flattened on the top from her hat, which lay on the floor.

  “Hey,” he said softly, kneeling down next to her.

  She lifted her face, revealing eyes rimmed in red with dark circles beneath them.

  He gave her a smile. “You look like hell.”

  “Thanks.” She buried her face in her hands again, but this time she pressed her palms against her eyes and ruffed up her bangs with her fingers.

  “How’s the patient?”

  She shrugged. “You know as much as I do.”

  Pete shuffled around until he was side-by-side with Zoe, his back against the wall. But his knees complained too much to mimic her squatting position. Instead, he sat and stretched his legs out. She slid down and did the same.

  “What’s your professional opinion?” he asked. “Think he’ll make it?”

  Zoe didn’t answer right away. She stared into space, and her face transformed through a succession of expressions from a scowl to a deep frown to something Pete interpreted as fear.