"You might want to go over him for pre-op clearance. I don't think they've had time yet to get a full EKG."
"I'll take care of that."
"Also, find out who's on for orthopedics, if you can."
"Zachary, I meant what I said about Robillard, " the Judge said as Suzanne and the technician wheeled him from the room.
"I never meant anything more." Zack could only shake his head. "Hey, listen, " Frank said when the two of them were alone. "Just go in there and see Robillard, and do whatever you have to do. Leave the Judge to me."
"I know he's hurt and angry, Frank, but all the same, I can't believe he would talk like that. I just can't believe it."
"You've been away from here-away from the man-for a long time. Remember, buddy, we're not the only ones he keeps passing judgment on. Years and years of sentencing the same stiffs over and over again has done something to him. Listen, don't worry about him. I can handle things.
Just go on in there and play doctor."
"Did you call Mom? "
"I have one of the state troopers going to get her."
"Okay. I'll be next door. Frank, thanks for your help. I hope things with Lisette get straightened out."
"Not to worry. Just get on in there and do whatever you have to."
The two of them left room 8. Zack entered the trauma room and Frank crossed the E. R. to the X-ray department. The Judge had been moved, on the transfer board, to the X-ray table. "I need a minute alone with him,
" Frank said, motioning Suzande and the technician away. "Judge, listen,
" he whispered, when the others were out of earshot. "I tried to reason with Zack about not seeing Robillard, but he just won't listen. I'm on your side on this one. One hundred percent. Just relax and let them take your pictures. I'll keep trying to make Zack see what's right."
The rescue team, nurses, and emergency physician cleared a path as Zack entered the trauma room. His programming in the evaluation of nervous system damage was in reflex operation before he reached the 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.