The Unknown Soldier

by Mickey Zucker Reichert

Genres: Fantasy; Fantasy action & adventure; Epic Fantasy

Synopsis

When Shawna Nicholson, Chief Resident of an Iowa hospital, treats an emergency patient who came from the future with multiple wounds and amnesia, neither Shawna nor the mystery man is prepared for the deadly pursuers determined to destory Shawna's patient and anyone who tries to stop them.

Release date: May 1, 1994

Publisher: DAW

Print pages: 320

Sample

Doctor Jason Walker kicked open the residents’ on-call room door with the toe of his running shoe. A bar of light from the medical ward hallway played over a metal-framed bunk bed, the sheets and blankets crisp and unrumpled. At its head, shelves nailed to the walls held awkward stacks of reprints, journals, and textbooks piled so high Walker suspected his slightest movement would cause an avalanche. Directly opposite the bed, a chair blocked a full-length mirror. A digital clock/radio on the seat blazed 2:17 a.m. Walker flipped on the light, stepped inside, and let the door swing shut behind him.

Walker unclipped the green plastic beeper from the waistband on his on-call scrubs and flung it to the lower bed. It bounced once, then lay still and mercifully silent on a woolly green blanket that looked like something from an army barracks. “Only less comfortable,” Walker grumbled, irritable from fatigue. He shrugged off his white coat, swept it from his shoulders, and tossed it to the bedpost amid the rattle and clang of equipment in its pockets. Tuesday: April 30, 1985. Another Jason Walker “black cloud” night.

Early in their first year, each resident seemed to develop a pattern of call. Some, those with the “white cloud,” unfailingly managed to be assigned evenings with no patient activity; they slept through the night. Others would keep busy with emergency helicopter transports or brilliant diagnoses of rare diseases. But for Jason Walker, it was always the same. Minor complaints on the ward would keep him awake into the early morning after which a long train of adults with coughs and sniffles would appear in the emergency room.

Walker shouldered through the door in the far wall that led into a bathroom he shared with the intern in the adjoining room. It’s not fair. Walker rummaged through the pile of residents’ toiletries until he found his own shaving kit. Unzipping it, he removed a bar of soap, his toothbrush, and a tube of Crest. The staff physicians justify the residents having to take call every third night by saying “as it is, you’re missing two-thirds of the good cases.” He brushed his teeth with rapid strokes. Right about now, I’d settle for a single interesting patient. The only advantage of being in-house at night was that, without the attending staff physicians present, the residents in training handled all emergencies. But, though already into the second year of his internal medicine residency, Jason Walker had never had the chance to lead a code.

Walker rinsed his toothbrush and tossed it back into his kit. He ran a hand through sand-colored curls, trying to ignore the widening semicircle of scalp visible at his temples. His hair felt slightly oily. He glanced longingly at the shower but knew the instant he undressed, an emergency call would come over the beeper. For an instant, he considered doing it for that reason alone. Stupid, superstitious nonsense. Fluffing his hair with his fingers, he yawned and returned to his room, pulling the restroom door closed behind him.

Another night kicked to hell. Walker retrieved his beeper and nestled it on the pillow beside his ear, where it would certainly awaken him no matter how deeply he slept. Neatly, he untied his shoes and placed them, side by side, beneath the chair. Removing his wire-rimmed glasses, he put them on the clock, checked the alarm, and found it set for 7:00 a.m. Satisfied he could catch as much as four and a half hours of sleep, he flipped off the light, peeled back the covers, and crawled between the sheets. In the dark, he fumbled at the lowest shelf to uncover a push-button telephone beneath the assortment of residents’ reading material. His efforts sent magazines skittering to the floor beneath the bed. Better there than on my face in the middle of the night. Walker lay back and tried to sleep.

Instantly, uncertainty crowded Jason Walker. He relived every decision, admission, and complaint. The quiet darkness forced him to pass judgment on each examination, every medication order he had written or spoken that day, and even the amount of research he had performed on his patients. Sleep receded, impossible with his mind jumbled with self-doubt. Questioning his ability had become a nightly occurrence. No matter what method he chose to confront a problem, there was always a higher level resident or attending who would have done it differently and was quick to evaluate and criticize. Now in his second year, Walker had finally become confident enough of his clinical skills to develop techniques to help him disregard the guilt and fear that descended upon him whenever he tried to rest.

Gradually, Walker replaced thoughts of ulcer treatments, blood sugar levels, and hypertension with an image of the new house he had chosen to rent in a town north of Liberty Hospital called, appropriately, North Liberty. The house was an ugly A-frame constructed of materials a grade above thumbtacks and cardboard, but the surrounding six acres of forest made it worth the fifteen-minute drive to and from work. Walker smiled as he recalled his discovery of a beaver living in a lake nestled in the woodlands; the surrounding trees bore the scars of its nightly feasts.

Thoughts of his new home’s peace lulled Jason Walker to sleep.

The high-pitched shrieks of the beeper jarred Walker awake. Heart pounding, he fumbled for the plastic and thumbed the button silent. The number dialed in by the caller flashed red across the display; in his startlement, Walker caught only the last digit. He pressed the button again. The numbers appeared one by one: four-eight-zero-eight.

Four-eight-zero-eight. Though the shock of Walker’s abrupt awakening had tightened his muscles, exhaustion still fogged his mind. It took his brain an unusually long time to identify the caller. 4808. The E.R. Groaning, Walker rolled, grabbed the phone, and punched out the number in the dark.

The unit clerk answered on the first ring. “Liberty Hospital. Emergency Room.”

Walker’s voice sounded more hoarse than he expected. “This is Jason Walker, medicine resident on-call. Someone paged me?”

“Just a second, Dr. Walker. I’ll find out who called you.”

Walker glanced at the clock. 3:42 a.m. An hour and fifteen minutes of sleep. Record high for me.

The familiar voice of an energetic emergency room nurse named Nancy came over the line. “He-ey, Dr. J! Sorry to bother you, but we’ve got a patient down here for you.”

A patient, not a question. No avoiding it now. Jason reached up and flicked on the light. He cradled the phone with his chin as he replaced his glasses and reached for his running shoes. “He-ey, Nan-cy!” He tried to imitate her enthusiasm, but his effort fell flat. “What have you got there? Anything exciting?”

“Something … different.” She pronounced the last word in a way that suggested he might find the case amusing. “Don’t kill yourself getting down here. See ya.” The line went dead.

Walker pulled his laces tight with a sigh of annoyance. He appreciated Nancy letting him know it was not a real emergency. Few things bothered him more than charging recklessly through the corridors, arriving gasping and fluttering at a bedside only to discover a smiling patient with a condition less in need of urgent treatment than his own breathless wheezing was. He paused to run a comb through his hair, wipe sleep from his eyes, and brush his teeth. His chin sported a stiff growth of stubble, but he did not bother to shave. It never seemed fair to blow morning breath on a patient, but anyone who crawled into an emergency room at 3:00 a.m. had to expect his doctor to look reasonably disheveled. Grabbing his white coat amid a metallic clatter of shifting tuning forks, reflex hammers, and penlights in its pockets, he exited the on-call quarters.

The walk to Emergency seemed to take forever. Once there, Walker found it relatively quiet. The unit clerk was reading a newspaper, and most of the other Emergency Room personnel knelt in chairs around the charting table, working on a crossword puzzle. Nancy met Walker by the computer printer beneath the paramedics’ call-in radio, her short, red hair immaculate above blue eyes as alert as her manner. She offered him a bowl of warm popcorn. “Cubicle six,” she said, pointing to a drawn curtain in the main ward. “His name’s George Malaphy. Are you all right?” She caught his arm, genuinely concerned.

This early, the buttery aroma of the popcorn made Walker queasy. “Just tired. What’s he got?”

Nancy smiled, removing her hand. “I think you might want to ask him. I’ll come with you.”

Walker nodded. He knew Nancy worked hard and never shirked her duties. If she suggested he ask Malaphy himself, it was only because she felt the patient’s explanation would have a greater impact on his diagnosis.

Nancy set aside the popcorn. As Walker headed toward the room, several of the nurses waved around the crossword puzzle. “Hi, Dr. J.”

Walker returned the gesture mechanically and pushed past the curtain into cubicle six.

Clothed in jeans and a T-shirt, George Malaphy sat on the metal Emergency Room table. Walker judged the patient’s age in the early fifties. He appeared larger than Walker’s slim 5’10” frame by a good three inches and a hundred pounds. A ring of mixed black and gray hair separated his receding hairline from his bald spot.

“Mr. Malaphy, I’m Dr. Walker.” Walker extended a hand. “What can I do for you?”

Malaphy accepted Walker’s hand in a tight grip, and Walker examined his patient’s fingernails from habit. Though dirty, they retained a normal shape and pink color with no evidence of chronic diseases. “Doc, I’ve got this spot on my scalp, and it don’t got no feeling in it.” Releasing his grip, Malaphy traced a coin-sized space on the bald area of his head.

Walker glanced at Nancy who shrugged. He cleared his throat. “Numb, huh?” Walker started, not certain what to say. The symptom did not go along with any diagnosis he could conceive of, and he could not imagine how Malaphy would notice such a thing at all, let alone at three o’clock in the morning. “When did you first notice this?”

“Just before I came in. I was sleeping and reached up and noticed it.”

Obligingly, Walker walked around Malaphy and put his fingers on the man’s scalp. It felt uniformly warm, the indicated site the same healthy hue as the rest of his skin. “Mr. Malaphy, are you on any medications?” Walker braced himself for the possibility of a long list.

“None at all.” Malaphy sounded proud.

“Any medical problems? Did you injure this part of your head recently?” He glanced at Nancy over Malaphy’s head. “Does he have a hospital chart?”

Nancy and Malaphy shook their heads simultaneously. “I’m fit as a fiddle, Doc,” the man said.

Walker massaged the scalp, thinking Malaphy’s fiddle might have a few screws loose. “So, as far as you know, there’s no good reason why you should have a numb … skull?” Walker carefully separated the last two words. Even at this time of the morning, it seemed unnecessary to antagonize the patient.

“No, Doc. Don’t know why. It’s just a numbskull.” Malaphy slurred the words together as if on cue.

Walker turned a laugh into a cough. Nancy struggled valiantly against a smile, loosed a loud snort through her nose, and to Walker’s relief, left the cubicle. If she had lost composure in front of him, he knew he could never have reined in his own. “Mr. Malaphy, I don’t think it’s anything serious. I’d like to try one thing.” Without explaining further, Walker unsnapped a safety pin from the buttonhole of his white coat. He tapped the point against the indicated area of Malaphy’s scalp.

“Ow!” Malaphy jumped in surprise.

Walker reclasped the pin to his coat and stepped around in front of Malaphy, keeping his manner as professional as possible. “Good. You seem to have regained sensation. Go home and get some sleep. If it happens again, don’t worry. Call us the next morning after eight o’clock, and we’ll set up an appointment in the clinic.” He ushered Malaphy from the cubicle. “Thanks for stopping in to see us.”

Walker waited until Malaphy left the Emergency Room, wandered through the waiting room to the main entrance, and the door whisked closed behind him. Then Walker collapsed into a chair by the charting table, laughing hysterically. Across the table, Nancy joined him. Apparently, she had informed the other nurses because soon everyone at the table was snickering along with him.

Regaining control, Walker seized the patient’s clipboard from its numbered slot and started writing up the incident for Malaphy’s chart. The words came slowly. Walker found it difficult enough writing coherently after twenty-one hours of work, but this one seemed particularly hard to phrase in a way to justify his lack of treatment without making the patient sound stupid. He did reasonably well until he reached the box marked “diagnosis.” He had just discarded “deadhead” and a host of psychiatric diagnoses he did not feel qualified to make and settled on “Area of perceived decreased sensation on the scalp” when the paramedics’ radio blared once, then blasted static through the Emergency Room.

The personnel fell appropriately silent, and a male voice emerged, thinly, beneath white noise. “Liberty, this is niner-eight-oh. Can you hear me?”

Nancy rose and took the microphone. “This is Liberty E.R.”

“Do you have a doctor in the room?”

Walker glanced around. Both of the Emergency Room staff physicians had gone off to see patients, leaving him the only doctor in the room. As a specialty resident, he had the right to refuse the call and insist they retrieve one of the emergency attendings.

Nancy looked questioningly at Walker before answering.

Walker’s heart raced. This is my chance. He nodded affirmation.

“Go ahead,” Nancy said, her usual jovial manner blunted.

“We have an unidentified white male, late twenties, with multiple trauma. Respiratory rate 30; heart rate 120. Blood pressure 60 over palpable …”

Shit! Impending shock. Walker rose and walked to Nancy’s side.

“… unconscious, multiple lacerations and burns especially on the face, chest, and upper extremities. Breath sounds absent on the right, diminished on the left. Pupils equal and reactive. We’ve controlled all external sources of bleeding. Got an IV in on the left running lactated Ringer’s at about 200 cc’s.”

Walker knew the radio was intended for the paramedics to convey information and did not operate well in the opposite direction. But if they don’t increase his blood volume fast, he’ll die in their hands. He nudged Nancy. “Tell them to open that IV all the way and get another one in if they can. It’s worth the delay.”

Nancy relayed the message.

“It’s done. Estimated time of arrival …” The voice paused, followed by a flutter of conversation that sounded indecipherable over the radio. “… five minutes.”

Five minutes! Walker caught at the front of his white coat, suddenly frightened. Multiple trauma victims usually went to the Surgery Service. But the surgery resident took home call; it would require at least ten minutes for him or her to reach the Emergency Room. You wanted it, buddy, now handle it! Every self-doubt Walker harbored emerged at once. Not even a vestige of sleepiness remained. I know my stuff; I’m prepared. He gathered his composure as nurses rushed to ready the trauma room.

The first thing to remember is not to be proud. I’m not alone. Walker instructed the unit clerk. “Page surgery and neurosurg. Let them know this guy’s coming. Call anesthesia, too. We’ll need to intubate. Oh, and page beeper 142, Shawna Nicholson, my chief resident.” Walker turned to Nancy as the unit clerk responded. “We’d better order some O negative blood, say two units for now. I don’t think we’ll have time for a cross-match.”

Nancy gripped Walker’s shoulder. “You’re doing fine,” she said before grabbing a telephone to make the necessary call to the blood bank. Walker paused, glad for the calm competence of the Emergency Room nurses. Their support and faith in him would do more toward making the experience successful and smooth than anything else. Quickly, he entered the main hallway, trotting past the empty waiting room and around the corner to the trauma room.

Walker had scarcely reached the threshold when, down the corridor and to his left, the electronically controlled emergency doors slapped open, admitting damp, summer air. Red light from the ambulance strobed across metal and glass. Three paramedics maneuvered a gurney through the entryway, and the glass panels slid closed behind them.

The cart wheels sounded thunderous on the tile. The clang and slap of the IV bottle against its pole rose faintly beneath the hubbub of conversation. A portable EKG monitor made rapid, steady beeps, indicating the patient’s heart rate. Three Emergency Room nurses joined the paramedics as they raced through the hallway. Walker stepped out of the way. No matter how severe the patient’s injuries, he knew the nurses needed to transfer the patient from the gurney to the table, secure lines and bandages, and wire the patient from the portable to the stable monitor before treatment could begin.

Walker slipped into the room behind the gurney as the nurses fell into their skillful routine. He found one paramedic near the door. His name badge identified him as Douglas. “What happened?” Walker asked.

Douglas tore his gaze from the patient to look directly at Walker. “Well, Dr.—” He glanced at Walker’s name tag. “—Walker. We’re not sure. A fellow in one of the houses out by City High said he heard something that sounded like a ‘muffled bang.’ He got worried some kids might be vandalizing the school, ran over, and found this guy lying in the field.”

Walker’s eyes traced the constant blips of the patient’s heart as the nurses hooked him to the overhead monitor. The complexes appeared normal aside from a rate of about 130.

“Luckily for him,” Douglas inclined his head to indicate the patient, “the insomniac was smart enough to stop some of the bleeding before he called 911.”

As the nurses finished their tasks and moved aside to draw up medications, Walker found a space at the bedside. The patient seemed close to his own age, in his mid to late twenties. Certainly no high school kid. His skin appeared doughy and ghostly pale. Despite a multitude of gashes and pressure dressings, Walker noted the features appeared handsome, almost aristocratic, the hair thick, black, and clotted with blood. Walker clamped his fingers to the patient’s neck and felt a pulse, rapid and thready. A wave of pity enveloped him. The appropriate treatment for impending shock rose naturally and, with it, a less professional thought. Why do we always feel so much sorrier for the young, good-looking ones?

Douglas had followed Walker to the patient, still talking. “Some sort of explosion …”

Walker noticed two large bore IVs in place with satisfaction. The nurses were replacing the nearly empty bottles of Ringer’s lactate. Nancy appeared in the doorway with the bags of O negative, and Walker motioned her to use them instead. He’s bleeding somewhere. A rapid examination revealed no external source. The paramedics had done a fine job of bandaging. If it’s internal, we need a surgeon and fast.

The pulse disappeared beneath Walker’s fingers. For an instant, Walker thought his own heart had stopped with it. Then the EKG monitor alarm screamed through the room, and the picture went flatline. “Start CPR,” Walker said, his calmness surprising him. Familiar with the nurses, he delegated responsibilities easily. One clamped a mask over the patient’s face, using an ambu bag to breath for him. Another compressed his chest at a rhythm about two-thirds Walker’s own speeding heart rate. The blood bags were opened fully. Another IV was slipped into a collapsed vein while blood was taken for studies from another.

Douglas’ words seeped between Walker’s shouted orders. “… definitely an explosion … fragments through his chest. I was a medic in Nam … grenade or a homemade explosive … attempted suicide or killing …”

“Type and cross for ten units!” Fragments in his chest? Walker shook his head. If something hit a great vessel, he wouldn’t have made it this far.

“Should we give epinephrine?” one of the nurses prodded, trying to help.

Walker hesitated. Usually, epinephrine was the first and most appropriate drug to give in a code situation. It stimulated the heart to work harder. But, in this case, the heart’s working fine. He just doesn’t have anything in his veins for the heart to pump. Epinephrine will only make him bleed faster.

“Hold the epi,” Walker said. He looked up to see a female staff anesthesiologist had taken over the airway. With the ease of long practice, she removed the mask and slipped a plastic tube into the trachea.

Recalling the absent breath sounds, Walker informed the anesthesiologist. “I think he’s got a pneumothorax on the right.”

The anesthesiologist inched the tube backward. By anatomical design, an endotracheal tube pushed in too far would slide down the right main stem bronchus. In this case, that would mean ventilating only the bad lung.

“Can someone get a blood gas?” Walker asked. “I got it.” Walker recognized the voice of Shawna Nicholson, his chief resident.

The surgery resident, Robert Sharmin, appeared immediately behind her. “Has anyone given this patient epi?”

Walker seethed. Typical goddamned surgeon. Wanders in the door in the middle and decides to take over by throwing treatments at an unidentified problem.

A nurse prepared to inject the epinephrine, immediately halted by Nicholson’s words. “Dr. Sharmin, I believe Dr. Walker has control of the situation. I think he has a task for you, too.”

Walker found it amazing how, in the midst of chaos, Nicholson could not only remain collected but resist the urge to wrest control from a less experienced house officer. Somehow, she had managed to restore responsibility to the youngest, least seasoned resident without insulting either party. Taking his lead from Nicholson, Walker said, “I think he’s got a right pneumothorax, and he’s bleeding somewhere. Can you get a chest tube in?”

Sharmin grabbed a kit and set to work, jabbing a trocar and tube between the patient’s ribs and into the lung sac with the brutality the procedure required.

The unit clerk stuck his head through the door. “I have the blood gas results.”

“Go ahead,” Walker said anxiously. The numbers would indicate, in undeniable and vivid detail, the success or failure of his resuscitation efforts.

The unit clerk read each digit slowly. To Walker’s surprise, they revealed only a mild decrease in respiratory function, attributable to the pneumothorax. In a cardiac arrest, he expected far worse and had to wonder if the lab had made a mistake.

Sharmin echoed his concern. “That’s impossible. They must have mixed him up with another patient.”

“I’ll get another.” Nicholson said, grabbing another heparinized syringe.

Walker waited only until she had finished and passed it to the unit clerk. “Stop compressions.” He placed his fingers against the carotid artery.

Obediently, the nurse stopped pushing on the patient’s chest, her hands remaining in position for the order to resume.

A pulse thrummed beneath Walke. . .