Excerpt from Trauma Plan

Chapter One

“MAN ON FIRE!”

What?

Jackson Travis hurled his Army duffel to the floor and charged out the clinic door, his mountain boots pounding the splintered wooden porch. He squinted into the April sun; the parking area was swarming with people. A car swerved toward the San Antonio Street curb, brakes screeching. He vaulted over the porch rail as honks joined a rising barrage of screams and shouts.

“Someone’s burning up—quick, film it!”

Jack bolted toward the crowd, clenching his teeth against a whiff of smoke and singed hair—far too reminiscent of his weeks in Kandahar. There was a terrified howl and he pressed forward, impeded immediately by a young man in a knit cap who wedged in front of him to raise a cell phone overhead.

“Stand back,” Jack ordered, familiar anger prickling. He gave the man two seconds to comply before shoving his shoulder into him. “Let me get by!”

“I called 911,” an older African American woman told him, tugging at Jack’s uniform sleeve as he passed. “Fire department’s coming, sir.”

“Good . . . thanks,” Jack huffed, breaking through the crowd at last. It had been no exaggeration—an elderly man’s clothing was on fire. “Hold still! Don’t move!”

“Please, God . . . help me!” the man begged, flames licking at his stringy, unkempt hair. He staggered backward, wild-eyed, waved his arms, then lost his balance and sat down hard.

Jack was there in a heartbeat.

“Don’t move, sir,” he repeated, dropping down beside the man—and feeling an immediate jab of pain as his right knee touched the ground. Jack ignored it and went to work, blinking against the smoke and flames as he stripped off his field jacket. “Hang in there. I’ve got you,” he promised, using the camouflage fabric to smother the still-hungry flames. That accomplished, he swaddled the man inside the jacket and eased him to a lying position on the dusty asphalt. “Easy, buddy. Stay still. Let me help you now.”

“Okay, ohhh-kay,” the man groaned, the last word stretching into a puff soured by cheap wine and bad teeth. His tear-filled eyes studied Jack’s face, and then his body relaxed. “It’s you. Oh . . . bless you for being here.”

There was a smattering of claps from the bystanders, but a teenager holding a skateboard hooted, “Yeah, well, GI Joe better pray he don’t get some ugly disease. You wouldn’t catch me touchin’ that.”

“That”? Jack glared at the boy as sirens wailed in the distance. The call to 911. At least someone had done that for . . . Gilbert. Yes. Jack recognized him now. Former hardware salesman. Alcoholic, a smoker with emphysema, and a clinic patient on several occasions. Jack glanced at a nest of smoldering bedding and a grocery basket piled high with empty aluminum cans. On the ground nearby was a broken half-gallon wine bottle, translucent green shards scattered. Probably the reason for the jab in Jack’s knee and even more evidence that this homeless man had spent the night on clinic property. Jack cursed under his breath. If word got out, it would be one more item on a long list of complaints that the clinic attracted unsavory elements and depreciated property values.

He turned his attention to the victim, who’d begun to tremble uncontrollably. One of his ears was blistered, the eyebrow and lashes on that side singed: a red flag for risk of airway burns. Had the man inhaled much smoke? No audible wheezing, lips pink . . . Jack estimated the man’s respiratory rate at thirty, then reached for his wrist: pulse rapid but regular. Panic was probably taking more of a toll than the burns.

“The ambulance is on its way, Gilbert.” He made a point of using the man’s name, hoping it would make him feel like more than the ugly public spectacle he’d suddenly become. I know how that feels, buddy.

Jack glanced toward the clinic porch, debating carrying the man inside. No staff there yet, and the supply cupboards would be locked. Besides, the paramedics were moments away. They’d get this man on oxygen, transport him to the ER where he belonged. Maybe there weren’t more burns than those visible. Hopefully the poor man hadn’t been lying here in flames for too long.

Jack fought a searing rush of anger and glared at the gathered crowd, including the man in the knit cap who’d backed off a few yards but was still avidly filming. All of them were no better than scavengers around a rotting carcass. Two dozen or more people had responded to shouts of “Man on fire!” yet no one had attempted a rescue. Not one person had stepped up.

Jack jabbed his finger toward a man talking on a cell phone, then swept it across the crowd like he was drawing a line in desert sand. “Do something helpful or get out of here! You hear me? What are you, vultures?”

He rose to his feet, fighting an urge to grab one of the gawkers and shake him, just as the engine company first responders pulled to the curb. The siren yelped. A strong hand clapped onto his shoulder from behind.

“Jack, I almost didn’t recognize you in uniform. What’s going on here?” San Antonio police sergeant Rob Melton surveyed the scene, radio mike squawking on his shoulder. “Fill me in.”

Jack grimaced. “I go to Dallas for my Reserve weekend and come back to find a disaster in the parking lot.” He glanced down at Gilbert and lowered his voice. “Homeless alcoholic who probably fell asleep with a cigarette in his hand. Set himself on fire.” Jack stared at the receding crowd being dispersed by a second police officer. “And he would have burned to a chickenfried death if your heartless citizens had their way.” He sucked a breath through his teeth. “Heartless and gutless. I’ve got no use for people like that.”

Rob’s gaze met Jack’s, his compassion as evident as the telltale bulk of his body armor. “I hear you, Jack. But there are plenty of decent folks here. If you give them half a chance.”

“Yeah, well . . .” Jack waved at the firefighter crew making their way with equipment bags in hand. “Over here, hustle! And watch out, there’s broken glass everywhere.”

Jack stepped back as a paramedic attended to Gilbert. Then he gave a brief report to a young firefighter who’d begun to make notes. “Second-degree burns from what looks like a bedding fire. Mild respiratory distress. Alcohol on board. History of emphysema. Where are you taking him?”

“Alamo Grace Hospital.”

“Good. I’ll grab my things and follow you in.”

“Uh . . .” The firefighter’s eyes swept over Jack’s uniform, settled on his name tape. “We appreciate your offer, Major Travis, but . . .”

Rob Melton smiled. “Dr. Travis. He’s director of this clinic.”

“It’s Jack.” He extended his hand to the firefighter. “Emergency medicine is my day job. I’m working a shift at Alamo Grace this afternoon.”

“Good thing.” Rob pointed to Jack’s leg. “You’re bleeding.”

Jack flexed his knee. A warm trickle and mild sting confirmed the observation—a puncture from that broken wine bottle. He’d grab the medical records and close up the clinic. The wound could wait until he got to Alamo Grace. Right now it was far less important than what he’d glimpsed out on San Antonio Street: A trio of news vans. And a white Lexus.

He knew the car. It belonged to the head of the action committee that wanted his clinic torn down. The city council was meeting in three weeks to discuss the neighbors’ issues, which boiled down to the fact that they preferred people like Gilbert in another zip code. Meanwhile, they were building a fortresssize security gate; the block had been torn up for weeks.

Jack stood watch as the paramedics loaded Gilbert and then made his way toward the clinic. As he started up the wooden steps, he saw something out of the corner of his eye and sprinted back down.

He caught the man in the knit cap before he got to the San Antonio Street curb, startling him enough that he dropped his cell phone. It clattered across the sidewalk. The man grabbed for it, then attempted to lurch away.

Jack grasped his arm, whirling him around. “I see that film clip on the Internet—” he jabbed a finger into the short space between them, barely missing the man’s nose—“and I track you down. Count on it.”

Jack released his grip and watched the young man scuttle away before turning his gaze on the white Lexus. His jaw tensed.

Close this clinic? Over my dead body.

- + -

Trauma chaplain Riley Hale straightened her elbows and leaned over her patient’s bare chest, using her left hand to sink her right palm as deeply as she could into his pliable breastbone. Her long hair swung across her shoulders with each focused effort. “Twenty-one, twenty-two, twenty-three . . .” She pushed again, counting cardiac compressions while visualizing the patient’s failing heart squeezed between sternum and spine, her rescue efforts delivering essential blood to his brain and vital organs. “Twenty-four, twenty-five, twenty-six . . .”

Riley compressed again, felt sweat trickle beneath her tailored shirt, then glanced at her patient’s pale, waxen face. She told herself that she was saving his life with her bare hands. My own two very capable hands. A registered nurse performing exactly what she’d been trained to do, had done a hundred times during her years in the ER. Nothing had changed, except . . .

“Aagh!” Riley yanked her hands away as the right hand cramped mercilessly, fingers curling inward beyond her control. She whirled to face ER charge nurse Kate Callison. “I’m working on a dead body, right? He’s dead because I’m doing a pathetic job trying to save him. Tell me the truth, Kate.”

“Well . . .” The petite brunette took a long swig from her vitaminwater, then leaned back in the conference room chair. “It’s not looking good for Mrs. CPR Training Manikin—she should probably buy a nice black dress. But on the bright side, the chaplain’s already here.”

Riley tried to smile . . . and failed.

“Look—” Kate nudged her lunch plate aside—“you have spinal cord damage that affects your arm. It’s weak; you can’t help that. The truth is that I’m amazed you’re doing as well as you are.”

Riley took a slow breath, refusing to let disappointment get the best of her. She’d asked Kate to be honest. In the four months since Riley began work at Alamo Grace, she’d come to admire this California native a lot. She was a skilled critical care nurse and a hands-on leader who could be counted on to roll up her sleeves and work alongside her staff. Plucky, dependable, and honest. She was far less gregarious than the other nurses, yet Kate and Riley had connected immediately. She was the one person Riley had confided in about her injury. And if Kate ever finished packing, she was going to be Riley’s new roommate. A good thing. Still . . .

Riley traced her right index finger slowly across the training manikin’s plastic shoe and felt nothing. Dull as wood, completely numb. Her life had begun to feel that same way. Numb, except for unrelenting frustration and the stabs of guilt that came every time people applauded her “brave” journey to recovery. Was it selfish and ungrateful to want to be healed completely? Was she supposed to be happy that a horrifying assault left her with “only” a permanently weakened arm?

“Riley?”

“It’s been a year now.” Riley’s eyes connected with Kate’s. “Physical therapy, occupational therapy . . . every kind of therapy. I want to be back in the ER—” she glanced at her suit jacket draped over a chair—“in scrubs. I want to be a real part of the team.”

“You are. You’re great at what you do.” Kate cocked her head, offering Riley a teasing smile. “You know I’d be the first one to vote a preacher off this island. Or a slacker. I run a tight ship. You’re the best trauma-chaplain-slash-assistant-safety-officer we’ve ever had.”

Riley sighed. She was the only employee to ever have that position at Alamo Grace. Your basic overpaid gofer, because the Hale Foundation was a large contributor to this medical system. Thank you for not saying that embarrassing truth: that I’m broken, useless . . . and skating by on my family name.

Riley scanned the array of training devices scattered across the conference table: adult, child, and infant CPR manikins; an intubation head with simulated lungs protruding; Ambu bags; and a big arm—bicep to fingers—for practicing IV insertion. Each a plastic replica of the real thing. Exactly how she felt about herself right now. But she was determined to change that. Whatever it took.

“How’s it going with your IV practice?” Kate checked her watch. “I’ve got a few more minutes on my break. Want to give it a try?”

“I guess.” Riley frowned. “But I could poke that rubber arm a hundred times and it wouldn’t be the same as on a live patient. How am I ever going to prove that I’m capable if the hospital won’t even give me a chance to—” She stopped short as Kate pulled off her scrub jacket and began wrapping a tourniquet around her own arm. “What are you doing?”

“Giving you a chance. If I’m going to talk you up at the charge nurse meeting today, I’d better have something to base it on.”

“I . . . Really?”

“Yeah—wait, hang on.” Kate answered her buzzing cell phone with the tourniquet still dangling from her arm.

Riley listened to the one-sided exchange, distracted by the fact that her pulse had quickened like a first-year student nurse’s. If Kate could report that Riley’s dexterity was improving, it might help her chances. It had been a year since she’d used this skill, given that direct patient care was no longer part of her job description. Prayers, yes; needles, no.

“Something in the ER?” she asked as Kate disconnected.

“Ambulance coming. Seventy-two-year-old man with burns and possible smoke inhalation. Basically stable.” Kate shook her head. “Bizarre—it happened in the parking lot of Jack’s free clinic.”

“Jack?”

“If you have to ask, you’ve never met him. Jackson Travis, trauma doc, rabid defender of the oppressed. And mountain bike lunatic, and . . .” Kate clucked her tongue. “People call him Rambo behind his back. I met him when I helped at the clinic. He works in a couple local ERs, and now he’s picking up some shifts at Alamo Grace. This afternoon, in fact. He’ll probably parachute in.” Kate glanced down at her arm. “I’m turning purple from this tourniquet and we’ve got seven minutes before the ambulance arrives.”

Riley reached for an iodine swab. “You’re sure about this?”

Kate settled her forearm on the table. “Prep me and grab a needle before I change my mind. And no praying out loud, Chaplain Hale.”