Burden of Guilt





PREVIOUSLY:
"Dr. Benton, don't let them g-g-give me anything.--- Please." Carter's voice was faltering.

"Okay, Carter." He solemnly replied.

Peter nodded his head, not wanting to argue with his friend. What Carter didn't know was that honestly didn't think he could keep his promise.

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Carter was exhausted. The process of taking small, useless breaths was sapping the little energy he had left. The rain had not tapered off in the slightest, and his ears were filled with the pounding of the storm, which seemed to reverb through the dead vehicle. The other two doctors were silent, and he wasn't up to starting a conversation. Besides, he had a feeling that Benton wouldn't allow him to speak. It was odd to see him so worried. He hadn't seen that look of fear since that horrible night in the OR. In a way, he was glad that he wasn't alone.

Peter was getting restless. There was nothing they could do, and the sound of Carter's labored breathing was making him more and more anxious. He was just so stubborn. When help arrived, he would have to convince him to accept some form of pain medication. Peter's thoughts were interrupted when he heard the distant sounds of sirens. He banged his head on the ceiling as he stood up to look out the window. Mark was closest to the back door. He had some difficulty releasing the lever in his rush to open the door. Finally, he swung the door open, climbing out to direct the EMTs, nearly falling in the process. He turned to Benton, who was following right behind him.

"Stay with Carter, I'll go tell them what's going on." Mark walked away leaving, Peter no choice but to remain with their patient.

Peter felt he had been Carter's primary doctor, and he wanted to inform them of the patient's condition. He knew Mark was equally competent, but he felt that he was in charge of Carter's care. He was almost tempted to jump out and follow Mark, but managed to control himself, instead preparing Carter to be transported. He knelt down beside him, observing that his breathing was faster then it had been during the entire ordeal.

"Its going to be okay, man," Benton told the panicked doctor. "Help is here." His face was shining with perspiration, and Carter locked eyes with him, face frozen in that same mask of fear-an expression Benton never wanted to see again. It was hard to reassure Carter when he himself was just as worried. Peter grabbed his hand again for the third time that night. He held it in his own, giving Carter strength and courage. "I will be there the entire time, Carter. Nothing will be done without my knowledge." Peter knew he shouldn't be promising things that he didn't have any control over, but hel pwas here, and Carter needed to calm down.

Mark returned with two paramedics: one redheaded woman, and a burly, ark-haired man. Peter didn't bother looking at their nametags; he just began to bark orders to regain control over the situation. "We have a male Caucasian, 29, struck by a vehicle. He has a concussion with two lapses of consciousness. Complains of dizziness and blurred vision. He has two broken ribs on the right side with a probable sternal fracture, no symptoms of a flail chest..."

"Peter, I already went over everything," Mark called from outside the van. Benton got out of the way of the EMTs and stood beside Mark as the two paramedics slid a backboard into the van. They shifted Carter onto the board after placing a cervical collar around his neck, asking him a series of routine questions as they did so. Carter's replies were inaudible over the noise of the transfer. Benton hopped into the back after the gurney, and ark went to the front to sit in the passenger seat of the ambulance.

The lady paramedic started a large bore IV, then placed a blood pressure cuff around Carter's arm. The other medic was cutting off Mark's old T-shirt. Finally in a well-lit area, Peter could see the large bruises that marred Carter. They were a dark shade of purple, covering his chest and dotting his side. There were some scrapes that he hadn't noticed before. He prayed that he hadn't overlooked anything else, anything more serious.

The male attendant was placing an oxygen mask over Carter's face while radioing the hospital with his patient's vitals. "We have a male, 29, victim of a hit and run. Pulse 125, BP 140 over 90. Resps 25 and shallow on the right side. Our ETA is 15 to 20."

The EMT turned to Benton."How long ago was the accident?"

"About three hours ago," Benton replied.

"Any dementia or hallucinations?"

"No."

"What's his name?"

Benton was annoyed by these mundane questions, but wearily answered. "Carter." Peter looked down at the patient. "John Carter."

The female medic began to place cardiac leads on his chest. She spoke to him in a placating tone. "Now, Mr. Carter, we know you're a little distressed, but you have to try to slow down your breathing."

Carter closed his eyes, willing his lungs to take slower, deeper breaths. He could hear the heart monitor beeping faster as his rate of breathing slowed. His blood pressure was probably through the roof, but he couldn't turn his head to check on it with the neck collar on.

The female spoke again. "Looks like you sustained a chest injury. I know you're in a lot of pain. We'll have you in the hospital in no time, and then the doctors can..."

Peter cut her off, his voice irritated. "He's a doctor. He knows the routine and he knows the tests. You don't have to talk to him like a patient." He checked the blood pressure reading. It was up to 145 over 90.

"Please, ah, I presume Dr..."

"Dr. Benton," Peter finished for her.

"Well, Dr. Benton, please don't touch the instruments. And remember he is a patient today. Alright?" The woman went back to monitoring Carter's vitals. Peter Benton sat there quietly, feeling more and more fed up. The night had all the ingredients of a bad dream, now it had erupted into an unstoppable living nightmare. He just prayed it would end very shortly.

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The ride to the hospital was worse then uncomfortable silence in the van. The mbulance kept running over bumps in the and each one elicited a grimace or groan from Carter. All he wanted to do was sleep. He wanted to forget this night, to forget the past three months. He wanted all his problems to disappear. In his heart, he knew this was impossible, but he could try. The confrontation with Benton had made it perfectly clear how close he was to the edge.He had been walking a fine line for months now. He had started with extra doses of his pain medication, but, in the confusion of the ER, he had done the unthinkable. He still couldn't believe he had started injecting himself with narcotics whenever there was a sudden onset of pain. Not only did he endanger patients' lives, but he had put his friends in danger. If they had not felt the need to send him to rehab, then Dr. Benton might not have been out in a dangerous situation. It didn't even occur to him that he saved the man's life.

Carter suffered through the painful ride, sighing with relief as he felt the ambulance slow at what was apparently their destination. He was unloaded and wheeled into a foreign ER. There was a flurry of activity, people shouting and poking him. They were asking him questions again, the same ones he had been asked all night. He answered each one, tired of the unwanted attention.

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Mark and Peter followed the gurney into the ER. They were instructed to wait outside, so they informed the staff that they were doctors. One of the nurses told them that trauma two was cramped as it was, and only one of them could come and observe. Peter was in the room before the nurse could finish giving him instructions on protocol. Peter wasn't gloved or gowned, but he stood back, keeping at least one of his many promises.

He watched all the procedures that were being performed, noting that the team was running efficiently. The man running the trauma was busy checking vitals.

He yelled to one of the nurses, " I want a chest film, abdomen, and call radiology for a head CT." The paramedics had explained that Dr. West was excellent, and even Peter had to admit that his command of a trauma was impressive as he continued to examine Carter, ruling out various injuries.

"Mr. Carter, have you had some recent surgery? I have noted some surgical scars on your abdomen." Dr. West leaned over for the answer, but Carter's reply was muffled by his oxygen mask.

Peter walked over to the doctor, ignoring the warning stares of the nurse. "I'm Dr. Benton, and I was the surgeon who operated on Dr. Carter," Peter explained, placing a little too much emphasis on "Doctor."

Dr. West looked over at the man who had answered for his patient. He looked very serious and was obviously concerned for a colleague. This was a man who clearly wasn't going to allow hospital politics to dictate how to properly care for his patient. "Dr. Benton, by all means, please update me on Dr. Carter's history," Dr. West said sincerely. "It will be helpful when examining the X-rays."

Peter glanced over at John, knowing he didn't want to think about the recent past. But there was no choice, and, as a doctor, Carter understood the medical reasons for speaking for him.

"Dr. Carter was stabbed twice in the lower back about three months ago. I repaired the kidney; there was no permanent renal damage. I performed a colostomy, and he hasn't had any complications since."

"Thank you, Dr. Benton, I'll look for any scar tissues from his previous injury and order an MRI." Dr. West ordered the test as one of the nurses returned with Carter's chest films and x-rays. Both Peter and the other doctor looked at the chest film, noting the sternal fracture. Carter's ribs were indeed broken on the right side, but he wasn't suffering from a flail chest, meaning no respiratory complications. Peter sighed with relief when the other x-rays confirmed that there was no internal bleeding. This meant no ex-lap, no additional surgery.

Dr. West was pleased, and turned to one of the other residents. "Alright, et's take a look at that concussion with a head CT. Hopeful we can rule out a subdural hematoma and any other head trauma." Dr. West turned back to Carter as he was being wheeled to x-ray. "Your pupils were sluggish, and I think you may have a medium-degree concussion, but I'm pretty sure there are no addition problems. Once we confirm that-should be a couple of minutes--I'll hook you up with a small does of morphine, IV, okay?"

"No!" came Carter's garbled, but vehement, answer.

"Excuse me, Dr. Carter?" Dr. West asked, confused. The nurses stopped wheeling the gurney so the conversation could continue.

Carter clumsily took off his mask, in order to make his point clear. "I don't want any pain medication. No narcotics. I'm within my right to refuse," he told the bewildered doctor. Carter looked around the despite the pain it caused in his head until he located Peter. He locked eyes with him, knowing his friend would back him up.

Dr. West looked at both men at a loss for words. He shook his head and turned to Dr. Benton, noting anther man hovering behind him. "I don't understand. Dr. Carter, it is very advisable that you accept some form of pain medication. I can give you 10 to 15 milligrams of morphine IM, or if you'd prefer, 75 to 100 milligrams of Demerol IM. If you don't want to take it orally I can give it to you through an IV."

His voice grew louder and more agitated as he spoke Carter closed his eyes after glimpsing Mark standing next to the gurney, beside Dr. West. He wasn't up for a confrontation regarding his care. "No. I don't want any pain medication. I'll take some aspirin. Dr. Benton understands, he's my doctor." Carter looked past Mark and at Peter.

Peter had three different people staring at him for answers, each with a different expression. He looked away from all of them for a second and searched his heart. Carter had just called him "his" doctor: he trusted him. Benton returned his gaze to Dr. West. "Yes, I'm his doctor," Peter confirmed, almost proudly. "If he doesn't want any pain medication, don't give it to him." Peter didn't like what he was saying, but it was what Carter really wanted.

Dr. West indicated for the nurse to take the patient for his head CT. Then he placed his hands on his hips in obvious irritation. It was late at night, he was exhausted, and he wanted to avoid this argument at all costs. He looked over at the guy with glasses, who was trying to send lightning bolts to the surgeon with his eyes. The guy with the glasses turned to him.

"I'm Dr. Mark Greene, and Dr. Benton is no longer Dr. Carter's physician. He hasn't been his caregiver for over three months. I have to disagree with Dr. Benton's opinion."

Dr. West clasped his hands together. "I don't know what is going on here, but my patient has a fractured sternum and broken ribs. He's in a lot of pain. Right now, he is in my hospital, and he is my responsibility."

"And he also clearly indicated that he doesn't want to be administered morphine," Peter said forcefully. "He has the right to refuse."

"Peter, you know the circumstances under which he made that decision. It's in his best interests..."

"Mark, I think we should respect his wishes," Peter said wearily. "Let him take control of some aspect of his life."

"Excuse me, Doctors. If you are truly being this man's friend, then I suggest you change his mind. He is within his rights, but I don't think it's his option right now," Dr. West tried to reason.

Peter turned to both of them. "For once, I am being his friend. He has to start fighting his problem, and if he wants to do it the hard way, then I'll support him." Peter took a deep breath. "In any way." He walked away, searching for a quiet place to relax.


To be concluded...



Part 7
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