POCKET CHANGE 2: A GAME OF CARDS
by Sharon R.
Chapter Ten
Both broke out in uncontrollable laughter as they sat midway up the tree, far enough to be out of ear shot. Reaching to grab a limb, Carter missed completely and, as if in slow motion, fell straight down. Luka watched horrified not able to do anything.
"Carter!"
He saw his fingers just miss the branch he had thought was in his reach, the same he had easily used for leverage on the way up. Carter was so confident of his tree climbing - or in this case, tree descending - abilities that he didn't even look before reaching out for it. But before he knew it, in the middle of laughing with Luka just above him, he turned his head just in time to see his left hand grab at - air.
Luka's hand seemed to be slowed down as he wrapped his left arm around the limb he was sitting on and thrust his right hand down at Carter who plummeted through the foliage. His cheek scratched by the bark of the tree, Luka almost allowed himself to fall too as he slithered down the tree bizarrely trying to get to the ground before Carter.
First his shoulder hit a branch, then the leaves whipped at his exposed skin as the velocity lent itself only to the torture the tree was imposing on his helpless form. Although he tried to reach for something to grab onto, his brain surrendered and Carter realized there really was nothing he could do but ride it out. Almost at the same time, he wrenched his left armpit in the crotch of the tree, the front of his body slamming into the tree trunk as it was violently slowed. A flash of pain as he bit his tongue was quickly overshadowed by the blow his throat took when he jolted his head back. There was a good side to this - it broke his fall so that he eventually simply tumbled to the surface below allowing him to avoid a head injury. The bad side, however, was that he could feel his arm pop out of its socket and separate from his body at the shoulder. Although it hurt like a son of a bitch, it wasn't a new feeling for him, having already dislocated his shoulder years ago. But his throat having connected with the tree trunk was a pain that frankly frightened him.
THUD
Luka let himself go into a controlled fall himself about four branches from the bottom ending up on his feet just inches from Carter who was on his back struggling to get a breath. A-B-C, Luka maintained his composure outwardly as he leaned back on his heels. "The A-B-C's," Luka thought aloud. Airway, breathing and circulation. Right off the bat it was obvious that Carter was having difficulty breathing, and he had a huge abrasion on the front of his neck in the throat area.
"Carter," Luka put his hands on each side of Carter's head to keep it still and looked in the struggling man's face, "what's going on with your breathing? Hmmm? Do you feel like something is stuck in your airway?"
Carter shook his head as much as Luka's immobilizing hands would let it, and with his right hand pointed to his chest at the level of the diaphragm.
"Your solar plexus?"
Carter nodded.
"Okay - you got the wind knocked out of you. That's the least of your worries." Luka tried to comfort him, then turned around to the people behind him. "Todd, come up here and hold Dr. Carter's head very still just like I am. Othiamba and Joseph run back to the clinic as fast as you can and get Dr. Maggie. Tell her to bring a backboard and a collar." By the time Luka had farmed out tasks, Carter had regained his ability to control his breathing but was in great pain. "You have to stay still, Carter, and not move around."
Carter tried to speak but something in his throat prevented any sound from coming out. Luka began a cursory exam by palpating his frame starting with his head, then the neck, arms, chest abdomen, hips and legs.
"Move your feet for me." Carter wiggled them, but the movement alone caused pain to sear through his shoulder. "And your fingers." No problem there as Carter reached up in a panic and grabbed Luka's shirt pulling him closer to his face. Luka placed his own hand on Carter's putting it down. "You've got a lot of blood coming out of your mouth, your left shoulder is obviously dislocated and you have a serious abrasion over your trachea. You know the drill Carter, now help me out here. Do you think you have a tracheal injury?" Small nod. "How about pain in your chest or abdomen?" Carter thought for a second as he forced himself to shift his focus away from the obvious areas of pain. He shook his head 'no'. "How about your head? I didn't see how you landed. Any big hurts up there?" Again, he shook his head.
Sean's white Land Rover was rumbling through the field at top speed, a huge cloud of dust trailing it as tire marks were left in the landscape. Maggie, Sean, Othiamba and Joseph jumped out, leaving the engine revving as it recovered from the assault.
"Oh God, what happened?" Maggie asked as she brought over the backboard and cervical collar.
"Fell out of a tree." Luka, Sean and Maggie positioned Carter so that the board could slide under him easily. "Okay, roll him on three," Luka announced as they all positioned themselves at Carter's left side. "One , two, three…"
Carter howled as best he could without the ability to make much of a sound. The pain in his shoulder was excruciating as they put him on his side and pushed the board under him. With the collar in place, Sean raced back to the Rover and knocked down the rear seat. With their patient loaded carefully in the back, Maggie sat backwards in the front passenger seat with her hands on Carter's shoulders while Othiamba and Luka stood on the running boards. This time Sean kept the Rover at a much slower pace, trying as best he could to avoid the ruts.
The nurses were waiting for them when they arrived at the clinic and quickly helped the doctors to assess Carter's condition. An IV was established in his right arm and the blood was wiped from his face as the other vitals were taken. Maggie and Luka were very thorough in their exam and when they were certain that his neck was clear, they removed the collar. Once more he was rolled to his side as Luka put his hand up the back of Carter's shirt to carefully check each vertebrae for any abnormalities. Maggie gloved up and tended to Carter's mouth wounds as Luka once again palpated his abdomen for possible signs of internal bleeding.
"Probably a bruised larynx," Maggie judged. "It will heal, but you won't be doing a lot of talking for a few days." Maggie's bedside manner helped Carter relax as she joked with him. "Are you allergic to anything?"
"Compazine," Carter mouthed.
"I know you don't want to hear this Carter," Luka told him in his own laid back way, "but you're going to have to give us a urine sample after we fix your shoulder."
Carter rolled his eyes and shifted slightly as he thought about the grace and humility, or lack thereof, of pissing in a jar while flat on his back in front of an audience. He shook his head 'no'."
"Or we can cath you," Luka offered as an alternative.
"No," Carter mouthed, barely making a sound. He raised his hand up to wave Luka away when a huge wave of pain overtook him and he drew his knees up reflexively.
"Your shoulder?" Maggie asked. Carter nodded and beat his right fist into the mattress of the exam table. "Then let's get that reduced. How about something for the pain? We might be able to find some morphine back there."
Carter stared straight up at Maggie, not attempting to talk, nor was he communicating in any form. He was thinking. Thinking about how nice it would feel to get something to take the excruciating pain away from his shoulder, arm, and throat. And of course his ever present back pain wouldn't mind. Instead he turned away knowing that there weren't any meds like that in the building. He and Luka had already checked. Convenient for a recovering drug addict. But he'd pretend. He certainly had enough in his memory bank to draw from, all labeled "Carter: strung out."
"No." Luka didn't even give Maggie a chance to look. He just threw it out there. No.
"No meds to do the reduction," Maggie was confused, "or no, we don't have any morphine back there?"
"I mean no meds for Carter. We can do this without. Right Carter?"
Carter nodded reluctantly.
"Are you sick, Kovac?" Maggie shouted over the patient. "Let me get this right. You want to put Carter through a fully conscious shoulder reduction after what he's already been through?"
"Just…" Luka combed his hand through his hair and clenched his mouth before finishing. "Just … no meds. Okay? Trust me." Luka patted Carter's legs before heading out to get a long sheet to use for the reduction. He was sick of having to justify himself to Maggie and didn't think it was his place to divulge Carter's private past and certainly not to her.
"This is bullshit." Maggie went to the other side of the room and took a box out from under some shelving. "What the hell kind of thrill does he get out of seeing you in pain?" From the box, Maggie took out two vials. She drew something up into the first syringe and injected it into the port of Carter's IV, then drew more from the second vial and did the same. Carter immediately felt relief. Relief and the feeling of floating off the bed. He'd felt this way before, he knew the source, but he just didn't care.
Luka came back in with a sheet and wrapped it around Carter's chest to use for leverage. "Wow, it didn't seem to bother him," he mumbled as he got into position. "Okay, Carter. This is going to really hurt, but we'll be quick."
Maggie burned her eyes into his as the two worked together to pop Carter's arm back into its socket. Crack. With only a slight moan from his patient, Luka became suspicious and checked Carter's eyes. His pupils were constricted.
"What did you give him?"
"Versed and Fentanyl."
"What?" Luka hadn't heard the mention of those meds since leaving Chicago. "Where did you get them?'
"I have my own private supply for emergencies. And watching Carter in pain definitely qualified, don't you think?" He was sick, she thought. What did he care? What, was this -Survivor-Pakwach?
"I told you not to do that," he yelled at her through his tightly clenched mouth.
"You know, you have issues with me and haven't even given me the benefit of treating me like a colleague since I got here. But I'll tell you, your issues shouldn't be with me. They should be back in that supply room where your supplies and meds keep disappearing from right under your nose." Maggie hit hard with her words when she needed to. "What the hell is wrong with you?" Maggie spit at him. "I don't get you. He's stable. He's handling it well and he's obviously more comfortable. Don't take your immature petty feelings for me out on Carter. I know what I'm doing."
Luka was furious as he drew a blood sample from Carter. "Do you?" He was livid as he left to run the sample through the chemistry machine.
Carter's mouth was dry and the taste of blood woke him from his outing. His tongue was swollen but he still was able to run it over his teeth to make sure they were still there. They were. He felt so woozy and then remembered that Maggie had sedated him. Bringing his right hand up and over his chest he felt his shoulder and was relieved to feel it back home where it belonged, but in doing so managed to stretched his bum muscles in his back which were in spasms.
Maggie heard the rustling of the sheets under Carter as she was charting his vitals. Putting the file down she ran to him when he let out a painful, rough sounding scream. "Carter, what is it?" He'd woken up quickly.
His hand grabbed at his throat, then moved to his left shoulder and then finally his back. He was sweating and his breathing was labored as the pain was mounting. "You have pain?" she asked him.
Carter nodded quite vigorously as tears streaked down his temple - tears that came without effort, the kind that just show up when you least want them to. Not tears of sadness, but ones produced by an inner struggle to overcome riveting pain. When Maggie grabbed the vial of Fentanyl he shook his hand at her and motioned to his back. "Sta…. sta…" He couldn't talk and barely got those few horse sounds out. "Stab… Stabbed." He needed to finish telling her what he started to the night before. Maggie should know, he thought. She is my doctor now. The small of his back shifted again as he pulled his arm back resting it on his chest. Once again gripping pain coursed through him as his muscles and joints fought against each other.
"Stabbing pain? Carter do you want more pain meds?"
Carter looked at her and lay very still as his foggy brain did some searching. He felt as though he were frozen. He wanted relief so bad, anything to make the pain stop, but… but…
"It's your decision. Not Luka's."
Carter contemplated and his head nodded just once, very slowly, almost as though he had no control over it.
As Maggie injected the Fentanyl into Carter's line she smiled at him, glad that she could give him some comfort. "This should do the trick. I gave you a good dose that will put you out for a while." After the Fentanyl was in she gave him just 1cc more of Versed for good measure. As Carter's eyelids fluttered Maggie settled back into her chair. "I'll just call you Loopy," she joked.
It was a circus and Carter was on one hell of a ride. As he fell into unconsciousness he heard the innocent music of the old time carnival. The out of tune organ grinders, calliopes, and horns, all inviting him to the biggest show on earth, and he was the ringmaster. Spinning around, going up and down, bright lights and child-like music all colored his state of mind.
(Lyrics to a few lines of Carnival Townby Norah Joens and Lee Alexander previously properly attributed, deleted as per new regulations by site administrators 5/3/05. The complete original text of Pocket Change can be found at LUKAFIC)
Loopy. That's what he heard Maggie say. Loopy. Loopy. It fit. He liked this carnival and thought he might stay a while, so long as those freaky clowns stay away. He was still in pain, he just didn't care. He was just an observer at that point.
(Lyrics deleted)
"His crit is good," Luka said as he came around the corner. "But let's check it every 30 minutes for a couple hours to make sure it's steady. I don't want to…" He looked down at Carter who seemed even more out of it than before if it was possible. "Why hasn't he regained consciousness?" Luka checked his eyes and then his vitals.
Carter only vaguely heard Luka and Maggie talking above him. He was drifting and feeling as though he hadn't a care in the world. His own little world.
"He did," Maggie spoke over the chart without looking up. "He said he was having stabbing pains in his back. Said he wanted more meds."
"So you gave them to him?" Luka couldn't believe that she would completely ignore his order not to give him narcotics. Or could he?
"Well, yeah. You never gave me a reason not to, and besides, he asked for them." Maggie felt like she was either dealing with a child or an over protective parent, neither giving her the trust she deserved.
"You think he's in a state of mind to think rationally? Did you even check his back?"
"No, you already did. Look we need to get him undressed. He's going to be out for a while and he's a mess."
"Do you have some Narcan in your magic box too so we can try to reverse this?" Luka gave Carter some IV steroids to help with the inflammation to his trachea and laryngeal area.
"What? No. What for anyway? He's getting the same meds here as he would back in the states. I'd think that would be something."
By this time they had an audience of Bob, Sean, Colleen and Todd, although they wouldn't have known as the two doctors were fighting like cats and dogs.
Luka wasn't about to change the subject. "You can't give him narcotics," he screamed at her.
"What is this about you wanting to watch him suffer? I certainly didn't waste what little of it was in stock here." The only thing keeping the two apart was Carter, the patient, between them.
"Hold it," Sean stepped in, and then Colleen as she went to Luka's side. "You two have been on each other's nerves since day one. Now, there's no one to blame here and I trust that you have Carter's best interest in mind… both of you."
Luka pretty much ignored Sean as he walked around the treatment bed and got right in Maggie's face. "You think you know him, but you don't."
That hit her fast as she stepped back away from Luka's hard, angry face.
Luka balled his fist at his side, and closed his eyes as he broke Carter's confidence and blurted out his secret. "He can't have narcotics. He's a drug addict." The faces in that room dropped as the secret was out. "He doesn't want narcotics. We've talked about it." Luka took a deep breath as Colleen put her arm on his back. With nothing he could do, Luka stepped back and took a moment to calm himself. "We'll just have to watch him. He shouldn't be out too long."
"Excuse me," a meek voice came from the doorway as Todd spoke up, "but would it make a difference if he had alcohol in his system?"
"He doesn't drink." As Maggie said it, it all made sense to her now. The program, AA or NA, would discourage drinking. Carter was following the program and she cursed herself for not being able to put two and two together.
"Well, yes, he um…" Todd fidgeted and wiped the nervous sweat of his palms on his pants, "…um, I saw him drink a couple beers at the field just before he ran to the tree."
"Shit." Luka went to the head of the bed and once again assessed Carter's vitals, worried about his breathing. "A couple?"
"Yeah, at least two. Maybe more. There was no water there and I think… but… will he be okay?" The young man's concern was genuine.
"The alcohol will enhance the effects of the Fentanyl, which is already a hundred times more potent that morphine," Maggie admitted as she was putting the clues together that equaled Carter's predicament and her own guilt. "We should tube him."
"No. We can bag him if we have to, but we can't give his trachea another reason to bleed or swell." Luka was mad at himself for spoiling Carter's privacy but equally mad for not explaining the situation earlier to Maggie. "We'll just have to wait and see. I'll stay with him until he wakes up."
No one moved from their place until a gurgling sound came from the bed. Rushing to Carter, Maggie, Luka and Sean rolled him on his side to keep him from aspirating the vomitus into his lungs. Luka wiped as much away from Carter's face and cleared his mouth as best he could without the aid of suction.
Stepping to the other side of the bed to get some more towels, Maggie was horrified when she looked at Carter's back exposed for the first time as his shirt rode up. There she saw two large scars - scars from stab wounds, the type that she had seen before while working with patients in inner city hospitals. But there was more partially hidden by his shirt that didn't fit Luka's explanation. She was speechless as she stood and gawked at Carter's back. As he was rolled back she looked at his pale, unconscious face and saw a stranger. Maybe she really didn't know him.
Luka heard Maggie leave the curtained off area but couldn't bring himself to look that way as Sean and Bob followed her. "Todd, why don't you help me get Carter undressed." As Luka started to cut Carter's shirt away, he looked at Colleen and with his eyes asked her to step away to give the men some privacy.
Maggie walked as quickly as she could to the back office. She wanted to get away. How could she not have known? Why didn't he tell her? She slammed the door behind her on the faces of Sean and Bob who were following her.
(Lyrics deleted)
"What is Dr. Carter's condition?" Norman asked from his desk.
"He fell from a tree. He'll be fine." Maggie just didn't want to talk to him and cut him off, glad that Bob and Sean had come in to prevent her from strangling the thin necked accountant.
"I will need to notify the Foundation of this," he succinctly told the trio standing at the end of the office.
"That's not your job," Sean gave him with backbone.
"This could change things."
"It's NOT your job," Maggie spit out as she walked up to the man. "Carter is fine, and when he wakes up he will make the decision on who gets called, if anyone."
"Can you give us a moment, Mr. Tyson?" Sean asked politely
"I'll be finished up here shortly"
"Get out, Norman," Maggie snapped at him.
With that, Norman bustled out through the side door not wanting to walk near Maggie who was parked on the table near the main exit to the clinic area.
"You didn't know, Maggie," Sean tried to reassure her after Norman had closed the door behind him, "he'll be okay."
"Did you?" she asked Sean. "Did you know?"
"Yes. He had to disclose his background information, but it's confidential."
"And you, Double-Oh-Seven," she pointed to Bob, "you knew?"
"About the stabbing back in the states, yes. And what happened in the Congo, but not the addiction part. But it makes sense now. He can withstand… "
"What?" Maggie stood, now with even more unanswered questions. "What happened in the Congo? And what the hell is going on here with Kovac and Carter and their secrets?"
"Look, Luka and Carter have a special bond that only people have who share a deep, emotionally scarring experience." Sean gently put a hand on her arms crossed in front of her. "You and Luka need to work things out, eh? When all of this has passed, you can sit down with Carter and talk to him."
"Why didn't he tell me?"
"You know him well enough to understand that he is not the type of person who shares the bad stuff in his life. He just doesn't dwell on it, at least not openly. Give him time. Let him tell you on his terms."
Before Maggie got a chance to pry more information from Sean, a nurse stuck her head in the door to announce the arrival of an injured refugee.
Once they were alone, Luka started getting Carter's blood stained and soiled clothes off of him knowing that as Todd helped, he would see more than he was ready to explain. First off was the shirt. Luka cut the t-shirt away, careful not to poke Carter's throat or cut the IV lines. The two were quiet in their work. It was par for the course with the nervous Todd whose self confidence measured in the red. He was uncomfortable enough in a hospital-like setting, let alone that he was undressing his superior who he both looked up to yet who also made him tuck his tail and scat.
"Bring his knees up," Luka mentioned as he unbuttoned Carter's pants. "It's easier to slide them down over his hips, then straighten them… there you go." To get the shirt out from under him, they had to roll Carter once more. Luka watched as Todd saw the scars of Carter's past for the first time. Words formed on the young man's lips, but it was like his thoughts and questions stalled inside his head.
Luka had been keenly aware of Todd's unease and tried to reassure him. "It's okay. Those are just scars. They aren't hurting him now." Then to himself he thought that with all the narcotics in his system, Carter wasn't feeling anything at all.
"Will he sleep a long time?"
"He'll be out from the medication for a few hours. And then he'll probably sleep deeply for several more after he initially awakens."
"Won't he…, I mean is he going to, um, …" Todd motioned to Carter's mid section. "How will he, um…"
"Go to the bathroom?" Luka finished for him. "I'm going to put on something called an external catheter. It goes on like a condom." Todd's face blushed at the mention of that. "And his urine will drain into a bag." As Luka finished with this task he took Carter's vitals one more time and covered him with a sheet.
Todd had taken a seat to the side strangely not wanting to leave Carter. "How did he get those scars?" he asked meekly.
"The two big ones are stab wounds. A psychotic patient stabbed him."
"What about those other ones?" Todd asked as he cleared his throat wondering if he was overstepping his boundaries.
"A few months ago he and I were kidnapped in the Congo and held for about a month. Those other scars are from whippings." There, he said it. Didn't hurt to tell the kid.
"You have them too?"
"No," he said in almost a confessing manner.
A commotion outside of the curtains surrounding Carter's bed grabbed Luka's attention as he went around the corner to see what it was about. A child had been carried in with injuries and even though a nurse was returning from the office with Maggie, he wanted to be there as well.
"Todd, I have to tend to an emergency out there. Watch Carter, and if he looks like he's going to vomit, turn his head, okay?"
Todd's eyes widened as he mechanically acknowledged Luka's orders.
A soldier who commonly walked the perimeter of the camp carried the boy to a table. He was familiar to them. A boy who played with Mbuto and Joseph and was one of the stand out soccer players. Upon initial exam it was apparent that he suffered multiple fractures including his legs, hip and possibly his pelvis.
"What happened?" Luka asked as Maggie stepped in to help.
Wide eyed and scared, Joseph came to Luka's side. "We were playing football. Mani kicked the ball away and ran with it. He kept kicking it and it went over the fence." Joseph tried hard to control his tears. "We told him not to, but he went around the gate to get the ball. He ran into a car."
Even with both doctors and the nurses bustling around doing what they could, the boy's injuries kept mounting. His abdomen was rigid from blood loss, they didn't need to tap it to find that out. As Maggie checked the boy's head she could feel the edges of fractured bone. His eyes were fixed and dilated. Blood and brain matter came from both ears. There were no spontaneous respirations, only agonal breathing.
"Dr. Kovac?" Todd had stepped into the emergency area. Immediately his eyes went to the boy and recognized him as one of his soccer players. "I, um, I think I need to ask you a question." He wanted to stay and see to the boy, but he had pressing matters.
"Not now, Todd," Luka answered.
"Go." Maggie motioned to the boy's head. "I think I can handle this."
Luka took her hint and checked Mani's head out as well, coming to the same conclusion.
"Dr. Kovac, I don't know…" Todd tried again.
"Is Carter vomiting?" Luka cut him off.
"No, but…"
"Then get back to him. I'll be there shortly." Luka's head did a mental break down of what was going on around him. Carter lay unconscious not far from him, the only other doctor in the camp was close to stringing him up by his Croatian balls, one of the camp boys lay dead in front of him, his mother stood to the side as Joseph wept telling her in her native French that Dr. Luka the Wonder Doctor would save her son, Mbuto stood like a statue taking it in but showing absolutely no emotion, and Colleen was annoying everyone as she callously took pictures of the scene.
"Please," he barked at Todd. "I'll be right there." Turning around as Todd went back to Carter, he caught Colleen as she paused to change out cameras. "Stop. Just stop. This is not the time."
"Oh come on," she remarked with excitement, "this is good stuff."
Colleen was tall, she was a woman who made her presence known in more ways than one. But that day, at that time, Luka was the one who decided what was 'good stuff' and what wasn't.
"I am about to tell that mother that her son is dead," Luka told her very quietly just a few inches from her face, "then I have to explain to those children why I couldn't save their friend. One whose own father was assassinated so close to me that his brains splattered on my shirt, and the other boy who came here so devoid of emotion and had just started coming around now going back in his shell. So no, this is not good stuff."
With the doctors standing idly no longer working on her child, the mother had no more need for Joseph to translate. She knew. Her boy was dead and she knew. Moms know these things. She felt it and ran to him throwing her arms over the lifeless body, wailing, wanting that one last moment but gypped out of it.
Joseph sobbed not caring who saw the growing boy's tears. He wanted to feel his own mother's arms around him as he felt the sudden shock of losing his father all over again. In stark contrast, Mbuto was the only one in the room seemingly disconnected from the emotion, taking it all in as an objective observer - unaffected. Maggie cocked her head at the boy's stone cold face, taken by his distance.
"He was like that in Bunia," Luka explained. "He's seen it all. He's never had that connection like Joseph did with his own father." As he grabbed Maggie's attention and her own eyes, Luka kept his voice down. "You have to love and be loved in order to express sadness."
Paulette stepped away to look in on Carter and quickly returned motioning for Luka. "What is it Paulette?" he asked in defeat. She couldn't find the right word but opened and closed her hand in a repetitive motion.
It took Luka a moment to realize just what she was mimicking, then bolted away from Colleen and around the curtains. Todd's face was tense, beads of sweat dripped from his brow, and his hands shook in nervousness as he squeezed the ambu bag covering Carter's nose and mouth, breathing for him.