First, Do No Harm by Chesley Richards

First, Do No Harm by Chesley Richards

I had a $10,000 gambling debt. I was a rising 5th year surgery resident, with a year more before I would be on my own and making real money. I convinced myself that I could earn enough then to pay everything off. But the man I owed the money to, Earl, didn’t see it the same way.  He wanted to be paid soon. Too soon. I was in deep trouble, and I probably wouldn’t be here today if a friend hadn’t made me an offer I couldn’t refuse—to moonlight for him over Memorial Day weekend. For one weekend of work, I could pay my debt to Earl—a big, violent man, with a tattoo of the devil on his right shoulder and a single pearl earring in his left earlobe. Earl the Pearl.

I had already worked a 12-hour shift at the hospital once before, on a weeknight, and it had been a piece of cake—I slept that night without interruption. Far easier than being on-call in my teaching hospital in Atlanta.

Julie wasn’t happy about it. She had been looking forward to some time together and some rest. When I told her about taking the shift, she threw plates, smashing them on our terra cotta kitchen floor. First, she thought maybe I had another woman on the side, but I convinced her that wasn’t true. I patiently explained that I was just worried about money. Technically true.

I never told her about my gambling debt. She knew about my poker games. Those had been going on since I was an intern, but I had lied once when I lost and that lie had been perpetuated through the years. I didn’t want to disappoint Julie after all we had been through together. I didn’t want to admit to her that I had a habit I couldn’t control.

&  & &

The hospital was a two-story building built in the 1950s with about 50 beds, all located on the second floor. Only one-third of the beds were occupied, and the hospital was losing money. Small rural hospitals were beginning to close back then, and this one was at the top of the list for closure. The E.R. was in the rear of the hospital—a single room with four stretchers, cabinets and a counter running down one wall, a big sink, and the necessary equipment to handle the most common emergencies.

Patients entered the E.R. by driving around to the back of the hospital. In the rear was a loading dock for the occasional ambulance and a set of concrete stairs for patients who came by car. Entering through an automatic sliding glass door brought you into a waiting area adjacent to the E.R. A thick, heavy wooden door separated the waiting area from the E.R. Being in the E.R. with the door closed felt a bit like being in jail. Or a tomb.

From 7 a.m. until 11 p.m., the waiting room was manned by a clerk, checking in patients as they arrived. The clerk went home at 11 p.m., so the emergency room was locked. After 11 p.m., patients pressed a red buzzer beside the automatic door to call a nurse down from the second floor. Then the patients sat in the waiting area until the nurse arrived.

On Saturday, I arrived around 7 a.m. after the 2-hour drive from Atlanta. There were three patients to see right away: a 3-year-old with a rash and a fever, a woman with diarrhea and an old man who had a bad cut on his back from a bar fight. The baby had a classic case of roseola, so I reassured the mom and sent them home. The woman got some I.V. fluid and medicine to settle her stomach.

The man’s laceration was deep.  On the skin surface, I could use non-absorbable nylon sutures to close it up. The sutures could come out in a few days. We had plenty of nylon sutures in the E.R.  But in a deep wound like this one, the internal sutures needed to eventually dissolve, when everything healed up inside. The deeper part of the wound was the hard part, and I used up all the absorbable suture thread left in the E.R. fixing up the old man. Around noon and with no more patients waiting, I was free for a while.

I went to the on-call room at the end of a long, dark hall on the second floor. The hall was quiet, like a mausoleum. The on-call doctor only had to emerge from the room when the nurses called. The on-call room had a bed, a TV, an old worn leather chair and a small wooden table. Sparse, but comfortable. It felt like a comfortable jail cell.

I went down to the hospital cafeteria to eat lunch around noon. All my meals were comped as long as I ate in the cafeteria. There were only six tables and about ten people having lunch, a few nursing assistants and some visitors. I sat at a table with the hospital security guard and two local cops who dropped by to eat lunch and chit chat. The conversation quickly turned to me.

“Hey doc, how come your spending Memorial Day weekend with us?” the security guard asked.

“Money,” I said.

The men chuckled at first but then they got deadly serious.

“You ever been here on Memorial Day weekend?” one of the cops asked.

“No.”

The three men looked at each other with a look of dread.

“Well, I hope for your sake it’s quiet,” the security guard said.

“Over a holiday weekend lots of gunshots, knifings,” the older policeman said matter-of-factly between bites of his fish sandwich. “Especially down at the lake. Lots of drinking down there, lots of mischief.”

“Well, I work in Atlanta at the biggest trauma center in the state,” I said. “I’m used to it.”

The three men looked at me smiling.

“When things get out of control here—it’s more like a war zone. Families don’t wait to get their revenge. They come here,” the security guard quipped.

& & &

The rest of Saturday afternoon was quiet and slow. I couldn’t find much on T.V. I was still thinking about the lunchtime conversation. I couldn’t shake the peculiar dread that the three wise men had filled me with. Before dinner, I called Julie to check on her.

“I’m still mad at you,” she said defiantly.

“I know. But this job will catch us up.”

“I still don’t see why you must work. You work hard enough. For God’s sake, take some time off. We need to enjoy what little time we have before the baby comes. And what are you going to do when the baby comes—you going to leave it all here for me to do?”

“No. I will be there, Julie.”

“No more poker games. I mean it. Something has got to give. I need you here more.”

The guilt hammered me. My lies were building up.

“Your right. I will give them up. Promise.”

“Well, I’ll calm down and I love you. You know that.”

“I know sweetheart. And I love you too.”

“I’ll get over it. Just get some rest. I’m going next door tonight. Betty said their going to have a cookout.”

“Wonderful. Have fun.”

“You know what happened after you left?” she asked, her voice a little lighter and sweeter. “Our baby, she kicked just after you left. Whew, really popped. She’s going to be strong girl.”

“Just like you, sweetheart,” I said.  

& & &

The evening meal was a traditional southern supper of barbecued pulled pork, rice with hash, corn on the cob, peach cobbler, white bread with sweet pickles, and sweet tea. I sat with the nurses this time and listened to their gossip about who was seeing who without feeling the need to comment. I mostly thought about Julie.

The evening was drearily slow. Around 11:45 p.m., I wandered down to the nurse’s station and started gabbing with the nurses and the security guard. After midnight, I don’t remember exactly when, the E.R. buzzer went off. Repeatedly. It activated up at the second-floor nurse’s station. Thelma, the security guard, and I ran down the stairway to the E.R.

A nurse and I entered the waiting room to find a hysterical woman yelling that her boyfriend had been shot. At the loading dock, a little red Toyota Corolla sat with emergency flashers blinking and interior lights on. I could see a man in the back and lots of blood on the beige seat. I pushed the red button outside by the automatic door and the intercom came alive.

“This is the nurse. How can I help you?” came over the intercom.

“We need help down here in the E.R.  Now!” I shouted.

Stifling humid night air greeted us as we jumped down from the loading dock and walked to the car. In the back seat, we could see a man in a white T-shirt soaked with blood, his chest heaving with a death rattle. We pulled him out and carried him into the E.R. We laid him on the first stretcher as a second nurse ran in as I pulled on surgical gloves. Thelma attached cardiac electrodes to the man’s chest and a device on his left index finger to measure the oxygen in his blood. The other nurse attached a blood pressure cuff to his now flaccid right arm.

“Blood pressure—40 over nothing, pulse 140,” she said.

I saw two holes in his chest, each bleeding. Frothy, pink bubbles came out of his mouth with his ever-quickening breaths. The bullets had ripped through his lungs. His lifeless eyes stared straight ahead. The small wound over his right collarbone appeared to be a bullet entry wound as did the wound right under his breastbone, into his stomach, the contents of which were squirting out, mixed with blood, with each labored heave of his chest.

“No blood pressure,” Thelma yelled.

She inserted an I.V. into his right arm, running the I.V. fluids wide open. I reached for the big metal multi-drawer emergency cart. I found a laryngoscope, the metal device to stick in the guy’s mouth so I could slide a tube into his lungs and put him on a ventilator. His lungs were filling with blood, and I needed a way to suction them out while also keeping him breathing. I inserted the endotracheal tube down his throat. Frothy, foamy bloody mess squeezed shot out of the tube and onto my gloved hands. My gut told me he was going to die and there wasn’t anything I could do to save him.

We suctioned out as much as we could, but the man’s breathing was faster and faster, and the oxygen in his blood continued to drop. His blood pressure came up at first but dropped again. His heart rate dropped. 140-100-70-40. And then his heart stopped. He was dead. Sweat poured off my forehead.

My attention turned quickly to a new commotion in the waiting room. The security guard and a nurse’s aide were helping a tall man through the automatic door into the waiting area, his arms draped over their shoulders. The bloodstain on his t-shirt was spreading, all over his belly. I eased out from the dead man on stretcher 1 and met the next victim at the E.R. door.

“Hey, doc. I got a gut shot you need to patch up,” boomed the guy, about half a head taller than me as he stumbled, near collapse.

“Stretcher 2,” I said quickly, seeing the outer door open again and a third man walk in holding a bloody towel wrapped around his left hand. Thelma helped the security guard take the second man to stretcher 2 and she started working with him.

“Doc, we need you over here!” the security guard called out.

I turned and saw on the telemetry unit that the second man’s blood pressure was 90, and his heart rate was 150. I ran over and felt his belly. The gunshot wound had intestine protruding from it. His belly was tight and dull when I thumped it. Internal bleeding, I suspected. He would be dead soon too if we didn’t get him stabilized.

The third guy stood in the middle of the waiting room.

“Nurse” I yelled. “Go get the man in the waiting room and put him on stretcher 3!” I reached behind me and pulled a curtain closed between the second and third stretchers and then I turned my attention back to the man on 2 with the belly wound.

“We need a couple of big I.V.s in him. Run them wide open. Can we get a surgeon in town to come in?”

“No, sir,” Thelma replied. “Not in time. The only real surgeon still living in town is at the beach, and the nurse anesthetist is sick.”

“Then we’re going to need to transfer this guy to the regional hospital ASAP,” I said. “He’s going to need to be in surgery in under an hour.” 

I went to the 3rd stretcher. A disheveled man was sitting still on the stretcher. The nurse had already cleaned his wounded hand as much as she could, covered the wound with a thick cotton pad, and wrapped it tightly in place. His blood pressure was a little high, and his heart rate was okay. He wasn’t complaining too much. He reeked of alcohol.

“Sir, what’s your name?” I asked.

“Bobby Monroe.”

“What happened, Mr. Monroe.”

“I got shot in my hand. I think the tip of my thumb might be gone.”

“Let me see it.”

“Listen, doc, just fix up my hand quick like.”

“Well, I need to see it first,” I said as I pulled back the bandage. The guy’s left thumb was gone. Blood spurted out—bright red arterial blood pulsing once a second. I used forceps to squeeze off the bleeder. There’d be no salvaging this—I just needed to close up the stump.  I pushed some sterile gauze down into the hole where his thumb used to be. He winced but didn’t object. Then I injected anesthetic. The tendon that was ripped out with his thumb left a big void deep into his hand and I thought I needed some of the absorbable suture to sew it up on the inside. But we had used that up with the old man in the morning.

“Okay, now listen. I’ve put some numbing medicine in the wound and it will take about ten minutes to get numb. Then I’ll irrigate it to get it cleaned out and put stitches in to close it up. We’ll give you plenty of pain medicine. Sound okay.”

“Yeah, doc. Just hurry.”

“Doc!” the security guard said as he walked up, huffing and puffing.

“What?”

“Listen,” the security guard’s words spilled out like the blood I was seeing everywhere. “I found out from the lady who brought in the first guy, the one who died, that all these folks came from a big shootout down at the lake. A poker game that went bad. More on the way. I’m not sure if they’re dead or alive. And their families are showing up too.”

“Okay.”

The guard’s eyes grew wider and became fearful when he looked at Bobby. The guard looked as if he wanted to say something but then he backed away and went back to the waiting room.

My attention turned back to Bobby. “We should have you out of here in about thirty minutes.”

“Well, if you can do it a faster, that would be better,” Bobby said.

“I’ll try. I need to check on the other guy. Excuse me.”

I checked on the 2nd guy. His blood pressure was low but stable, and both I.V.s were running. He was moaning from the terrible pain he was having. We already knew with the internal damage he would need surgery, so we gave him a heavy dose of pain medicine. I called the regional hospital, got a surgeon on the phone, and relayed the situation. We had already arranged for an ambulance to transport the patient 2.

More cars squealed into the parking lot outside.  I heard voices outside in the parking lot—loud and excited—talking about the shooting. I couldn’t make out what the people said. I just caught snippets here and there of conversations filtering in from the waiting room. There was yelling. Cursing. But I was back behind the curtain working on Bobby so I couldn’t see what was going on.

The security guard, a fat seventy-year-old guy past his prime, had been a policeman for almost forty years before he retired. He came back to me after a few minutes.

“Hey doc…”

“I’m swamped. But, okay, what’s up.” I laid Bobby’s hand gently on the metal table beside his stretcher. “Bobby, I’ll be back in a minute.”

“Okay Doc. Just get on with it,” Bobby said.

I motioned for a nurse’s aide to come back and set up a tray so I could sew up Bobby’s hand. Then the security guard and I walked out of the E.R. and into the hospital main hallway where three freshly arrived corpses from the lake were parked on hospital stretchers. The bodies were covered with white sheets and plastic bags filled with melting ice. The coroner would be coming soon to look them over. The body closest to us had a large blood stain on the white sheet where his face should be.

“Doc, that guy on the third stretcher in the E.R.—did he tell you what happened?”

“You mean Bobby? No. Why?”

“Did he tell you who did the shooting?”

“What’s your point?”

“Doc, it was him. Got a bad reputation. Real loser. The folks just arriving keep saying his name. but they don’t know he’s in there with you. If the folks in the parking lot find out he’s in here, they aren’t going to wait for the police, or a judge or jury. You get my drift?”

“Bobby? Wouldn’t the shooter be running away?”

“Well, he’s the one and he’s here.”

“So, what do we do?”

“Go back in there and stall him, and I’ll let the Chief know. When Bobby does come out, we going to need to get him out of here, quick. Probably down to Atlanta. For his own protection if nothing else. Just hope to God no one finds out before then.”

I turned away from the security guard and headed back into the E.R. When I walked around the third curtain, I stopped cold. Bobby had a nickel-plated pistol pressed against the nurse’s aide’s head. My pulse started to race. My palms sweated profusely. A surgeon with sweaty palms is an accident waiting to happen. Bobby looked at me.

“Doc don’t talk. I told you I need get out of here,” he said slowly. “I came here because I couldn’t stop the bleeding. Now put a couple of goddam stitches in and give me a bottle of pain pills, and I’ll get out of here.”

I put on surgical gloves, but I was shaking almost too much to sew. For expediency, I decided to sew up the deep wound in his hand with a few nylon sutures—it wasn’t medically correct, but I doubted it would matter now. Then I tried to close the surface with a quick single line of nylon sutures. He still had the pistol barrel pushed against the aide’s head.

“You got to let her go,” I said.

Bobby relaxed, and the aide walked away. I should have told her not to say anything. As she cleared the stretcher, she ran for the E.R. door.

“He’s back there with the doc,” she blurted out. “The guy who did the shooting!”

Bobby looked at me with a look of resignation.

An ambulance drove into the parking area. The driveway outside was so crowded that the ambulance struggled to reach the loading dock. The security guard finally directed enough people out of the way that the ambulance could pull in. The security guard came back into the E.R. and told the nurse it was time for the transfer. I heard that. Then he slowly pulled his revolver out and held it straight in front of him as he walked towards us.

I could see him clearly through the curtain, but he couldn’t see me. And he surely didn’t see Bobby. In one swift fluid movement Bobby fired three quick shots through the curtain. The security guard fell dead with a sickening thud on the cold tile floor. Screaming spread through the waiting room and out into the parking lot. Someone slammed the E.R. door shut. We were all prisoners now.

I looked at Bobby. He was nearly bald, scrawny and short. He had a Nazi swastika on one side of his pencil thin neck and a cross on the other side. I didn’t know what to say to him. I could hear the E.R. door open and I leaned out a little bit to see who was at the door. A 12-gauge shotgun poked through the door opening followed by a six-foot-four-inch tall, heavily muscled, black police officer. He walked through the door with the gun pointed our way.

“Doc, you okay?” he called out.

“Yes. I’m okay.”

“Bobby, this is Chief Delroy Carter. We need to send the ambulance crew in to pick up the guy on 2. You stay still now. No use to kill anyone else.”

“Long as you all don’t come near us, I’ll play nice,” Bobby answered. “And I can see you through the curtain, Delroy. I see that shotgun you got pointed at us. You shoot that damn thing at me you’re going to kill the doctor too.”

“Bobby, I’m not planning to shoot anyone just yet.”

No one mentioned the poor security guard laid out on the floor. He had stopped breathing, and he wasn’t bleeding anymore. The EMTs rolled a stretcher in and quickly loaded the second patient up. They rolled out without incident, and a siren could be heard, gradually diminishing as the ambulance sped away. The big wooden door shut. I was alone with Bobby and two dead bodies—stretcher 1 guy and the security guard—and lots of blood.

“Well, doc. It’s just you and me,” Bobby said with his gun pointed at me.

“Yeah,” I said.

“Is there a way out of here without going through that waiting room?”

“No. Just the door out into the waiting area.”

“Well, hell. How we going to get out of here?”

“Do you want to live?”

“Yes.”

“Well, Bobby, surrender.”

“And I’m supposed to just walk out of here?”

“Right.”

“Shit.” He dropped his head for a moment, staring at the floor. “What’s your name by the way?”

“John Block. I’m a surgeon.”

“Lucky me. Guess you fixed my hand good after all.”

“You’ll need surgery on it.”

“Doc, that ain’t happening. Once I give up, well, I’m probably done for.”

I could hear a commotion outside. Not just in the waiting room but out in the parking lot. Voices, and screams. Ranting. Someone yelling— “that bastard ain’t going to make it out of here alive.” A bullhorn and voices of authority telling the swelling, sweating crowd to calm down. All anger and venom and hate out there. And it was getting louder.

In the E.R., things were quiet at that moment. Bobby walked away from me toward the door to hear what was going on in the waiting room. I wasn’t sure why he did it, but I didn’t care. He had his back to me now, and I had my chance to do something. But what? Hit him with an IV pole? I’d probably miss and end up dead. I thought about what they drilled into us in medical school— “first do no harm”—and it stuck in my mind. Hell of a time to do no harm, I thought.

“Doc, did you say your name was John Block?”

“Yes. Why?”

Bobby turned around to face me, his back to the ER door. He had a weird smile on his face.

“You lost a bunch of money a couple of weeks ago in a poker game down in Atlanta, right?”

“Yes,” I said, stunned.

“And you’re late on your payments. Yep, it is you. I got a call from my buddy down there, Earl Ledbetter, to scare you a little bit. With all the commotion tonight, I forgot about it until now. Well, shit.”

“What were you going to do to me, Bobby. Hurt me? Kill me?”

“No, I wouldn’t kill someone for being $10,000 in the hole. That’s more like broken arm territory. Maybe for you as a surgeon I’d break a couple of toes or something. Wouldn’t want to mess up your livelihood.”

“I guess we’re both in a mess then,” I said. I was shaking now. Uncontrollably. Sweat was pouring down my face, my back, into my underwear. I felt hot and sick.  

“Bobby, listen, there is only one way to get you out of here alive. One way. Just surrender.”

“What the fuck? Doc, you don’t get it. I’ve been in the state prison a couple of times already in my life. They’ll either fry me this time or lock me up for good. And being locked up is worse than dying. So, if there ain’t no way out of here, I just need to end it. Face up to it like a man. Now, what about you?”

“What about me?”

“What’s your excuse, doc?” Bobby said. “Earl showed me a picture of your pretty little pregnant wife. Told me to go after her first, but I told him I don’t do shit like that. She ain’t done nothing wrong. But I’ll be out of the picture soon. The guy Earl sends next to collect won’t give a shit. He’ll hurt her. Bad. You’ll lose that baby I bet. Maybe her too.”

I felt numb.

Bobby smiled. He reached out to shake my hand.

“Doc, you’ve been nice to me tonight. Didn’t treat me like a low life. Just treated me like another human being.” Bobby stared at me for a long while but didn’t say anything else. His eyes reddened, and a tear slid down his cheek. We were both sitting on the floor by this point, the weight of our individual demons pressing us down. Time seemed to stop for a while. We talked.

The crowd was loud outside and police cars from all over were rolling in. Bobby and I could hear guns in the waiting room: being loaded and cocked.

“Boy or a girl?” Bobby asked.

“Excuse me?” I said.

“Are you having a boy or a girl?”

“A girl.”

“Doc, I don’t have no wife or children. Got no one to speak of.” Bobby pulled out a wallet buried deep in his back pocket. The wallet was worn and tattered, and bulging with hundred dollar bills. He opened it and took all the cash out, handing it to me. “That should be enough for my burial. I lived a sorry life. I would like to be buried somewhere nice. It would give me some peace.”

I took the money. It was $10,000 and change. I nodded to Bobby that I would see to it.

“The second thing is that I want you to go meet Earl on Tuesday, after the holiday. Hand him this key. He will know what to do.” Bobby pulled out an old safe deposit box key from his pants pocket and handed it to me.

“I won’t have the money by then,” I said quickly, worried about my own fate with Earl.

“Won’t matter. Just go see him with the key. He won’t do nothing to you. Not with that key. Promise.” I took the key and nodded again.

“And the third thing?” I asked.

“Doc, don’t gamble no more. Be a man and give it up.”

I shook my head. I couldn’t speak.

Bobby sat still for a minute as the knocking on the E.R. door started and the Police Chief shouted to us that he was coming in.

“You know doc, it’s a relief,” Bobby said quietly.

When Bobby pulled his hand up with the gun cocked, I closed my eyes. The gunshot was loud, and I heard a sickening splatter of brains and blood on the wall behind him. The E.R. door flew open, and a blur of people rushed in. I opened my eyes to see Bobby, lifeless, with his hand having fallen down by his side. His face with a slight smile, his eyes still open. The bullet entered under his chin and had blown out the back of his head onto the wall behind him.  

I don’t remember much after that. They took me to the Regional Hospital for an evaluation and I stayed there for 24 hours. I got to call Julie, and her folks came to stay with her until I got home.

On Tuesday after Memorial Day Monday, I slipped away from work, to go meet Earl at the Stardust Diner in downtown Atlanta. He was a big man. Tall, muscular, tattooed. His left eye was scarred from a knife fight. He had a pearl in his left earlobe. We sat quietly in a booth drinking coffee. He asked about Bobby. I told him the story. He shook his head.

“Bobby was my best enforcer. He didn’t fear nobody. Going to miss that old boy.”

“He wanted me to give you this key,” I said as I slid it across the table.

Earl looked at the key for a moment before he picked it up. He studied it and then put it in his left pants pocket.

“Well Doc, it’s your lucky day. You’re off the hook. The key makes us even.”

“The deal?”

“Bobby always figured he would die violently. So, he told me that whoever brought me the key after he was gone—be decent to them. They were a friend.”

Earl got up and left without telling me any more about the key.  I sipped the rest of my coffee. Then I left to go make arrangements for Bobby’s burial.

* * * * THE END * * * *
Copyright Chesley Richards 2025

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2 Responses

  1. Bill Tope says:

    Excellent genre fiction. Good backstory, a protagonist who is seriously flawed by who overcomes his personal demons — we think — in the end. Exciting narrative, lots of action. Really enjoyed this; it was recommended by a friend with a keen eye for fiction. Well done!

  2. billy h tope says:

    Excellent pulp fiction. Good backstory on clearly flawed protagonist, who ultimately overcomes — we think. Lots of exciting action and a satisfying conclusion. I was turned on to this fiction by a friend with a keen eye for the genre. Nice job!

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