The Unexpected Hero
Rachel Lee
The Unexpected Hero
Rachel Lee
www.millsandboon.co.uk (http://www.millsandboon.co.uk)
Table of Contents
Cover (#ubb4316fd-4fe4-54e1-8d19-eed5334e97af)
Title Page (#ua98dee1e-2e98-508e-a2b9-c898ae988213)
Dear Reader (#uddd95dc5-ec88-5521-b54a-6136bfb3f8c7)
About the Author (#ulink_1603c15d-9c45-5f89-abe5-3a288ec97118)
Dedication (#ue13126d9-f5fa-5891-b8e1-57349ad5c74e)
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Chapter Six
Chapter Seven
Chapter Eight
Chapter Nine
Chapter Ten
Chapter Eleven
Chapter Twelve
Chapter Thirteen
Chapter Fourteen
Copyright (#litres_trial_promo)
Dear Reader,
The idea for this book was born out of my concern for some unsung heroes. We are aware of our combat vets, and the dangers they face. Too often we forget the people they depend on: the medics, nurses and doctors who face the same risks, the same horrors.
I cannot praise enough the military medical people I’ve known, from medics in the field (now there’s heroism), to those who function in field hospitals that are not always safe from attack. They risk their lives to bring relief and healing. I’ve never known a medic, a nurse or a doctor who didn’t also treat civilian casualties whenever they could.
And then there are the hospital ships. One of our greatest gifts to Indonesia after the tsunami was the presence of a hospital ship. We sent her and her wonderful facilities and staff to help the injured and sick, and many of these medical people ventured ashore, despite warnings that they could be targets of warring factions. These people bear scars, too. People who have devoted themselves to one of the highest callings: saving human lives. And they venture into places willingly where few of us would choose to go. God bless them all.
Rachel
About the Author (#ulink_2ba264e6-de52-5634-aa48-02f808ca5be7)
RACHEL LEE was hooked on writing by the age of twelve, and practiced her craft as she moved from place to place all over the United States. This New York Times bestselling author now resides in Florida and has the joy of writing full-time. Her bestselling Conard County miniseries (see www.conardcounty.com) has won the hearts of readers worldwide, and it’s no wonder, given her own approach to life and love. As she says, “Life is the biggest romantic adventure of all—and if you’re open and aware, the most marvelous things are just waiting to be discovered.”
To my editor, my agent and the many others
who help bring Conard County to life,
from copy editors to cover artists.
Chapter One (#u23b2ebd0-5109-5469-a66a-27cc6ca7daa3)
She thought it was going to be a good evening. Finally.
Kristin Tate, known to family and friends as Krissie, stood at the nurses’ station and looked out the window across the corridor at a view of purpling Wyoming mountains to the west as the sun settled for the night. It was, she told herself, good to be home in Conard County.
Six years in the navy followed by eighteen months at the VA hospital in Denver had thoroughly killed any taste she had for the so-called excitement of trauma care. If she lived the rest of her life without ever seeing another human being in that kind of condition, it wouldn’t be long enough.
But tonight, her first night on her new job at Conard County’s community hospital, it felt good to be in scrubs and facing a patient load of ordinary illnesses, and taking care of people who would recover.
A review of the charts assured her she would face no major difficulties: a kid with a broken leg in traction by himself in a room. An older man with phlebitis receiving anticoagulants. She’d need to check him frequently. A woman with congestive heart failure who seemed to be recovering nicely as her fluid retention diminished. A gastritis that should be ready to go home in the morning, along with a dehydration case and a man with diverticulitis on IV antibiotics.
Straightforward, likely totally uncomplicated. An easy night of checking up on patients who were getting better. God, what a relief that was going to be.
Julie and Nancy, the two licensed practical nurses sharing her shift, were off down the corridor, beginning to usher visitors out for the night. Both LPNs seemed nice, if terribly young, and she wondered if they were new to the area, or if she had somehow just forgotten them. It was possible. They would have still been kids when she left for nursing school, well beneath her radar.
And all these thoughts, she realized as she looked at the mountains, were thoughts designed to distract her from the familiar antiseptic smells that could so easily cause her to regurgitate memories of horrors best forgotten.
The sound of rapid footsteps drew her attention down the hall.
A man bore down on the nurses’ station looking a bit like a thundercloud. Dark-haired, dark-eyed, a bit rough around the edges, as if he were too busy to worry about things like haircuts and five o’clock shadow. He wore blue scrubs beneath a white coat. As she watched him approach, she saw her two LPNs glance at each other and dart into separate patient rooms. One of those, she thought, somewhere between amusement and impatience.
“Ms. Tate,” he said peremptorily.
She stiffened a bit at his tone, and scanned his name plate: Dr. David Marcus. She’d heard a new doctor had started since her last visit home, and this must be him. She forced herself to reply pleasantly, “Yes, doctor?”
“Before we begin, I’d like a few words with you.”
Okay, Kristin thought, as she followed him to an empty patient room. One of those. Big ego, martinet, wanting everyone to kowtow just so to him. Well, she’d dealt with that kind before. If he was the only thorn on the rose of this new job, she could handle it.
In the patient room, he tossed down a chart he was carrying on the bed and faced her from the far side. His brows lowered, making him appear angry.
“Close the door,” he said. No please or thank you. Forcing her face to remain empty of expression, she gave the door a quick tug. On its pneumatics, it swung slowly closed behind her.
Then, as a result of years of long training in the navy, she assumed the at-ease position: feet spread, hands clasped behind her back. That was the most she would give him.
“I read your jacket,” he said.
Kristin stared at him, wondering where the devil this was going? She had ample training and experience as a nurse and excellent recommendations. Did he have something against the navy? “Yes, sir?”
“I know about your experience. I know the conditions you practiced under, because I practiced under similar conditions years ago, with the army.”
And this meant?
“Yes, doctor.”
“I want to make it very clear that this is a different kind of medicine we practice here.”
“That’s what I was hoping.” She tried to smile, but her dislike for him was rapidly growing. Kind of sad, because he was actually an attractive man. Not that she wanted to be attracted to any man right now.
“The thing is, Ms. Tate, on severe emergencies, we stabilize and transport. The cases we have here are uncomplicated. They don’t require any extraordinary measures, as a rule, and they don’t require any creative treatment. I know what it’s like in a field hospital and in a trauma center, and I’m telling you right now, you will follow proper protocols at all times, and you will not step outside your legal responsibilities as a nurse.”
That’s when she began to simmer. Really simmer. Part of her wanted to take him on and ask what kind of yahoo he thought she was, what kind of nurse? Instead she kept her voice level. “Nurse practitioner,” she corrected.
“Nurse whatever, I don’t care. Your experience is all wrong for this kind of hospital, and I want you to be aware of it before you make a decision you have no authority to make. I want you to review protocols to re-familiarize yourself with the proper way to practice medicine. Are we clear?”
“Yes, sir!” she said smartly, when what she really wanted to do was crawl across that bed and shake him until his teeth rattled. Who did he think he was? And how dare he make judgments about her when he knew absolutely nothing about her or the way she worked?
“I will be watching you,” he said sternly. “Now let’s go on rounds.”
She followed him, feeling like a dog on an extremely tight leash, waiting for a command to sit or roll over. A nurse didn’t go on rounds with a doctor, didn’t trot after him this way. A nurse was supposed to be treated as a professional who could read a patient’s chart and follow the orders on it, not as someone who needed to be instructed on every step in the treatment plan, certainly not in uncomplicated cases like these.
With the patients, however, he was a different man entirely. Trying to swallow her anger with him, she watched as he spoke gently to the boy and to the older patients, showing genuine interest in everything they said as he checked them out and entered information about them on the computer that now held pride of place in each room, having replaced the old paper charts.
In the last room, however, things changed. Mrs. Hester Alexander lay on her bed, asleep. She was recovering from congestive heart failure. Her chart showed she had already lost about thirty pounds of excess water, and her urine outputs were subsiding as the edema vanished. Her heart monitor trace showed a slightly altered lambda wave, sure indicator that a heart attack at some point had caused enough damage to her heart muscle to lead to the arrhythmia which had caused the edema. The lady had been drowning in her own bodily fluids, but now was stabilizing at near normal. The arrhythmia was also being treated.
Dr. Marcus moved quietly, gently palpating the woman’s skin to test its sponginess. “That’s good,” he murmured. “That’s excellent. If she’s still doing well tomorrow, we may be able to send her home.”
“That’ll make her happy,” Krissie volunteered quietly. “Earlier she was talking about how tired she is of being here.”
For the first time, David Marcus smiled. “She’s been complaining about everything since she got here. She especially hates the salt-free diet.”
“We talked about that. I made her promise to give it two weeks, and assured her by then she won’t miss the salt anymore.”
At that he faced her. “She has to stay on this diet forever, not just two weeks.”
“I didn’t tell her…” Krissie trailed off as Marcus turned away. Her simmer rose a notch closer to boil.
“What’s that doll?”
“Doll?” Reluctantly, Krissie stepped closer to look across the bed. On the pillow, partially tucked under the blanket, was an awkwardly sewn doll, made of stuffed hopsacking. The eyes and mouth had been stitched of brightly colored embroidery floss. “The family must have left it.”
“It shouldn’t be in the bed. We don’t know what’s in it.”
At once Krissie stepped around him and removed it, placing it on the window ledge. She looked at it, feeling unnerved in some way. “It looks like a child did it.”
David Marcus came to stand beside her. “Yeah,” he said after a moment. “She doesn’t have any small children or grandchildren, though.”
“Maybe something she made when she was a child?”
“Could be.” With that, the doctor turned away, as if he were done with the doll. He typed a few things into the computer. “I want to cut her dose of diuretics by half and see how she’s doing in the morning. Start that immediately, and keep a close eye.”
“Yes, doctor.”
“If, for any reason, the change seems to cause the slightest distress, raise the dose immediately and call me.”
“Yes, doctor.”
Back at the nurses’ station, he began to scrawl notes in manila folders he apparently kept for his personal records. Krissie left him to it, walking the floor again to find her LPNs busying themselves tightening beds and talking to patients…in short, taking the low profile and staying out of the way.
Which told her a lot about Dr. David Marcus. The only question remaining was why he was such a pain. Was he an egotist? A perfectionist? Or was there something more?
And here she’d been thinking that she’d come home to calm and peace and a nursing job that wouldn’t wake her with nightmares. Boy, her dad was going to have a laugh at this. The former sheriff had warned her just last week when she’d finally come home for good, “Krissie, baby, the harder you look for peace, the more elusive it gets.”
Yup, he was going to have a major laugh at her expense.
David Marcus was still at the nurses’ station when she returned. She considered walking past and finding another place to busy herself, then decided that avoidance wasn’t going to solve the problem or make her situation with him any easier. Best to just act like nothing had happened.
She settled into the chair at the station, checking all the monitors and finding everything green. Even Mrs. Alexander appeared to be still soundly asleep. The poor dear probably needed to catch up on a lot of rest after what she had been through.
Dr. Marcus cleared his throat. Krissie reluctantly looked his way.
His expression revealed little, but he said, “I guess I should explain.”
Krissie remained silent. She wasn’t going to give this man an inch unless she had to. He wasn’t the only one allowed to get angry.
“Until about three years ago, I was in the army. Iraq mainly.”
The light in Krissie’s brain began to come on.
He looked down at the folders in front of him. “Ms. Tate, I know what we had to do in those field hospitals. Medicine gets invented under those conditions. And before medical school, I was a medic. I…just know that kind of experience can affect how we practice in the civilian world. Sometimes we do things that could cost us our licenses under normal conditions.”
At that Krissie gave him a nod. No more, just a nod. He was looking at her now, his dark eyes steady.
“The transition can be difficult. I know from personal experience. I should have handled this better, but sometimes…” He left the sentence dangling.
She understood a lot of the freight he was referring to, stuff that just stayed with you like coal dust in a rail car. She decided to meet him halfway.
Rising, she held out her hand. “Let’s start again,” she said. “Hi, I’m Krissie Tate. Nice to meet you, doctor.”
“Just call me David,” he said with a crooked smile, and shook her hand.
“Krissie,” she agreed. She even managed a smile. “Part of the reason I came home was because I don’t want to have to invent medicine anymore.”
He nodded and finally, finally, his face fully relaxed into a pleasant, even attractive, smile. “It can still come up to bite you. Take it from me.”
And there it was. He had been reacting to his own difficult transition and to his expectation she would have the same problem, perhaps even make the same mistakes. And he might be right, she admitted honestly. While time with the VA had helped ease her back, she hadn’t come back all the way, because VA hospitals were woefully underfunded and understaffed. She’d had to “invent medicine” there sometimes, too.
“Okay,” she said. “I’ll take the warning the way it was meant, not the way it was given.”
At that, a chuckle escaped him. “Fair enough,” he agreed. “I was heavy-handed about it, as if you’d already done something wrong.”
“I haven’t had time to mess up yet,” she said on a humorous note.
“And you probably won’t. It’s just that I know how long it takes to come back from all that adrenaline.”
“Meaning?”
“You walk in, you smell the antiseptics, the other things that you identify as hospital, and after years of experience in wartime conditions, the adrenaline automatically kicks in. We’re like Pavlovian dogs in that respect. We go up the instant the smells hit our noses.”
She nodded slowly. “I guess you’re right. But I spent the last year and a half at the VA in Denver.”
“Still stressful, even if it’s not as bad. Anyway, you and I learned trauma medicine under the worst imaginable circumstances. It’s not something you can shuck easily like worn-out clothes.”
“No, it’s not,” she admitted. “I felt it when I first walked in here tonight. I had to remind myself this is different.”
“Exactly. Anyway, I guess I was harsher and more critical than I needed to be by far.”
She pursed her lips. “You might say that.”
He flashed another smile, quickly. “The thing is, like it or not, we become adrenaline junkies after a while. That can affect our judgment. So just watch out for it. I found when I first came here that I had a tendency to magnify every symptom. If you’re not careful, every cold can look like pneumonia or lung cancer or TB. I know that sounds like a stretch, but I’ve run that course. Sometimes still do. Where we’ve been, nothing was ever as simple as it looked at first glance. Now we’re in a place where it most often is that simple.”
“I can see that.”
“I’m sure you can. Just remember, you’ve been conditioned to see things otherwise. Don’t run on automatic. Ever.”
With that, he picked up his charts and walked away, leaving her feeling as if, despite their friendlier conversation, she’d just been scolded again.
He had the most unfortunate manner, she decided. And was probably hypercritical, to judge by the way Julie and Nancy were trying to avoid him.
It was kind of funny, when she thought about it. Dr. David Marcus might have a bark, but at least he had the good grace to realize when he had crossed the line. And there were four other doctors in the joint practice that served the county and the hospital, so it wasn’t as if he was the only one she’d be dealing with.
That was the point at which she realized that peace could have another downside. With only six patients on the ward, she actually had very little to do. There were only so many times she could disturb them by entering their rooms, only so many treatments and checks to be administered, and with a twelve-hour overnight shift yawning in front of her, she would need to make work to occupy herself.
Quite a change. Quite a change indeed. One thing Dr. Marcus had been right about: she was used to being on adrenaline most of the time. The cases on this ward shouldn’t elevate her stress level by so much as a molecule.
A doer by nature, she decided to check the linen closet and supply closet for the routine needs of any hospital ward. She expected to find everything well-stocked, though. She wasn’t the only night shift nurse to have time heavy on her hands.
As she was approaching the linen closet, an orderly emerged from the nearby cleaning closet with a cart, pail and mop. He seemed startled at her approach, then took a wide stance, as if planting himself firmly. A young man with tousled blond hair, a too-thin body and a narrow chin, he watched her approach almost warily. He looked to be fresh out of high school, which would have put him well out of her milieu when growing up, and the kindest word anyone would apply to his appearance was “ordinary.” Poor guy probably had trouble getting dates.
“Hi,” she said as she approached. “I’m Kristin Tate, the new night nurse.” Something about him looked familiar, but then darn near everyone in the county looked familiar, even after all her time away.
“I recognize you,” he said. Then, as if making a decision he added, “Charlie Waters. You probably don’t remember me. We only talked a couple of times.”
She smiled. “Sorry, I’m still getting to know everyone again. Nice to meet you. I was just wondering what I’m going to do all night. Any suggestions?”
A shy smile lit his face. “I play cards.”
“Now that’s an idea. Maybe the four of us can play.”
“After I finish,” he agreed.
“Do you have a deck of cards?”
He looked down at his scrubs as if to say, “Where would I be hiding them?”
“Good point,” she said in response to his gesture. “I’ll look through the drawers at the nurses’ station. We can’t be the only folks who have wondered how to get through a quiet night.”
“Probably not,” he agreed. “But I have a lot of work to do. Bathrooms and floors before the patients go to sleep. After that?”
“It’s a date.”
Julie and Nancy joined Krissie in her tallying of the supply closets, then returned to the nurses’ station with her. No call lights, no monitor warnings. All the patients were happily watching TV or sleeping and, for the moment at least, experiencing no problems.
“It’s awfully quiet tonight,” Julie remarked.
Krissie perked at that. “You mean it’s not usually like this?”
“Absolutely not,” Nancy said. “We usually have a few more patients than this. More injuries, for one thing. And in August it’s strange to have only one dehydration case.”
“I’m not complaining,” Julie remarked. “When the ward is full, we hardly get a breather.”
“True that,” Nancy agreed in the slang of the young.
Julie hesitated, then said, “I heard Dr. Marcus riding you. Not what he said but…just so you know, he can be hard to get along with sometimes.”
Krissie wasn’t quite sure how to respond. There were certain rules of professional etiquette, and while she’d seen them broken countless times when some doctor or nurse was a pain the rear, she didn’t think she should encourage it her first night on the job.
But she didn’t have to say a thing. Nancy chimed in. “I try to stay out of his way, because you never know when some little thing will annoy him. But mostly he’s okay. I don’t think he means to be edgy.”
“I don’t think so, either,” Julie agreed. “Because he can be really nice sometimes. But other times, there’s this look on his face, and you know he’s uptight about something. So I just duck.” She gave a little laugh. “If he’s mad about something I did, he has to find me.”
Krissie couldn’t contain her smile. “Sometimes that works.”
“Yeah, you can’t really hide, being the charge nurse. Anyway, you’ll find he’s here a lot. The other docs all have families, so Dr. Marcus is on call most of the time.” Julie scrunched her face a little. “Sometimes I think he doesn’t sleep.”
Or maybe, Krissie thought, he has trouble sleeping. She certainly did, even after all this time. Nightmares seemed ready to pounce, and were one of the reasons she preferred the night shift. When she had a nightmare while sleeping during the day, she only had to open her eyes to see sunlight, and she had learned it dispelled those images quickly. At least most of the time.
“Anyway,” Nancy said, “it’s probably the war.”
Her comment was laden with the knowledgeable tone of someone who thought they knew. Krissie didn’t think Nancy could imagine the half of it.
They did find a deck of cards, however, and after ten, when the patients had all been checked on, medicated and settled, Charlie joined them. He remained shy, but Julie seemed to have taken a shine to him, making him blush with alarming regularity.
Charlie left at midnight, his shift over, and Krissie sent Julie and Nancy to take a break. They announced they were going to the cafeteria to meet up with some friends from other wings and would be back in half an hour.
Krissie was amazed to discover how relieved she was to be left alone for a little while. The ward was quiet, the call board remained silent, Hester Alexander’s heart monitor continued its steady rhythms.
One by one, she checked on her patients, moving soundlessly as she opened doors and looked in. Mr. Hedley was going to need a new IV bag of antibiotics in about an hour. Other than that, everyone seemed to be resting comfortably and sleeping deeply. Mrs. Alexander opened her watery blue eyes just briefly, then returned to sleep. Krissie silenced the monitor in her room. It was enough that she could keep an eye on it from the nurses’ station; no need to disturb Mrs. Alexander’s sleep.
The next couple of hours passed smoothly enough, and finally Krissie decided to take her own break, a half hour in the break room with her bagged lunch and another cup of coffee from the coffeemaker on the counter.
She had eaten only half of her turkey sandwich when her pager sounded. Julie. Dropping her sandwich on the waxed paper, she took off for the ward at a fast walk, just as the PA system announced a code and a room number.
She arrived a few seconds later on the ward to see Nancy waving at her from the door to Mrs. Alexander’s room. From the nurses’ station she heard the unmistakable warning from the cardiac monitor. Ignoring it, she began to jog down the hall, even though you were never supposed to run in a hospital.
“Cardiac arrest,” Nancy said quietly. Inside the room, Julie was hovering over the patient looking helpless. Damn it, an LPN should know better.
“CPR, Julie. Did you call the doctor?”
Nancy nodded. “Yes. He answered the page.”
“Julie, I’ll take over. Where’s the crash cart?”
“Getting it.” Nancy fled.
Flatline. It was a sight a nurse saw too often, but never wanted to see. She joined Julie at the bed and motioned to her to take the breathing bag, while she herself climbed on the bed, straddled the patient and took over the chest compressions. Each compression registered on the monitor, but nothing else.
Dr. Marcus and the crash cart arrived together, along with a crash team assembled from all over the hospital. The high whine of the charging defibrillator filled the room along with business-like chatter as the team acted.
“Intubate.”
Krissie paused in the compressions to allow the doctor to insert an endotracheal tube in the esophagus. He worked swiftly, and moments later the breathing bag was attached to it, again worked by Julie.
“Two hundred,” the doctor said, then to Krissie, “Off the bed.” He was holding the paddles and Krissie quickly jumped down. “Clear!” he said, and applied the paddles.
Mrs. Alexander’s body jumped, but the flatline remained.
“Push 20 ccs of sodium bicarb.”
Another nurse stepped forward with a syringe. “Pushing.”
“Give me three hundred.”
A jolt of three hundred volts was applied, lifting the patient half off the bed. Still a flatline.
Krissie climbed back on the bed and continued compressions, counting automatically until Dr. Marcus said, “Clear.”
She jumped down again and another shock was applied. Nothing.
“Epinephrine.”
A large syringe was slapped into his hand, and Krissie watched as he stabbed the needle directly into the old lady’s heart.
“Clear!”
Snap!
Nothing.
“Clear.”
Snap!
Still that awful straight line…
“Compressions,” Dr. Marcus said.
Krissie started to climb on the bed, but a male nurse beat her to it, giving her a break. Her arms were shaking. Her stomach turned upside down.
They called time of death at 3:31 a.m.
Chapter Two (#u23b2ebd0-5109-5469-a66a-27cc6ca7daa3)
David Marcus evidently had no desire to leave medical matters until morning. He sat at the nurses’ station while orderlies worked in Mrs. Alexander’s room, cleaning up the inevitable detritus of the code. In those moments where every second counted, items such as syringes and swabs went flying, along with their packaging. Mrs. Alexander herself lay carefully arranged beneath a sheet, awaiting whichever came first: a visit from immediate family or the trip to the morgue.
From moments of intense activity to absolute stillness. Krissie sat on a chair, staring at nothing. It didn’t matter how many times she saw this, every time felt like a personal failure.
“There wasn’t any warning?” David asked.
“I was in the break room eating my lunch when I got the page. The code was called right after that. You’ll have to check the monitor.”
“Wasn’t anyone watching it?”
“Julie or Nancy, I thought. But you can check and see if there was any warning.”
His face tightened and he looked off into distant space. “She was getting better.”
“That’s how it looked.”
“I guess we’ll find out from the autopsy. But damn.”
She managed a nod. “Why’d you push the bicarb?”
“Because she was on a potassium-sparing diuretic. There was a possibility that her kidneys hadn’t cleared enough of it so it was one of the first things I thought of.”
“I can see that.”
“Except that tests didn’t show anything wrong with her kidneys.”
“Things change.” Krissie rubbed her eyes, trying to hold back a tidal wave of despair. Before long, the second-guessing would set in. It always did and seldom helped. A lot of medical people, herself included, belonged to a secret society of flagellants, beating themselves up when they lost a patient they felt they shouldn’t have. Given another half hour, she’d probably be telling herself it was all her fault for taking a break.
“Damn it, David, we both know how fast things can change. She’d evidently had a heart attack in the past. Hence the arrhythmia that caused the congestive heart failure.”
“I know that,” he snapped. “And I was treating all of that. The arrhythmia, the edema…”
“I know.” She almost snapped back.
“Maybe I shouldn’t have cut so much diuretic.”
Krissie shook her head. “That change shouldn’t have caused such a big effect so fast.”
“No, you’re right.”
Astonished that he had so quickly accepted her judgment after snapping at her, she blinked and stared at him.
He turned to the monitor and hit the buttons to play back the hour before the attack.
“Coffee?” Krissie asked finally. Every nerve in her body seemed to be firing. “I can’t just sit here.”
“Sure. Thanks. Black, please.”
Forcing herself to stand, she walked back toward the nurses’ break room. She didn’t want to wonder if things might have been different if she hadn’t gone on break, if Julie and Nancy hadn’t been so obviously overtaken by the enormity of what they were facing. Training. She’d need to give them more training. They were little more than kids, really.
And none of those thoughts helped. A woman had died, and no one in the medical profession would ever be comfortable with that outcome if there was the remotest possibility they might have prevented it.
She filled two cups, paused to look at her sandwich, then, realizing she wouldn’t be able to eat it, swept the remains into the trash.
Back at the ward, she found David peering intently at the monitor. “There it is,” he said, when she came up and put the coffee beside him.
“What?”
“See that? Major slowdown. Like it just wound down.”
“Arrhythmia?”
“For about fifteen seconds before the slowdown. Easy enough to miss. The monitor should have alarmed.”
“Maybe it did. It was screeching when I got here, and Julie and Nancy were in the patient’s room.”
He nodded slowly. “It was fast.”
She scanned the playback as he ran through it again. “Awfully fast.”
“Looks more like SCA, sudden cardiac arrest.”
Krissie nodded. “Not much time to do anything.”
“No.” He lowered his head for a moment. “I need to call her family.”
The worst task of all, Krissie thought. “I’ll talk to Julie and Nancy, see if I can learn anything additional. For the report.”
He nodded. “Thanks. God knows what I’m going to tell the family.” He pushed forward on the ECG readout, then said, “It’s clear compressions were started in about a minute.” The spikes showed that clearly. “You weren’t too late.”
It struck her then that he was trying to let her know she couldn’t have done any more. His generosity, when he was sitting there blaming himself, was all the more touching. And totally unexpected after the way they had started.
“David—”
He cut her off. “I need to call the family.” He rose and strode away, looking lonely as only a doctor at a time like this could.
The phlebotomist emerged from Mrs. Alexander’s room with his cart, trundling all the blood samples to the lab. Moments later the orderlies came out, carrying away trash, pushing the crash cart with them to restock it and prepare it for another code. Then came Julie and Nancy, both with hanging heads.
“We messed up,” Nancy said as they joined Julie behind the counter and sat. “We called the code and called you, but we should have started CPR.”
“Yes, you should have.” But Krissie took pity on them, too. “I was there in less than a minute. Compressions started soon enough anyway.”
They nodded. “We never had anyone die before,” Julie said softly. “Never.”
Krissie looked at them, not knowing quite what to say. “It never gets any easier,” she managed finally. “Now just make sure Mrs. Alexander is ready to be seen by her family. I’m going to check on the other patients. If any of them awoke, they’re probably disturbed by this. Tomorrow, we’ll talk about managing these events a little better.”
Rising, she touched their shoulders in turn. “We learn from our mistakes. I still do. But there was nothing you could have done that would have saved her.”
The two girls nodded, but neither looked particularly relieved.
To her dismay, she found the boy with the broken leg, Tom Mason, wide awake and looking frightened. He was only ten. “Am I going to die, too?”
“Of course not!” Krissie pulled a chair closer to his bed. “You’re young and healthy. The person who died was very old and sick. There’s a difference.”
He nodded and allowed her to pat his hand as she sat beside him.
“I know it’s scary for you,” she said calmly. “It’s scary for everyone. But you don’t even have a heart monitor, which should tell you something.”
“Okay.”
She waited, giving him space to talk, to say whatever he needed to, but he remained quiet, as if trying to sort through things in his own mind his own way.
“Look,” she said presently, “Some people are sick and come to hospitals to die. Others, like you, just managed to break their legs jumping out of a tree, and they come here to get better. Before you know it, you’re going to be hobbling around on crutches and asking your friends to sign your cast. Just tell them not to use dirty words.”
At that, a shy smile peeped out. “Mom would be furious.”
“You better believe it. She’ll probably go get a can of white paint to cover it up. And what if she just keeps painting the rest of you?”
A tired little laugh escaped him. “She’d paint my bottom, and it wouldn’t be with a paintbrush.”
Krissie forced a grin. “You think she’d spank you?”
He shook his head after a minute. “She never hits me. She doesn’t have to.”
“Oh,” Krissie said knowingly. “The mother voice.”
“Yeah. And Dad says her looks can kill.”
“Oh, I know all about that. My mother never spanked me, either, but one look and I’d practically burst into flames or something.”
“I go hide. I hate it when she’s mad at me.”
“Somehow I think she doesn’t get mad at you often.”
“No,” he said with confidence. “I’m pretty good most of the time.”
“I believe you.”
He looked at her from the corner of his eye. “But she was mad when I jumped out of that tree. Especially when she saw my leg.”
“Probably more worried than mad.”
“Yeah, that’s what she said later.”
“Do you want me to call your mom, ask her to come in?”
He hesitated, then shook his head. “I’m okay. You’re right. I’m not old and sick.”
“No, you’re not.” She headed for the door, but when she got there, his voice stopped her.
“Can you leave the door open?”
She smiled back at him. “Sure. And why don’t you turn on the light on your bed and read one of those comic books. But don’t turn the TV on, okay? Not with the door open.”
“Okay.” He reached for a comic book from one of the stacks on the table beside the bed and flipped on the fluorescent light at the head of the bed. “Thanks, Miss Tate.”
“Just call me Krissie, okay? Can I get you anything? A drink? Jell-O?”
“I’m okay. Thanks.”
“Use that call button if you want anything.”
“I will.” At that he grinned, then turned his attention to the comic book.
Am I going to die, too? Outside, Krissie had to stop and lean against the wall, closing her eyes and reaching for balance. How many times had she heard that question from boys only a few years older than this one? From men, women and children. And how many times had she had to lie about it?
Am I going to die, too? The question haunted her nightmares. Bloody hands gripping her arm. Shattered bodies, shattered faces, shattered lives. Death riding her shoulder as if he were her partner.
God!
After a minute, she regained her equilibrium and was able to continue her ward check. Everyone else still slept, apparently unaware the grim reaper had paid a visit.
Mrs. Alexander’s son—a rawboned man who looked as if he had worked hard outdoors his entire life—arrived and went into the room with David, then emerged ten minutes later by himself, walking away with a tight jaw and reddened eyes. David came out a minute later and approached the station.
“She can go to the morgue now. They don’t want an autopsy.”
“But…”
“I told him we needed to do one anyway, to find out what happened. He said he doesn’t care what happened. It’s enough she’s gone, let her be.”
Krissie nodded slowly.
“We got the blood samples and we have the urine bag, right?”
“Yes, I saw the lab guys take it all.”
“Okay, then. We’ll have to rely on toxicology, a BUN test, the other tests I ordered. It’ll probably be enough.”
She understood, though. He wanted to know exactly what had gone wrong, and if the blood and urine tests didn’t show anything, questions would plague him for a long time.
He reached for the now-cold cup of coffee he’d left on the desk an hour ago and drank it down. Then he gave her a kind of cockeyed smile. “That was awful.”
“I can get you fresh.”
“Tell you what. Let me buy you breakfast at Maude’s. You get off at seven, right?”
“Right.” Part of her hesitated, saying no, this would be stupid, but another part didn’t want to go straight home, not after this night. “It’s a deal. I’ll meet you there as soon as I get out of here.”
“Deal. A little artery-hardening food is what I need right now.” Then, with a nod, he left.
The sun was already well up and growing hot when Krissie left the hospital shortly after seven. Dressed again in her street clothes, carrying her small backpack, she walked across the pavement to her car. Her eyes felt gritty, a sure sign she needed some sleep, but she’d toughed this out before countless times. Impatiently, she ran her fingers through her short, streaked hair.
As she started to pull out of the parking lot, a small wave of panic washed over her and she almost turned for home rather than downtown and Maude’s diner.
This was purely professional, she told herself. Two colleagues getting together to eat and unwind a bit before going home to bed. There was nothing to be afraid of.
But her recently defunct relationship had left its own set of scars, among them her fear and dislike of controlling men. That little outburst from David last night about his expectations of her as a nurse had been controlling. She still squirmed a little when she thought about it, but reminded herself that he hadn’t behaved that way during their encounters the rest of the night. Still, he had the potential to become a problem of the kind she had just shucked.
But only if she let him, she reminded herself. Keep it professional, keep it purely social and don’t let him get close. That was a recipe for avoiding trouble, one she intended to follow.
Feeling more comfortable about it, she found a parking space near Maude’s and walked the rest of the way to the diner. For some reason, Maude had added a Café sign to her window, even though the neon above announced City Diner. Not that it mattered, she supposed. Everyone still called it Maude’s, or Maude’s Diner.
Inside, wonderful aromas filled the air, and the clanking of flatware and the clatter of crockery joined the hum of early-morning conversation. Like many such places, the early-morning weekday crowd was composed mostly of older people, men, women and couples, who had no need to think about getting ready to go to work. Later in the day, the composition would change, first with the lunch crowd, then the dinner crowd.
David stood out: a man in his prime, maybe around forty, with dark hair that didn’t yet show a dash of gray. In his dark blue polo shirt and khaki slacks, he looked lithe and fit. He’d taken a table near the window and already had a cup of coffee in front of him. He started to get up as she approached, but she waved him back into his seat and then slid onto the vinyl-covered chair facing him.
Before she had a chance to say a word, a cup slammed onto the table in front of her and started to fill with coffee. She looked up and saw Maude’s daughter, Mabel; the younger woman was surely a clone of her mother.
“Good to see you back, Krissie,” Mable said as she topped off the mugs. “Menu? Or do you know what you want?”
Krissie knew better than to ask for anything unusual or healthful. This wasn’t a place for healthful eating. “Two-egg onion omelet and rye toast, please.”
Mabel nodded, then looked at David. “The usual?” “Please. With some extra hash browns.” “Got it.” Mabel sort of smiled and walked away, coffee carafe in hand.
Krissie smiled. “You’re going for broke.” “The hash browns, you mean? Yeah. I need every calorie I can get. I still have office hours, starting at nine.”
“You should be catching a nap then.”
“I couldn’t sleep right now.”
She looked down at her coffee, then across at him again. “I would have thought you’d have learned to sleep anytime, anywhere.”
“Because of being military?” He shrugged. “That used to be easier. You might not understand this yet, I don’t know. But the losses are harder now. Maybe because the patients aren’t usually in such a bad state.”
Krissie nodded slowly. “I guess I can see that.”
“Maybe you won’t feel that way. I hope not.”
“Too early to tell. So what’s your background?”
He sipped his coffee as if buying time to consider what he should say.
“Oh, come on,” she prodded. “You read my jacket. Fair’s fair.”
At that, he smiled. “Okay. I enlisted at eighteen, became a medic in time for Desert Storm. Bad enough, but I was still on fire with the desire to be able to do more to help, so eventually I went to college, got admitted to medical school. The army picked up the tab on my medical training in return for a six-year commitment. It was mostly okay. Until Iraq.”
“Yeah.”
“Same for you?”
She shook her head, biting her upper lip. “Not quite. I went to nursing school on scholarship and enlisted after I got my B.S. in nursing. The navy trained me to be a nurse practitioner, and the next thing I knew, I was in Asia on the USS Hope after the tsunami.”
“My God, that must have been awful.”
“Not my favorite memory. But after that, I was attached to the Marine Corps and served in Iraq.”
“In the field,” he said as if it weren’t a question.
“In the field,” she agreed. “Well, at bases with field hospitals.”
“Yeah, the ones they pretend aren’t at the front line.”
She lifted her gaze and saw understanding there. A wealth of understanding. “There is no front line.”
He nodded. “Exactly.”
Mabel returned and slapped their plates down in front of them. Krissie stared at hers, certain there had to be more than two eggs in that omelet. Plus there were hash browns she hadn’t asked for and four slices of rye toast.
David must have read her expression. He laughed. “I think Maude thinks you’re too thin.”
“Maude thinks everyone is too thin.”
Krissie glanced toward the window and caught sight of her reflection. She was a little under her fighting weight, and worse, she suddenly realized that the blond streaks in her light brown hair were growing out to the point that they no longer looked good. She experienced a moment of self-consciousness, then quickly dismissed it. She’d only applied those streaks because Alvin had insisted on it. He’d wanted her to go completely blond, but at least she’d managed to draw that line. Of course, with Al, it was his way or the highway. It had taken a while, but she’d finally chosen the highway.
Whatever had possessed her to stay for so long?
“Penny for your thoughts?”
David’s voice drew her back, and she looked at him. “Nothing,” she said. “Just a memory.”
“And thoughts are worth a lot more than a penny these days.”
David could be charming, she realized. That concerned her as much as their initial encounter. Control and charm had gone hand-in-hand with Alvin. Just like that, she went on high alert.
“What’s wrong?” David asked.
Perceptive, too. “Nothing,” she said firmly and turned her attention to her overburdened plate. Just the sight of all that food made her feel full, but she hadn’t eaten a bite. And since she hadn’t eaten her lunch during her break, she knew she was going to have to tuck in or get sick later.
She picked up a slice of toast, already buttered by the prodigious purveyor of fatty food herself, Maude, and took a bite. At least her stomach didn’t revolt. In fact, once the toast reached bottom, she began to feel hungry. A sip of coffee took care of the last of her revulsion.
David tucked in, too, and for a while, they ate in silence.
The tragic mood of the night began to give way to life. One of the hardest and fastest lessons medical people had to learn was that life went on even when someone died. That they weren’t God, and sometimes had to just let go. Clinging to their losses only made them less capable of caring for the next patient.
But neither could they afford to grow hard. No, they just had to quick-time their way through the sense of failure and loss to be ready for the next case.
David spoke. “So you worked in the VA hospital in Denver, right?”
She tensed immediately. “Yes. I did.”
He looked at her. “Bad topic?”
She half shrugged. “Well, it was emotionally tough. Easier in some ways than Iraq, harder in others.”
“I would think so. At one end, you’re focused on saving a life. At the other, you’re looking at the destruction left in the wake of it.”
“You can never do enough. And the vast majority of the patients I had were amazingly positive, considering what they faced. Oh, they got angry at times, and depressed, but by and large, they handled it better than I did.”
“How so?”
She hesitated. “Well…sometimes I found myself furious. Because we saved them for this? A life without limbs, a life with brain damage, a life of paralysis? And every time it started to overwhelm me, some patient would say he was glad he’d made it.” She shook her head and closed her eyes for a minute. “Sorry.”
“No, I’m sorry. I shouldn’t have brought it up. The whole point of dragging you here for breakfast was to get some calories into the two of us and shuck what happened so we can get on with what comes next.” He looked rueful. “So, idiot that I am, I stick my foot right in it.”
She had to smile, and made a major effort to shake off the memories. “I guess we all get our scars.”
“So your dad used to be sheriff here?”
She almost laughed at the pointed change of subject. “Yeah. Forever, it seems. Certainly since before I was born. Deep roots in these parts.”
“I haven’t really had a chance to get to know him yet.”
“You will. Retired or not, this county belongs to Dad.” She grinned. “Or so he thinks. He’s keeping his hand in, one way or another. Small ways. It must be driving Gage nuts.”
“Gage? You mean the new sheriff, Gage Dalton?”
“Yup. And note the way you say ‘the new sheriff.’ He’s been doing it for three years now, and everyone still says he’s the new sheriff.”
David chuckled. “That could get annoying.”
“Gage doesn’t seem to mind. He’s either a really good actor, or he has his priorities straight.”
“I don’t really know him, either. I don’t have a whole lot of contact with the sheriff’s department.”
“Well, we’ll have to change that. It’s the best way to get wired into the county. You probably know my sister, though. Wendy Yuma, the flight nurse with the emergency response team.”
“She’s your sister? I know her all right, her and Billy Joe. Great people.”
“Maybe we should all get together some time.” As soon as she said it, she wanted to withdraw the suggestion. How much better did she really want to know this edgy, possibly difficult man? He might want to forget he’d come on like gangbusters at their first meeting, but she wouldn’t. Couldn’t afford to. She’d had enough of control freaks to last her a lifetime.
“Yeah, that could be fun.”
He went back to eating, obviously blessed with a healthy appetite as well as dark good looks. But as she sat there, nibbling at her toast and omelet, Krissie realized the man didn’t look happy at all. Either last night was still upsetting him, or he carried a load of garbage even bigger than hers.
Which wouldn’t be surprising. You didn’t come out of a war without garbage. Tons of it. Not if you were human.
But she didn’t want to go there. Not now. Maybe not ever. Even thinking about the VA hospital upset her, so how could she talk about what they’d both seen in Iraq? Sometimes it was better to let sleeping dogs lie.
Finally, Krissie simply couldn’t eat another bite. She pushed her plate to one side, expecting Maude or Mabel to come give her the standard lecture about wasting good food. Instead, Mabel didn’t say a word. She simply refilled their mugs with fresh coffee and took the plate away.
Maybe, Krissie thought with a burst of inner humor, miracles still happened.
David suddenly spoke. “You look exhausted. Why don’t you go get some sleep? I’ll get the bill. My treat.”
As soon as he spoke, she realized he was right. She was too exhausted to manage a conversation about even something as inane as the weather.
“I am tired,” she admitted.
“I can see that.” He lifted one corner of his mouth in a smile. “Go rest up. I’m sure I’ll see you tonight.”
“Tonight?” That rattled her, then she remembered. “Oh, yeah. Tonight. I’m on shift.”
He nodded, and his smile widened. “Definitely exhausted. Off with you. See you later.”
She was strangely glad to escape the normally pleasant sounds and smells of the diner and climbed into her little car with relief.
The night was over. So much for peace.
Chapter Three (#u23b2ebd0-5109-5469-a66a-27cc6ca7daa3)
Afternoon sunlight slanted through Krissie’s bedroom window, a welcome sight as she awoke. She smiled and stretched contentedly. The air mattress beneath her made its familiar hollow sounds.
Being in the navy for six years had taught her to minimize her possessions. If it didn’t fit in a duffel bag, she didn’t own it. Then the habit proved hard to break, and the few items of furniture she had bought while working in Denver had seemed easier to sell than to move.
She needed to change that mindset, she thought now. A bed, a table, some additional cooking utensils, maybe even a sofa. She could afford these things from her savings, and since she was determined to stay here now that she had come home, she didn’t need to live like a gypsy any more.
In fact, she thought ruefully, gypsies probably had more worldly possessions. She stretched again and glanced at the small travel alarm clock near her bed. Four o’clock already! She must have slept like the dead.
Just time enough to grab a shower and try to make something to eat, then pack a lunch for her shift. And maybe a quick chat with Mom on the phone.
Almost as if reading her mind, her cell phone rang, and she saw her parents’ phone number pop up. Smiling, she opened the phone and answered.
“Hi,” she said.
“Hi, honey.” Her mother’s warm voice filled her ear. “I hope I didn’t wake you.”
“I was just waking up.”
“Oh, goodie. So, you know what the best thing about having you back in town is?” Marge Tate’s tone became gently humorous.
“No, what?”
“I can ask you over for dinner now. And it just so happens we decided to eat early. That wouldn’t have anything to do with the fact you have to be back on shift at seven.”
Krissie laughed. “Oh, Mom!”
“So your dad’s heating up the grill and I thought we’d make burgers, and I’m in the middle of making this really great salad—”
“Sold!” Krissie said. “I just need to shower and throw some things together for tonight.”
“Don’t rush, honey. Dinner won’t be until five or so. But while you’re not rushing, hurry up. I miss you.”
Still smiling, Krissie closed her phone, jumped up and trotted to the shower. God, it was good to be home!
The Tate family house looked as it always had during the years Krissie and the five other girls had grown up there, except that it had a fresh coat of white paint and some new bushes out front. The full-size van was gone, too, no longer necessary for carting six kids around.
But it was still home, and as soon as Krissie stepped through the front door, she felt enveloped in warmth and love.
She found her parents out back on the deck, sipping tall glasses of lemonade. Immediately, they enveloped her in hugs, as if they hadn’t just seen her two days ago, then sat her down with her own glass of lemonade.
Nate, her dad, didn’t look a day older than he had when she left for the navy eight years ago. It was as if he’d weathered and aged all he could by forty, and then remained unchanging.
Marge had put on a couple of pounds, but on her they looked good. She had apparently stopped washing her short hair with henna, so the red had faded mostly to gray. The years, however, had taken no toll on her smile or her twinkling eyes.
“We invited Wendy and Billy Joe for dinner, too,” Marge said, “but apparently there was a car accident, so you’re stuck with just us for company.”
“As if I’d complain?”
Nate chuckled, a deep gravelly sound. “Well, I know how much you were looking forward to the three-ring circus.”
“No, that’s Christmas, when everyone comes home.”
Nate laughed again. “My favorite time of year.”
Marge smiled at him. “Go get the burgers, dear. Krissie has limited time and I want to have a private word.”
“Uh-oh,” Krissie said humorously as her dad rose from his chair.
He leaned over and dropped a kiss on her forehead. “Call me if you need protection.”
“Oh, go on,” Marge laughed. “It’s nothing like that.”
Nate disappeared through the sliding glass door, closing it pointedly behind him.
Marge looked at Krissie as if drinking in every detail. “I know you wrote and called all the time while you were away. But I’m a mother, and I can tell there was a lot you weren’t saying.”
“Mom…”
Marge shook her head and patted her hand. “Nate says I shouldn’t ask, and he would know. I just want you to know that if you ever need to talk, I’m here.”
“I’ve always known that.” But Krissie felt her throat tighten anyway, and she had to swallow hard.
“And if you feel it’s something only your dad would understand, well, he’s here, too.”
“I know…” Krissie could hardly talk around the sudden lump in her throat. Marge left her chair to come wrap her arms tightly around her daughter. All of a sudden, Krissie felt like a small child again, when all the comfort in the world could be found within the arms of her mother, with her head on her mother’s breast. Comfort and safety.
“I can only imagine,” Marge murmured. “I can only imagine. But you’ll heal now. I know you will.”
“I’m healing already,” Krissie managed, her voice thick.
“Yes, you are. I knew it when you decided to come home.”
Marge squeezed her hard then let go. As if reading a signal, Nate returned with a plate of raw burgers.
“I hope you’re hungry,” he said jovially. “ ‘Cuz I’m cooking for four.”
Marge resumed her seat, raising a brow. “He’s always looking for an excuse to get a second burger.”
“Well, if you’d let me have them more often, I wouldn’t need to resort to tricks!”
Krissie laughed, feeling the intense emotions begin to subside, allowing her to breathe and swallow again. “I love you guys,” she said.
Her answer came in unison, “We love you, too.”
When Krissie arrived at the hospital just before seven, she realized the auto accident must have been a serious one. Police cars and two ambulances stood at the emergency room entrance, and the medevac helicopter was on the pad not far away. Even as she walked across the parking lot, she saw her sister Wendy emerge alongside a gurney headed for the helicopter, an IV bag swinging in the breeze. The rotors were powering up even before the gurney reached the chopper.
Taking a chance, she entered by way of the E.R. and was collared immediately by David. “We need you here,” he said briskly. “Have someone call the ward and tell the charge nurse not to leave.”
“What happened?”
“Three-car pileup. One of them was a van with a family of five.”
Krissie nodded and took off. She called the ward herself to advise them she’d be late, then tore to the changing room to pull on scrubs and booties. Back out in the E.R. controlled chaos reigned. To a practiced eye, it was clear that everything was functioning as it should, even though they were shorthanded, but to the uneducated, it probably looked like total uproar.
“In here.” David motioned her into a cubicle and she found a child of maybe eight or nine on the gurney inside. He was unconscious, but breathing normally. David bent over him, ignoring the blood, and began to listen to chest sounds, then to palpate.
“I don’t see any wounds,” he said. “Do you?”
Krissie immediately stepped in and began to check the small body from head to toe. “Head gash,” she said. “Already stopped bleeding. Maybe two stitches, nothing major.”
“Got it.”
She kept working her way downward, checking limbs, searching every inch of skin. “Nothing else. Either he bled heavily for a while or it’s someone else’s blood.”
David finished putting two sutures in the scalp wound. “Check BP again, make sure it’s not falling.”
She pressed the button on the automatic blood pressure machine and watched the cuff inflate then release. “Good BP,” she said, scanning the readout.
“Good. Send him on to X-ray. No way to tell what’s broken, but make sure they do a good job on the head.”
But before they could take him away, David stopped them and looked at the boy’s abdomen again. What he saw made him pause. “Seat belt.”
Krissie stepped closer and watched David trace the faint outline of an emerging bruise. As soon as she saw it, she turned back to the BP monitor and took another reading. “Steady,” she said. But as she turned back to David, she saw the worry in his eyes. They both knew what a seat belt could do in an accident: ruptured spleen, other organ damage from sudden pressure. The damage might be small right now, too small to detect with palpation, but if allowed to go untreated, it could become a death sentence.
“You go with him,” David told her. “Monitor constantly. But we need those X-rays.”
“Yes, doctor.”
So, keeping the child hooked up to his IV, and with the blood pressure monitor tucked onto the bed with him, Krissie helped push the gurney to X-ray. “What’s his name?” she called over her shoulder.
David shook his head. “No names yet.”
“Tell the cops I need to know.”
“I will.” He was already moving on to the next patient. A woman suddenly screamed, but not even that woke the boy.
“Poor little tyke,” said the orderly helping her to push the gurney. For the first time, Krissie looked up and saw Charlie Waters.
“Oh, hi, Charlie. Sorry, I was focused on the boy.”
He nodded. “Everyone is focused right now.”
Two X-ray technicians were already waiting. Krissie insisted on remaining at the boy’s bedside, so she donned a lead apron. As they moved his little body around so they could get an unobstructed view of every bone in his body, she found herself grateful that, for now at least, he remained unconscious. If any of those bones were broken, this would have been hell on earth for him, and he’d already been through quite enough.
A radiologist had been called in, and he began examining the X-rays as they developed, before the entire set was even taken. Krissie kept checking the blood pressure, and every few minutes, palpated the child’s abdomen. No sign that it was hardening, even though the seat-belt bruise was becoming more apparent.
The radiologist joined her before they were even done. “He needs to be transported,” he said. “There’s a compression fracture in his left skull. It’s not deep, not something you’d probably find by touch, but he needs an MRI stat.”
That was all Krissie needed to hear. Small hospital, no MRI available. It was one of those things you dealt with here. “Call down to E.R. and tell Dr. Marcus, will you? We’ll get him out as fast as we can.”
The radiologist nodded and waved them on their way. Another gurney, holding a moaning man, was already waiting in line.
By the time they returned to the emergency room, another helicopter was landing, this one from a neighboring county. The boy was rushed on board, along with a woman who seemed to be wavering in and out of consciousness. Instructions were given, then Krissie, Charlie and David stood back as the helicopter lifted to the sky.
“God,” said David, “some days I hate being at a small hospital.”
“Yeah.” Krissie could understand his frustration. With something like this, every minute counted, and because they didn’t have all the bells and whistles, the minutes were stacking up.
Then she looked into David’s eyes, and saw the same ghosts that must be in her own. He visibly shook himself and started back to the E.R. She and Charlie followed.
“Maybe,” she heard David mutter, “we need to start a fund-raising drive for some new equipment.”
“I’ll help,” Krissie said promptly.
He looked at her, appearing slightly embarrassed. “That wasn’t meant for general distribution.”
“I know. But it’s still true.”
“Stabilize and transport usually works.”
“I know.” And she did. That’s mostly what they’d had to do in field hospitals. Even in major metropolitan areas, only one or two hospitals were equipped as trauma centers. Stabilize and transport was a medical dictum in many places, because it was the only efficient way to use resources.
An hour later, they’d cleared the accident victims. Two had gone to surgery, two had been moved to the general ward, the rest had been transported. Krissie hurried to take a shower and change into clean scrubs before going up to relieve the day-shift charge nurse.
Denise Albright greeted her like a savior. A small woman with surprisingly broad shoulders, she had pretty gray eyes and a huge smile. “Girl, am I glad to see you! My feet are screaming.”
“Been busy?”
“You wouldn’t believe. I guess the last week was the calm before the storm. In addition to the two accident victims you already know about, we got four more.”
“What’s going on?”
Denise grinned. “The usual. Accidents. You shouldn’t stand on the edge of the bathtub to change a light bulb.”
Krissie compressed her lips to stifle a laugh. “New rule.”
“Definitely. Lucky it was only a broken arm and a concussion. Then we have Mr. I-got-careless-with-the-farm-equipment. He needed twenty-nine stitches, a unit of blood and is on IV antibiotics. We have a first-degree burn case which is highly painful and resulted from splashing grease. New rule: watch it when you dump those frozen fries into a big pot of very hot grease. She’ll be okay, she was lucky to be standing back far enough for the grease to cool some, but the pain is enough that she’s on some powerful meds, so she needs watching. Also, they said she seemed a little shocky when she came in.”
“Got it. And the last one?”
“Now this is my very favorite.” Denise paused for effect.
“Another new rule?”
“Yup. When you get mad at your husband, don’t punch your arm through a plate-glass window.”
“Oh, my gosh!”
“Two units of blood, seventeen stitches, IV antibiotics and an emergency restraining order. I doubt she’ll get any visitors tonight. No one has showed up so far.”
“I’d be worried about who would.”
At that, Denise laughed. “Yeah. Anyway, Julie and Nancy are making the rounds, so you have time to read the files and get up to speed. Me, I’m off. I need my supper. See you tomorrow!”
Krissie settled in to read all the files, finding pretty much what Denise had told her. Except, the burn patient niggled at her. Linda Nelson had been admitted by Dr. Randolph at 4:30 p.m. with extensive first-degree burns on her stomach and abdomen, and a much smaller second-degree burn on her arm. The wounds had not been inspected since they had been treated and bandaged.
At once, she left the nurses’ station and went to find Linda Nelson. The thing about burns, even first-degree burns, is that when they first presented, you didn’t always see all the damage. Also, more damage could appear later and the body sometimes produced an immune reaction to burns, which could make them worsen.
Everyone had been busy with the mess in the E.R. so it wasn’t surprising that the nurses had forgotten to check the burns again.
She found Linda groggy from morphine, but still conscious. “It hurts,” the patient said plaintively.
“Burns are the worst,” Krissie said sympathetically.
“You’ve seen a lot?”
“Too many.” Another mental image to shove out of the way. “I’m going to check them, okay? Someone needs to look every so often.”
“Will it hurt more?”
“I’ll be as gentle as I can, I promise. Sometimes though, when the air hits a burn, the pain can spike a little.”
Linda bit her lower lip, then nodded. “I get more morphine soon, right?”
“As soon as I can give it to you. I won’t forget.”
“Okay.” She screwed her eyes shut. “God, I can’t believe I was so stupid. But Tommy screamed just as I was starting to pour the fries into the pot.”
“Tommy?”
“My four-year-old. I guess Sally, his older sister, accidentally hit him in the head with a ball…I don’t know. He just screamed, and I jumped.”
“Accidents happen,” Krissie said soothingly. Gently, she opened the woman’s gown and began to ease the huge gauze pad away. “I know you, don’t I?”
“Maybe.” Linda drew a sharp breath. “I was six years behind you in school, but everybody knew you because you were the sheriff’s daughter.”
“That was a curse, I can tell you.”
“I bet. Every bit as bad as being the preacher’s kid, probably.” Linda winced and gasped.
“I’m sorry.” She was even more sorry when she saw the reddened skin beneath the gauze. Widespread blistering had begun. Gently she laid the pad down. “I’m going to get the doctor in, okay? But first let me check whether you’re due for more morphine.”
“God, I hope so! I swear, it’s hurting worse.”
“It probably feels that way. Must be time for another shot.”
It was. She administered the morphine immediately through the IV port, then promised to come back in ten minutes.
Outside Linda’s door, Krissie saw Julie coming down the hall. “Stay with Mrs. Nelson while I get the doctor. Put her on the monitor and watch for shock.”
Julie’s eyes widened a hair. “Got it. What’s going on?”
“The burns are deepening.”
“Oh, no.” Julie’s step quickened, and she entered the room with a squeak of rubbery soles.
Krissie hurried down to the nurses’ station and paged the physician on duty. Of course it was David.
“What’s up?” he asked on the phone.
“We’ve got a burn patient up here. Randolph admitted her with first-degree burns of the abdomen and stomach. I just looked and she’s blistering badly.”
“I’m on my way.”
She couldn’t hold it back then. Closing her eyes, she leaned against the counter while memories washed over her in Technicolor horror. Burns of every kind and description, burns of men, women and children, burns so bad you couldn’t believe the victim still breathed. At its very heart, war burned.
A touch yanked her back from the precipice. She opened her eyes and saw David.
“Are you okay?” he asked.
“Burns,” she answered. It was all she could say.
His face darkened. “I know. God, do I know. Which room? You stay here if you need to.”
Sympathy from the devil. A crazy thought that just popped into her mind. David Marcus was no devil. No, there were real devils out there.
Gathering herself, she followed him to check on Linda. Julie sat beside the bed, the monitor had been connected, and the patient’s blood pressure, a tad low, was still okay.
David spoke a few words, then leaned over Linda. “Is the morphine helping?”
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