Heart of Hope: Books 1-4

by Williams, Ajme

  I wondered if I should venture down to the emergency room to check on Nick. It was good that he had a day off yesterday, but I wondered if getting back to work would be like getting on the proverbial horse after falling off. Would he be hesitant? I shook my head. Dealing with death was something doctors, especially emergency room doctors, had to accept and move on from.

  Instead, I opened up the files to the contracts I was working on and got to work.

  11

  Nick

  I parked out back and entered the hospital through a side door, not wanting to be noticed. I didn’t want the looks of pity or blame from anyone who might be lurking around the hospital or in the waiting area. I went to the locker room mostly to get my head in the game. I splashed water on my face from the sink and stared at myself in the mirror.

  “You got this, Foster,” I said to my reflection. My reflection didn’t look so sure. I left the locker room and headed toward the emergency department. As I reached the triage area, my chest cramped and I felt like I couldn’t take in a breath. My heart started racing, and I had to stop. What the fuck? I resisted putting my hand over my chest, as I didn’t want anyone around me think I was having a heart attack, but holy fuck, that’s what it felt like.

  “Dr. Foster? Are you okay?” one of the nurses asked. She was heading past me but had stopped and looked at me with concern.

  I took a deep breath. “Yeah, sure. Indigestion.”

  “You ate hospital food?”

  I smiled, hoping I looked jovial. “That must have been it.” I pushed down the anxiety and forced myself forward.

  “We’ve got a full waiting area this morning,” Peggy said as she walked with me to my first patient. “First up, a six-year-old who sliced his arm falling at an old construction site.” I plastered on my smile as I introduced myself, and then gave my usual spiel to the child about gluing him back together as I used liquid stitching to treat the gash in his arm.

  Next up, I set the arm of a hiker who fell while venturing off the trail. I began to note that often people ended up in the emergency room for breaking the rules, such as going into restricted areas.

  My next case was a twelve-year-old complaining of stomach ailments. My heartbeat quickened, as I started my differential diagnosis. Unlike the cut and broken limb, internal ailments could be any sort of problem something benign like a stomach ache to something serious, like a bowel obstruction.

  “He’s not so bad right now,” his mother said to me. “But the ride over, he was in agony.”

  I looked up at her. “In the car?”

  She nodded.

  “Was it worse when you went over bumps?” I asked.

  “Uh … maybe.”

  I turned to Peggy. “Let’s do blood and urine, and order an ultrasound.”

  “What is it?” the boy looked at me in a panic.

  “I suspect it’s your appendix. We’ll do a few tests to confirm that,” I said trying to be reassuring.

  He gripped his mother’s arm. “How do you fix it?”

  “We’ll arrange for you to have surgery.”

  His panicked eyes looked to his mother. “Will it hurt?”

  “They’ll give you some happy juice so you’ll sleep. You won’t feel it.” Peggy smiled at the boy.

  I wanted to reassure him, and at the same time, as routine as appendectomies were, that didn’t mean there was no risk. For one, I wasn’t sure how severe the issue was now. It could burst, and we’d have a whole new set of life-threatening problems. Surgery alone had its risks.

  Tension built in my shoulders and a drip of sweat ran down my back.

  “It’s a common surgery,” Peggy said. “Nothing to worry about.”

  I shot her look and then turned to the mother. “There are always risks, but the risk of letting an appendix fester and burst outweighs the risks from surgery.”

  Peggy cocked her head and looked at me funny, but continued to pull together the items to take blood and get a urine sample.

  I needed some water. “I’ve ordered the ultrasound and put in for the blood and urine tests. Can you stay on it? Make sure they’re done?”

  Peggy studied me but said. “Yes, Dr. Foster.”

  I exited the area and went to the staff lounge to get a bottle of water. I drank it down, willing the cool water to wash away the tension and anxiety. What the fuck was wrong with me?

  I returned to the emergency area. Since we were waiting on tests for the boy, I met with the next patient. I entered the area the middle-aged man waited for me in.

  “Hello, I’m Dr. Foster.” I shook his hand and then pulled up the notes on the computer. “You’re having back pain?”

  The man studied me, focusing on my face. “That’s right. You’re sort of young, aren’t you?”

  It had been a while since anyone had commented on my age. “I assure you I have gone through medical school.”

  “Is that what you told Ms. Mason?”

  His question was like a hot lance straight into my gut. “Where is the pain located?” I said, ignoring his question and starting my assessment.

  “Around the middle.” He reached his hand behind his back to show me.

  “Both sides?” I asked as I moved behind him on the exam table.

  “No, just this side.”

  That suggested a possible kidney issue. “Are you having any trouble urinating? Pain or maybe frequency?”

  “It’s my back, not my dick, doc.” He shook his head. “Are you sure you know what you’re doing? Rumor is you messed up and that’s why Ms. Mason is dead. She was my teacher and my kids’ teacher. An icon in the community, and you let her die.”

  My heart rate shot up and I had to put my hands on the examining table to catch my breath.

  The nurse looked at me. “Would you like me to order urine tests?”

  I nodded. “Yes.”

  “Urine? I’ve got pee in my back?”

  “What you’re indicating could be your kidney, not your back,” the nurse said.

  I tried to pull in a breath to calm my nerves, but it was like there was a tourniquet on my lungs and I couldn’t suck in air. My hands began to shake. I was fucking losing it.

  “Order the test.” I said moving to exit. “And see if Dr. Balding can follow up. I’ve got a kid with an appendicitis.”

  The nurse’s eyes narrowed and I knew what she was thinking. Doctors didn’t leave patients in the middle of an exam. But if I didn’t get out of there, I was going to fucking lose my mind.

  I rushed from the room and back to the staff room. I’d known that something had seemed to go terribly wrong with Ms. Mason. And I knew the word around town was that I’d fucked up. But something about hearing it in person, of having someone question my ability, affected me. It was like everything I knew about medicine went out the window. My confidence, already a little shaken, was now demolished. Realizing that make me feel weak. I was supposed to be a kickass doctor, and here I was being tortured and beaten down by my own self.

  I decided to go outside in the clean mountain air, hoping it would clear away the tension and self-doubt. It wasn’t like I hadn’t lost a patient before. I had. All of them were difficult, but I’d been able to suck it up and move on. So, what was it about Ms. Mason that had me unraveling? I did everything right. I ordered the tests. I asked the nurse to keep me apprised of her condition. So, what the fuck had gone wrong?

  “Nick?”

  I whipped around to see Mia. When she saw me, her brow arched up, as if she was surprised at what she saw. I must have looked as unhinged as I felt. “Are you all right?”

  “What do you need?” I asked wincing at the terseness of my voice.

  Her eyes narrowed. “I need to know you’re all right before you go back and work on anyone.”

  I ran my hand through my hair. “You and ole bubba seem to think I killed Ms. Mason.”

  “I never said that.” She moved toward me, with concern on her face.

  She reached out to touch my ar
m but I pulled back. “You gonna fuck me again to make me feel better?”

  Her hand jerked back like I’d slapped it. “Why are you being an asshole?”

  I closed my eyes, knowing she was right and hating that I had totally lost control of my sanity. “Sorry. Did you need me for something?”

  She huffed out a breath. “I want to know why the tests on Ms. Mason weren’t done.”

  12

  Mia

  After working on one of the vendor contracts first thing in the morning, Dick had called me into his office. He wanted to know what I’d learned so far about Ms. Mason’s death.

  “We’ve gotten calls from the local paper wanting to know what happened. Of course, I told them we’d done all we could. But we’ve also gotten some calls from residents asking if Dr. Foster was negligent.”

  I flinched. “There’s no evidence that he did anything wrong.”

  “Good. Tell me what you do have.”

  I explained to him what the pathologist had said about it might have been too late for her even if the diagnosis had been made sooner.

  “That’s hard to prove though, isn’t it?”

  “Nick … er … Dr. Foster ordered tests that would have found the problem, but they hadn’t been done.”

  “Do we know why?”

  I shook my head. “Not yet.”

  “Are you sure they were ordered? Did Dr. Foster just write it down in the notes or did he actually send up the order?”

  I frowned. “He sent up the order. I haven’t verified that it was received yet, though.”

  He waved a hand. “If he sent it, they received it. The more common problem is a doctor not hitting the final send button. If they do that, then the order is sent.”

  There was a tone in his voice that had me thinking he needed to believe what he’d just said. Or actually, that I needed to believe what he said. That the error was on the doctor’s side, not the lab or the software.

  “We need to find out why the tests weren’t done sooner,” I said.

  He nodded. “See what you can learn. But we need to keep this all on the downlow until we have answers.”

  “I know the drill,” I said sardonically.

  “I know it sounds callous, but we can’t have false accusations hurt this facility. If Dr. Foster is to blame, we’ll take action, but right now, we have no proof that anything he did or didn’t do lead to her death.”

  “Or the lab?” I asked, a little concerned that he seemed to be focused on Nick being in error.

  “Or the lab,” he agreed.

  I left Dick’s office and headed down to the emergency room. When I didn’t see Nick there, I found Peggy. “Have you seen, Dr. Foster?”

  “Ah … no. I think he was with the guy Dr. Balding is with now.”

  Why the switch in doctors? I went over to Dr. Balding and motioned for his nurse to come to me. “Have you seen Dr. Foster?”

  She made a strange face. “He took off. This patient made a comment about Dr. Foster killing Ms. Mason and he got all shaky. I’ve never seen him like that.”

  “Do you know where he went?”

  She shook her head.

  I stood for a moment while she went back to help Dr. Balding, trying to determine where Nick might go. I checked the staff lounge, but he wasn’t there. Deciding he might like fresh air, I headed out to the side patio. He was standing with his back to the building and his hands on his hips, taking in deep breaths.

  “Nick?”

  He whipped around like I’d invaded his space. “What do you need?” His voice was annoyed.

  Something was wrong. Had the patient’s comment rattled him that much? “I need to know you’re all right before you go back and work on anyone.”

  He ran his hands through his hair. “You and ole bubba seem to think I killed Ms. Mason.”

  “I never said that.” I moved to him as a friend, not the hospital lawyer. I reached to put my hand on his arm.

  He pulled away. “You gonna fuck me again to make me feel better?”

  I jerked back, feeling his comment like a slap. “Why are you being an asshole?”

  He closed his eyes as if he knew he was being a jerk. “Sorry. Did you need me for something?”

  I huffed out a breath, trying to keep from getting too annoyed. This couldn’t be easy for him, and what I came to talk to him about was only going to make it worse. “I want to know why the tests on Ms. Mason weren’t done.”

  At first, he just stared at me. “How the fuck do I know? I ordered them. Is Dick or the board trying to pin this on me?”

  “No one is blaming you, Nick.”

  He scoffed. “That’s not true. Goldrush Lake is blaming me. That dickwad who probably has a urinary tract infection is blaming me. Hell, I’m blaming me, although I can’t figure out why. I keep going through it and can’t figure out what went wrong.” He turned away. “I shouldn’t be saying that to you. I keep forgetting how much you can fuck me over … legally, not literally.”

  I hated that he saw me like that, but he wasn’t wrong. My fiduciary responsibility was to the hospital. Dick had already made statements that suggested he’d toss Nick under the bus if necessary.

  “Chances are nothing went wrong, Nick, except that Ms. Mason didn’t come in soon enough.” I wanted to alleviate his torment over her death, even though the unanswered questions were driving his unease. I didn’t have answers to them yet.

  “There’s no way to know that for sure.”

  “Even if the tests were done, the time to run them and analyze them, it would have been too late,” I said.

  “Had I stayed with her, I might have figured it out sooner and started treatment.” He shook his head. “Jesus, I must want to be fired.”

  “No one is talking about firing you, Nick. But we have to figure out what happened and if there’s something that could have been done differently, make adjustments.”

  He took in a breath and then started back to the building. “I’ve got a kid who probably has an appendicitis. Hopefully those tests have been done.”

  I reached out to him as he passed me. “Nick.”

  He stopped and looked at my hand on his arm, before turning his gaze on my face. “I don’t believe this was your fault. You’re a good doctor.”

  For a moment, I thought my words might have helped him, but then his blue eyes turned flat. “Maybe not good enough.”

  I watched as he returned inside and I hoped that this would pass. Not that he’d forget or become indifferent to death, but that the pain and guilt would wane enough to ease his conscious.

  Back in my office, Dick stopped by as I was finishing up my notes on some new HR proposals.

  “Any updates on Ms. Mason?”

  “Nothing significant.”

  “Dr. Foster stick to his story?”

  My eyes narrowed. His tone suggested he thought Nick wasn’t being completely honest. “His accounting of what happened is consistent, yes.” I left out the part where Nick was second guessing himself.

  “Let’s hope this passes. We’re getting some unhappy calls. We’ll need to draft a statement. Maybe you could do that, so we’re sure we don’t accidently admit to something.”

  “I’ll work on that next.”

  “Good work, Parker.”

  I had to remind myself that all this wasn’t unusual. I’d been through it before with hospitals and clinics. What was strange was to know the players so intimately.

  13

  Nick

  This wasn’t the first funeral I’d attended. It wasn’t even the first of someone I knew. But it was the first where I felt the need to hide. I showed up to pay my respects, not because Dick said it would make me look less guilty. Guilty. That was the word he used. Like I’d let her die on purpose. Based on the continued messages and the looks I got as I entered the church, guilty was what people thought I was. I knew the word out in the community was that I’d abandoned her to help another patient. Guilty as charged. The rumor was that I’d
missed the diagnosis. That wasn’t so clear cut. I hadn’t missed it; I just hadn’t had all the information I needed yet to make it. I’d been on the right track when I ordered a blood test and chest x-ray.

  Mia was at the funeral and gave me a sympathetic smile, but she was with Eli and so I understood why she didn’t talk to me. Besides, she wasn’t my keeper. Yes, we’d fucked on my couch, but we weren’t together.

  The day after the funeral, I was taking one of my increasingly frequent breaks after sending a man up for a heart procedure. I didn’t miss that one, I told myself. Fuck, I was losing it. Every patient, whether it was a splinter or an internal complaint, I was nearly in a cold sweat as I went through the differential diagnosis. When I was off duty, it wasn’t much better. At least once a night I woke up in a cold sweat from a dream in which all the patients I hadn’t saved haunted me. Blamed me.

  “Dr. Foster?”

  I turned back from where I was looking out the window in the staff lounge. Dick came in, his expression grim.

  “I’ve got some bad news. The Mason family has served us papers.”

  I closed my eyes. “Me?”

  “You, the attending nurse, and the hospital, claiming that had we provided the service we should have, she’d have been diagnosed and saved.”

  The problem was, I couldn’t be sure they weren’t right. The pathology report suggested it might not have made a difference if we’d diagnosed the embolism right away. And the reality was, the tests had never been done, and I still couldn’t figure out why.

  “So, what now?”

  “Now we let Ms. Parker do her job.”

  I nodded, but I knew Mia’s responsibility was to the hospital, not me. Granted, I was employed by the hospital, so I was an extension of it, but I had no doubt if I was in error, I’d be tossed out, and left to fend for myself.

  That evening I went home, changed into running clothes, and took a long run through the mountains. In the past, spending time in nature exerting myself did wonders for my mood. Today, I couldn’t shake the dread. I didn’t mind being sued as much as I worried that I’d fucked up somehow. Until Ms. Mason died, I was a confident man in my medical skills. I was decisive and confident. Now I was a bundle of nerves, constantly second guessing myself.