No. She wasn’t ready. But he didn’t have time to coddle her.
As soon as they hit the hallway, he sped up to run down the three turns it took to reach Emergency, with her following close behind.
Another thing he had no time for: dropping her off with Backeljauw to find a new sitter. That would have to come later.
No sooner had he reached the monitoring station than he had to step aside for a stretcher and team to roll past. The man on the stretcher had dark red compresses and bandages held to his abdomen. Conley headed the team, but, seeing him, nodded, which he took as a request to follow.
“Sabetta.” He said her name, leaving her to figure out what she was supposed to do, and hurried off with the team.
Abdominal bleeding. A mass event. His mind could supply only one cause. Was this it, what his gut had been warning him about?
“Was it a shooting?” he asked Conley when he caught up, prompting her to begin her report there, since she was obviously wanting to hand the patient off. Pediatric emergencies were a little different from this kind of trauma.
A look flashed across her bonnie freckled face, confusion and then sympathy, but she shook her head. “Subway derailed. Yours is in triage.”
She knew. His brother had obviously been sharing, and Lyons didn’t have the mental currency left to be angry about it.
Derailment. That could still be a man-made incident, but it wasn’t a gun. It couldn’t follow into the department and begin attacking personnel, unless it had been orchestrated and was the first step in a larger plan.
He turned, nearly trampling his unfortunate shadow, and had to grab her shoulders to stop them both making more of a mess of this. She grabbed his forearms in return, back to the wild-eyed stare as he took a breath and put her to the side to step around.
He pushed the tingle spreading from the center of his palms and hot on his arms from his head and jogged to meet the next stretcher coming out of triage.
Tingles didn’t matter. The delicate, fragile-feeling slender shoulders on his new colleague didn’t matter either. His too-young new colleague.
She kept up this time.
“What have we got?” he asked the nurses and paramedics rolling with his new patient.
“He was standing, and when it jumped track, he flew. Person from behind him hit him right after.”
Crushing damage.
“Name?” Sabetta asked, reaching for the chart as they ran alongside the stretcher.
“Samuel Riggs.”
“Mr. Riggs?” she called in his ear but got no response. “How long has he been unconscious?”
“Since it happened, probably. Uneven pupils, he’s breathing too fast. Tachycardic,” one of the paramedics filled in as they wheeled into the treatment bay.
“Get his shirt off.” Lyons gloved and reached for his stethoscope.
She beat him to it, listening to the patient’s heart while the others in the team fell in, taking the steps he didn’t even need to order at this point. Get an IV started. Hook up the telemetry to monitor vitals.
A good sign, not freezing up as he’d half expected.
“Get a blood workup,” he ordered, joining her in listening to the man’s heart and lungs.
She’d grown a bit paler than she’d been, but that wasn’t unusual for first-timers.
“Thoughts?” That would tell him more than blanching.
“His pulse is far too rapid,” she answered, backing up the paramedic’s report. “And he’s heavily bruised. There’s also a substantial lump on his head that I can see. If his pupils are unreactive, he needs a CT.”
This was easier, working with a critical patient to take his focus.
Lyons listened again. Everyone breathed faster when tachycardic. The heart didn’t pump blood and circulate oxygen efficiently, which caused the body’s natural remedies to kick in, even if they couldn’t help. He breathed faster naturally because his heart beat faster, it just didn’t help.
“What’s his pressure?”
One of his nurses took it manually while another worked on the telemetry and read off numbers far too low for his liking. She’d gotten the obvious things, and this wasn’t a teaching hospital, but it was his hospital, and he needed to know his peers could handle themselves.
“What do you want to check?” He knew what he wanted to check, but he’d give her one shot since all the techs should be descending on the room any minute.
“Rapid heart and low blood pressure, along with all this bruising from the impact. I’d want to check for internal bleeding.” She shook her head as she said it, as if she knew the answer was wrong, but stuck with it. “The head trauma is separate.”
Right about the head trauma, wrong about the internal bleeding—which, while probably present, wasn’t the most immediate danger to life.
“Look at his oxygen levels.” He indicated with a nod.
A number in the high eighties; he could tell by her expression that she recognized it wasn’t good.
“What tests?” he asked, giving her another shot.
“Typing for possible transfusion, a CBC, maybe troponin levels?”
Sticking with bleeding, but with a twist?
“Testing for heart attack?”
Wrong.
“All heart damage causes the same enzymes to release.”
He waited for her to listen to the patient’s chest one more time, still not leading.
She placed the bell to the man’s chest and listened, but not to his lungs. Just his heart. It was the obvious symptom, the flashy thing demanding attention. When she commented again, it was on the speed, and shouldn’t they slow it down? She’d somehow managed to miss that distinctive crackling sound his lungs made upon inspiration.
She’d said she normally worked Urgent Care facilities, not places that saw much active emergency. She wasn’t ready for this, so out of her depth it was almost laughable. When he spoke to Backeljauw, he’d suggest she be shifted to the non-emergency cases.
“I want a CT, head and chest. Image and circulation.” He directed his team. “And a blood panel. At least one lung has been damaged. I want a D-dimer.”
“For clotting?” she asked.
“Go back to the station and wait.” He grabbed his comm to suggest to Imaging that they hurry the hell up, but as she stood, looking confused, added for her benefit, “I don’t have time to hold your hand through this. Neither does he.”
CHAPTER THREE
STICKING AROUND TO defend herself or make excuses would’ve taken valuable time away from the patient, so Belle did as McKeag growled at her, slipped quietly out of the room and found her way back to the nurses’ station.
Her central nervous system couldn’t decide how to react to that whole humiliating set-down. Her face alternated between burning at a temperature best measured in Kelvin and the stormfront of an approaching Ice Age any time she relived the joy of the actual rebuke, and the number of eyes on her, the team working as she failed her first patient.
Still, with the hospital in the throes of a large-scale emergency, standing there, observing the bustle and scurrying about without helping somehow could be nothing short of dereliction of duty.
She wasn’t a doctor. She wasn’t trained for this type of medicine or level of emergency straight out of the gate and had truly only offered her best educated guess when prompted, but it still felt the same when an expert—a peer—immediately found her lacking. Even one she knew to be unpleasant in other circumstances already.
Something about it had felt like a teaching moment, but, in retrospect, she could see it had been a test. An unfair test, the kind of test only a real jerk would lob at a new colleague in the first five minutes on the floor, but still a test she’d failed.
It wasn’t just pride that never wanted to fail a patient. Not everyone went into medicine fo
r the right reasons, but Belle had. Her main role models had been Dad and Nanna, a city cop and a former Army nurse. Belle wanted to help people, it was a core tenet of her personality. Seeing the nurses who’d taken care of not only her dad as he’d lingered in the days between when the bullets had wrecked his insides and when he’d actually died, but also the fourteen-year-old girls who couldn’t leave his side, had solidified that need to help into a calling.
And she was just standing around, while other people helped eased suffering.
If this was just how things went in a large, metropolitan emergency department, she had to either get out now and make this a one-day affair or find that steel Sabetta core and a way to help.
Like a gift from a higher power, the woman they’d initially followed passed by the nurses’ station, a light at the end of the tunnel. Belle stood and gave chase. She’d directed McKeag earlier; she’d have ideas on where Belle could be of use.
“Doctor?” Belle called.
The woman spun to face her as if she’d been expecting her call.
“Ysabelle?” Her smile and the soft southern cadence of her speech seemed to project sunshine from her pretty, freckled face and blazingly blue eyes.
For a moment, Belle even stopped mentally cursing McKeag to a lifetime of stubbing his right pinky toe any time he tried to go shoeless and enjoy the simple pleasure of the earth beneath his feet. This doctor was the exact opposite to McKeag’s surly presence—someone Belle could identify with.
“I’m Dr. Angel Conley, and we’re going to be working together today.” She offered a hand. “Do you prefer to be called Ysabelle or Sabetta? You can call me Angel.”
“Belle,” she managed to get out, then shook the offered hand. “Dr. McKeag wanted me to wait, but—”
“Yeah, Lyons is—Well, he doesn’t work and play well with others.” Angel added, “But I’m sure we can make the request for you to stay with him if you want. Between you and me? I’d rather shadow an angry mule than Lyons when he’s on a tear. Which is nearly always.”
The gentle teasing confidence gave a little shot of hope to counter the increasingly awful rot in her chest.
Belle squeezed Angel’s hand, needing exactly that connection in that moment—she’d have hugged this stranger if she could’ve—it seemed the only thing to go in her favor since she’d arrived in New York. But still. “I’m not sure he should receive all the blame here. I apparently went the entirely wrong direction with the patient.”
“We all have our specialties, and I’m sure we’ll find yours,” Angel said, gesturing for her to follow. “I’m a pediatric emergency specialist. Kids are my specialty, but I still need the help of trauma surgeons in unfortunate instances. Or cardiac specialists. We have a network. But we’ll talk more about this later. How are you with stitching?”
“I’m good at stitching,” Belle said and, with just the simple act of reminding herself that she did have strengths, amended, “I’m actually very good at stitching. If I had my education to do over again, I’d probably become a surgeon. I’m good with my hands.”
And with patients, she reminded herself. She’d become a nurse because she needed to take care of people, and she was good at connecting. She made mistakes, and she didn’t know everything, but she cared and connected, she tried. And would keep trying.
“Perfect. We have a heavy load today because of a subway derailment, which you probably heard, but not all the injuries are critical. Most of them are much more minor. Cuts. Sprains. Broken bones.”
Even with the little mental pep talk, she must’ve looked off still because Angel stepped closer, her voice lowering. “I know what it’s like to be new and feel disconnected from everyone. Don’t let Lyons scare you off. He’s—” She paused, obviously searching for some polite way to describe the arrogant doctor. “Christmas is hard for him. There are extenuating circumstances. Just take whatever he says with a grain of salt, and if you have trouble with anything, come see me. Do you have your comm yet?”
Christmas was hard for him. Even among the other things Angel said, that was what stood out.
The words resonated in Belle’s head, bouncing off her guilt centers and disrupting her presently cursing him to a month of upper lip and tongue burns from the morning’s first over-eager sip of too-hot coffee. It took effort to focus on the other important things Angel had said.
“I’m supposed to get it this afternoon. They said I wouldn’t need it since I’d be shadowing today,” Belle said, ceasing her ever ineffective but frequently cathartic cursing because it’d been useless at soothing her ruffled feathers.
Christmas was hard for him. Hard enough to affect his behavior. It hurt him.
He lashed out because he was suffering.
“Right. Well, you’re shadowing me. I’m just going to be in and out with a couple other patients while you stitch. But if you need anything, come to me. Really. I’ve almost been here a year, but I’ve pretty much sorted out the people to see to get things done. I also know all the best places to hide if you need a minute to practice a completely silent, faux primal scream because they might sedate you if you actually let your feelings out.”
“My locker.” Belle wanted to laugh at the image of her screaming soundlessly into some cabinet because she was stressing out, but facing Lyons again was right there in the front of her mind, taking the humor out of living. “My locker is stuck. The emergency call came, and McKeag tossed my things into his locker so we could get down here. It’d be really nice to have it working for tomorrow.”
It wouldn’t save her facing him this evening to get her stuff back, but it would allow her to start tomorrow with some distance.
“I can do that. What’s the number?”
A moment later, Angel was on her comm, walking off in the other direction, and Belle had a folder in hand, and slipped into the room of a man with a large leg gash to stitch.
“Hi, my name is Ysabelle Sabetta and I’m a nurse practitioner. I’m going to help you get that gash sorted out,” she said to the man sitting with his trouser leg ripped open and a bloody wad of gauze keeping it from bleeding too much. After confirming his identity, she got started.
“Please numb it.” Mr. Axler said three words to her, and then laid back on the table. No comments on her qualifications or ability to do the job, no doubts.
In that way, outside the jerky way he’d gone about it, McKeag had a point. People accepted you’d be able to help them when you came in wearing scrubs. They deserved that confidence.
Washing up, she gloved, got supplies—some of which had been laid out for her by nursing staff—and moved over to get a look at what was going on with the patient’s leg.
Christmas was hard for McKeag. It was still there in her head, behind her duties to her patient, but still there.
She didn’t want it.
She gingerly lifted the bloody gauze to see beneath, causing her patient to draw a sharp, pained breath. It hurt; she knew it hurt.
“I’m sorry. I know it’s hard, but I need you to be still for this. I’ll be as gentle as I can to make it as easy as possible, but it’ll go quicker and cleaner if you lock that leg in place as best you can.”
That was part of her job, even if it wasn’t technically codified in rules of conduct—to make the painful things easier for those who were suffering.
Christmas was hard for McKeag. She’d seen that. Anyone could see that. But hearing Angel put it into words—now she couldn’t hold his behavior against him. Couldn’t curse him to a lifetime of mushy pasta or underwear that snuck into uncomfortable arrangements at inopportune moments.
Before Angel, he’d just been someone who hated the holiday, now he was someone struggling with it.
An important difference. If she’d had any distance, she should’ve seen that on her own. Nanna had said it to her and Noelle so many times, it was practically a family mantra,
even if it’d started out as a way to explain to two hurt little girls why their mother had left them.
Words said to make them understand it wasn’t their fault, because they didn’t remember her.
People who hurt others needed extra kindness to get better.
Their mother’s life had been too hard and her family too bad for her to know how to be a mother. Nanna made sure they understood Mama had become someone who didn’t really know how to love. That it was a tragedy she’d given up before all the love they and Dad had to give could transform her into the person she was always meant to be.
People who hurt others needed extra kindness.
Mama had been too far gone for quick fixes, and even now Belle couldn’t bring herself to consider looking for her. She wasn’t steady enough on her feet to take on that kind of damage. Besides, it felt like a betrayal to Noelle, who couldn’t make that choice anymore.
Was McKeag too far gone too?
The gash on her patient’s leg was deep but flayed open with remarkable precision. It barely grazed the muscle beneath; the only part that needed stitching was the cleanly sliced skin that now stood open.
She had a patient. This patient. The one with a wound she knew she could stitch.
She pulled a light down to see into the wound better, selecting one with a magnifying window so she could be certain the wound was cleaned out before she began stitching it.
Maybe the person who had included McKeag in that gift thing had been trying to be kind to him. Not a bad idea, but the execution was problematic. A gift exchange forced him to do something in exchange for his gift, which wasn’t what someone reticent to participate in the season needed.
She picked out a couple of little pieces of glass with tweezers. “I want to flush this with saline, Mr. Axler, to make sure it’s clean before I stitch it. I’m going to go ahead and numb it, so it’s easier on you when I work a towel underneath your leg.”
Healed Under the Mistletoe Page 3