Code Triage

by Candace Calvert

  Leigh pulled her stethoscope from her ears and nodded at the nurse. “Let’s switch Kristi to a cannula at two liters.” She smiled at Abby. “But we’ll have the princess keep the special mask for a little bit longer, okay, sweetie?” The child, her cheeks still flushed, nodded bravely and hugged her stuffed pony close. Leigh touched the toy’s dingy yarn mane. “And maybe later I’ll show you a picture of my horse. His name is Frisco.”

  “Is Finn okay?” The mother glanced toward the exam room door, tears shimmering in her eyes. “I was only using the stove for a few days, just until . . .” She bit her lip. “Is he breathing better?”

  “Yes.” Leigh raised her palm and signaled the mother to wait for a moment as she finished listening to Abby’s lungs: Clear, all fields. She glanced at the monitor: BP 88 over 60, heart rate 92, respirations 22, pulse ox 100 percent. So far so good. She pulled her stethoscope away and draped it around her neck, then walked back to Kristi. The nurse finished adjusting the nasal prongs and left the exam room.

  “Finn’s breathing completely on his own now,” Leigh reassured her, “so that’s much better. But I need to see his chest X-ray and his lab tests. Especially his carboxyhemoglobin levels.” She saw Kristi’s brows draw together and searched for a way to explain the situation; this woman was a new nurse’s aide and had some basic medical training. “The problem with carbon monoxide gas is that it binds with our bodies’ red blood cells much more easily than oxygen does. Since red blood cells’ job is to carry oxygen to body tissues, if they’re carrying carbon monoxide instead, the body tissues can be starved of oxygen. And there’s danger of damage to vital organs like the heart and brain.”

  “But I didn’t smell any gas.”

  “That’s what makes it so difficult. Carbon monoxide is colorless, odorless; can’t taste it; isn’t even irritating to breathe. It can be produced by woodstoves, furnaces, motor vehicle exhaust, and camp stoves. Especially if they’re used in contained spaces. That’s why it’s important to have a CO detector as well as a smoke alarm.” Leigh glanced at Abby. “The symptoms of exposure are mild at first—headache, flulike symptoms, nausea.”

  “That’s what I thought. That she had a little flu bug, and if I kept her warm and gave her some 7UP to settle her stomach, she’d be okay.” A tear splashed down Kristi’s cheek. “I’m so sorry. I try hard to take good care of my babies.” Her eyes widened and she turned her head toward the exam room doorway. “Is that woman from Child Crisis here?”

  Leigh tensed and she told herself again that she was being ridiculous. The city had a least a dozen Child Crisis workers. “I don’t know.”

  Kristi twisted a fold of the sheet across her lap. “I saw her from the window when Officer Nick came up.” Her chin quivered and tears brimmed again. “What if he hadn’t been there? What if—” She stopped short, her gaze on the doorway.

  “But I was there. And I’m here now.” Nick’s eyes met Leigh’s. “If that’s okay with Dr. Stathos.”

  “I . . .” She struggled against a foolish wave of dizziness, told herself that his sudden appearance shouldn’t affect her like that anymore. The ER was her territory. She was in charge, could deny him access. She could ask Cappy Thomas to restrict anybody but medical personnel. And then he couldn’t look at me like that, and . . . “I’m finished here.” She turned to Kristi. “Do you want to visit with him?”

  “Oh yes, please.”

  “Well, then, fine.” Leigh picked up her clipboard, willing her hands to stay steady. “I’ll order your labs and X-rays. And see how things are going with your son.”

  She walked toward the doorway, glanced down as Nick stepped out of the way, hated it that her pulse quickened. Two more steps and I’m out of here. She brushed by him, and he caught her elbow.

  “Leigh, may I talk with you?”

  +++

  Nick released her arm reluctantly, the first time he’d touched her in more than nine months. Since she packed her things, loaded her horse into the trailer, and took off to Pacific Point without a word. And now her eyes, brown like his own, filled with wariness. “Just for a minute?”

  “Well . . .” Leigh glanced toward the nurses’ desk, where a middle-aged man was engaged in earnest conversation with the clerk.

  Nick’s gut tensed as Sam walked past the desk, head down and searching her briefcase. He had no choice but to warn Leigh. She’d recognize Sam’s name.

  “I’m busy,” Leigh said finally. “Is this regarding the baby you rescued?”

  “Yes,” he said, after glancing quickly toward the desk again. “Can we go somewhere?” Home?

  “Okay, step over here. But I only have a minute.”

  Leigh walked toward the doorway of an empty patient exam room and he followed, watching the way she walked. Back straight as when she sat in her saddle, graceful but strong, her dark hair, caught back in a ponytail today, swinging with her movement. The ache to grasp her arm again, stop her from walking away—from leaving him—was almost unbearable. One week was all he had left. And now Sam was here.

  She stopped inside the room. “I saw you on the news clip. And the paramedic already reported that you started rescue breathing on the baby. Was there something else you wanted to tell me?”

  That I love you; I’m sorry—and I can’t stand this. He cleared his throat and let his gaze linger on the curve of her jaw a few seconds longer. “Only that the propane heater was running off and on for two days. She didn’t want anyone to know, but her power was turned off for nonpayment. She’s taken on a second job to help pay expenses—working nights at a nursing home—and had an arrangement with a friend who slept over and watched the kids.”

  Leigh glanced out the doorway, toward sounds at the desk. The man’s voice had escalated. She turned back to Nick. “But I heard that the daughter called 911. That she and the baby were alone.”

  Nick scraped his fingers across his mouth. “The friend didn’t show and Kristi didn’t get word. She arrived home, and right after, her building was surrounded by police . . . and Child Crisis.” He kept himself from looking to see if Sam had returned, though from the noise it was clear there was some sort of problem out there. He had to get this said. “Kristi’s worried that her kids will be taken away; she’s been questioned before. By the same Child Crisis investigator who’s here today.” This time he did look; no sign of Sam, but Cappy Thomas was talking to the man at the desk, who’d begun pacing back and forth. Clearly agitated.

  “So you’re warning me that anything I reveal to this Child Crisis investigator—” Leigh stopped as Nick took hold of her arm. Her expression was wary. “What?”

  His heart pounded in his ears. “You need to know something.”

  A barrage of curses exploded outside the door; then there was a flurry of voices—Cappy’s, a nurse’s, the clerk’s—before the man shouted again: “I want to see my wife! Let me . . . see . . . my . . . wife!”

  Nick bolted through the doorway with Leigh following. Then he walked forward slowly, addressing the agitated man. “Is there a problem, sir?” He kept his voice modulated, casual, doing his best to sound concerned and not authoritative; hands in plain sight, palms extended in a nonthreatening manner. Settle down, buddy. “Can I help?”

  The man crossed his arms, glared at the ward clerk, then looked past Nick to pin his gaze on Leigh. “Are you the doctor who’s treating my wife?”

  Leigh took a step closer to the man, and Nick moved to stay between them.

  “And your wife is . . . ?” she prompted.

  “Linda,” the man said, a play of emotions twisting his features. “Linda Baldwin. I got a message from a chaplain. She said my wife was brought in here by ambulance.” His hands balled into fists and he cursed again. “I’m telling you, no one’s going to stop me from seeing her. Not a doctor and not some rent-a-cop security guy. I’ll take this place apart if I have to!”

  Nick widened his stance but kept his voice calm. “Mr. Baldwin, I see that you’re worried about your wife. I can
understand that, trust me. I worry about mine.” Leigh shifted beside him. “But let’s take this down a notch.”

  “And who are you to tell me . . . ?”

  Nick met his eyes directly. “I’m a police officer, Mr. Baldwin. Nick Stathos, San Francisco PD. And if you’ll cooperate, I’ll be glad to help you get the information you need. Deal?” He watched the man’s eyes, saw his anger recede visibly. Whether out of fear of police intervention or relief, Nick wasn’t sure. But he’d take it.

  “Okay. Okay.” The man turned his attention back to Leigh. “Can you tell me what’s going on?”

  “Yes. I’m Dr. Stathos, and I’m treating Linda.” Leigh beckoned. “Step this way, would you?” He followed her as she walked away from the desk, and Nick did the same, at a distance. But close enough that he could protect Leigh and overhear what she was saying.

  “Your wife’s in stable condition, Mr. Baldwin. I’ll take you in to see her. But I want to explain something first. She’s given me permission to talk with you about her treatment, or I couldn’t do that because of confidentiality. You understand that?”

  “Right. But what’s wrong with her?”

  “I’ve had to pump her stomach. She took what could have been a lethal overdose of several medications, complicated by the fact that she’s consumed alcohol.”

  “Alcohol?” Mr. Baldwin pressed his fingers to his forehead. “Linda doesn’t drink.”

  Leigh glanced toward Nick. She faced Mr. Baldwin, crossed her arms, and sighed. “She tells me she’s been despondent. Can’t sleep or eat or work—doesn’t know how she’ll live anymore—because you left her for another woman.”

  Ah . . . no. Nick stepped back to lean against the corridor wall, guilt making his stomach churn. Then saw Sam watching him from the nurses’ desk.

  Chapter Three

  Leigh squinted into the noon sunshine, closing her eyes and wondering if the San Francisco Bay air smelled different than the breeze at Pacific Point. Same ocean. Couple of hours south by car. A safe cushion of space from heartbreak and loss. From Nick, my broken marriage . . . and the miscarriage he knows nothing about. Yes. Better air there. Safer. Even when it was threatened by that pesticide scare. She shuddered at the memory, then turned to Riley, seated beside her on a bench outside the ER. “Did we finish off Mrs. Cappy’s health nut cookies?” she asked, setting her knitting aside.

  “One left. Split it?” The assistant chaplain, eyes as blue as her native Texas sky, fumbled one-handed with the ziplock bag sitting between them.

  “Need help with that?”

  “Nope, I’ve . . . got it. Voilà!” She lifted the pecan-sprinkled cookie like it was a trophy. “Think the occupational therapist would count cookie snagging with my nondominant arm as progress?” She rolled her eyes. “No, I’d probably have to grab that big pencil and actually write, cookie, cookie, cookie.” She held out the treat and Leigh snapped it in half for her.

  “Ziplock therapy looks pretty impressive to me.” Leigh smiled, thinking once again how much she’d come to like this nurse–turned–assistant chaplain. Riley had only been at the hospital for about three months, but Leigh had already come to respect her dedication, compassion, and spunk. It had to be hard to leave what she knew—home state, profession—and start something new after life threw her such a cruel curveball. Six months post neck fracture and spinal cord injury and still unable to use her right arm effectively. Time wasn’t on Riley’s side anymore.

  She hadn’t given many details about her accident and Leigh hadn’t asked. She didn’t pry, either, about any personal situations she’d left in Houston. Or how she managed to end up with a job as a chaplain’s assistant two thousand miles away. Leigh wasn’t sure there had ever been an assistant chaplain assigned to the ER until Riley. But it was hard not to notice the impeccable styling of the clothes she wore. That, combined with the fact that Leigh had seen the Hale name listed prominently on the endowment plaques in the lobbies of several Mercy Hospitals, implied that this injured nurse had a privileged background. Her family had pull.

  Leigh pointed to the sling on her other arm. “How’s it going, by the way? With your right arm?”

  Riley sighed. “If I believed that doom-and-gloom neurosurgeon, I’d give up physical therapy and any hope of returning to ER nursing.” She bit into her cookie and smiled around it. “Good thing my hope comes from a far more reliable source.”

  Leigh nodded, glad Riley wasn’t one to press her convictions regarding faith. Even if she’d started conducting her own version of the hospital ministry started by Pacific Mercy nurse—and Leigh’s friend—Erin Quinn. Called “Faith QD,” after old medical terminology for “every day,” the fellowship invited staff to meet in the chapel fifteen minutes before their shifts, praying for patients, asking for God’s guidance during their workdays. Didn’t affect Leigh. Although she’d recently begun to speak to God in sporadic grumpy monologues, she’d given up on actual prayer this past year. It was pretty obvious that God had cut her loose.

  “You’re still going to physical therapy?”

  “Twice a week. But I’ve set things up so I can do the exercises at home too. Every night, for at least an hour. I’m not giving up.”

  Nick’s words surfaced, the vow he’d repeated so often this past year: “I won’t give up on us, Leigh.” She glanced toward the ambulance bay; he was still around here somewhere. She’d probably have to ask him to leave. She picked up her knitting—baby caps for an international charity—and turned back to Riley. “You sound like Linda Baldwin’s husband; he wasn’t going to give up on seeing his wife. That was quite a scene. Glad he wasn’t armed. I’m not up for a Code Silver.”

  Riley grimaced. “And I’m glad your husband was there to defuse the situation. He was calm and rational.” Her eyes met Leigh’s. “That must have been tough for you.”

  “Yes, well . . .” Leigh glanced away. She wasn’t sure if the chaplain’s concern was about Nick’s being here or the fact that he’d intervened in a situation far too close to her own. The hospital world was a small one; Leigh’s pending divorce wasn’t a secret. Nor, likely, were the reasons behind it. After her swift exit from San Francisco last December, people had to be wondering. And talking. The expectation of privacy was about as guaranteed as covering your backside in one of those hospital gowns. But the fact was that Leigh wasn’t at all like Linda Baldwin. She was moving on, moving away.

  She worked a few stitches, then looked back up at Riley. “All I’m thinking about now is finding a supplement that will put a little weight back on my horse, discovering a magic potion to keep the rest of the leaves from falling off my dwarf citrus tree, and—” she sighed—“getting my sister solidly on her feet after all the problems she’s gone through these past months.”

  Leigh saw the empathy in her friend’s eyes and reminded herself that anything she said would remain confidential—chaplain or not. It was the kind of person Riley was. “The drinking was only a symptom. Getting her into a counseling program and convincing her to start the mood-stabilizing medication is what’s really made a difference. I’m so grateful that the hospital granted a leave of absence. Between inpatient and outpatient treatment, it was over four months, and I wasn’t sure they’d hold her job in the lab, but—”

  Riley nudged Leigh. “There she is.”

  Leigh shaded her eyes and looked. It was Caroline. Hard to miss in the bright purple scrubs assigned to the phlebotomists. And because she was—had been since the day she was born—so astoundingly beautiful. As tall, willowy, and angular as Leigh was petite and curvy; broad forehead, wide-set gray eyes, and cheekbones that belonged on a New York fashion runway. Exactly what their mother had pushed for so ruthlessly. Caro had been as troubled as she was beautiful for as long as Leigh could remember. It worsened in the months that Leigh was living in Pacific Point.

  “I’m glad you don’t have to make that commute anymore, and that you’re both back at your house,” Riley added. “It’s good you came home to help
her, Leigh.”

  “Nick came and got me.” Her chest constricted at the memory of Nick in the chapel at Pacific Mercy Hospital. She’d thought he’d come to talk her out of the divorce and had been ready to tell him to go away, to stop trying to change her mind. And then he’d explained about her twenty-three-year-old half sister. The DUI, her night in jail. He’d taken her home to the house—“our house”—and had one of her nurse friends stay with her. His plan was to get her into a respected treatment facility in Sausalito and finally have an evaluation for her increasing bouts of depression and mood swings. He’d been deeply concerned. And completely right. She’s better because of him, not me.

  “Nick’s always thought of her as his sister. Always stuck by her. And . . .” Leigh’s eyes moved back to where Caro stood, leaning against the brick wall of the hospital. Her voice dropped to a whisper. “He still is.”

  Nick walked out of the ER doors and joined her sister.

  +++

  “Hi.” Nick stopped a few feet from where Caroline leaned against the building. The last time he’d seen his sister-in-law, she’d been in pretty bad shape emotionally. Not that he would have expected much else after she’d spent the night in jail for hitting a parked car while under the influence of alcohol and leaving the scene. And then being released into the custody of the brother-in-law who’d betrayed her sister. He’d talked to her a few times on the phone during her stay in Sausalito. Knew that Leigh was trying to get her interested in going back to college, maybe even pursuing a nursing career, but . . . “Long time, no see,” he said tentatively.

  “Yes, well—” Caroline met his gaze—“not my fault you’re living somewhere else.”

  He hid his flinch. Nice shot, little sister. There was no bulletproof vest for this situation. He hadn’t known what to expect from her—she’d always been capricious, moody—but what he saw now, despite the medication, looked like hurt wrapped in anger. Not that he didn’t deserve it.