“Mom? Mom, it’s me, Melissa. Can you hear me, Mom?”
No response. Melissa went on speaking, reassuring Betsy that she was going to be fine, that everything was under control, that there was no reason to be alarmed, all the lies that Melissa had tried to console herself with on the way over, with no success.
Rena Johns, a tiny nurse with a long braid of blond hair, reconfirmed that Betsy hadn’t regained consciousness after the resuscitation, which Dr. Wong had supervised.
There was no sign of him. He was an intern, Rena explained, and he’d been called away to another emergency. Because of the job action, the hospital was already seriously short of doctors.
Melissa saw compassion in the nurse’s dark eyes. “Didn’t Dr. Wong order an MRI? A CT scan?” The tests would show if any damage had occurred, and give some indication of how Betsy should be treated.
Rena shook her head. “There was no point in running tests at this hour—there aren’t any doctors around to read the results,” she stated.
Melissa was losing control. “Did anyone call Dr. Burke? Mom’s his patient.”
“Of course we did,” Rena soothed. “He’s on his way. He’ll be here any moment.”
For the next ten minutes, Melissa stood beside Betsy’s bed, murmuring comforting words, while inside her head a madwoman shrieked that this couldn’t be happening, not to her mother. She wouldn’t let it happen. There had to be something she could do.
But for the life of her, she couldn’t think what it might be.
Chapter Five
Melissa heard James Burke before she saw him. He was talking in a low, intense voice to Rena at the nursing station. Melissa knew he was getting the medical lowdown on Betsy, what drugs had been administered, what procedures had been followed. Having him here taking charge, doing something, was a relief. A little of her anxiety dissipated.
“Melissa—”
She turned toward him. He was wearing jeans and a white T-shirt, and his hair was sleep rumpled. He wasn’t looking at her. Instead, he was frowning down at Betsy as he spoke, his expression disapproving, as if his patient wasn’t behaving the way he’d ordered and he was not amused.
“If you’ll excuse me a moment, I’d like to examine your mother.”
Melissa felt like saying that he could do so with her in the room, too, then thought better of it. She swallowed the words and walked over to the nursing station.
Rena poured her a cup of coffee and silently handed it to her. It was strong and hot, and Melissa sipped it, feeling the caffeine jolt her nervous system.
The cup was almost empty by the time Burke joined her.
“Your mother’s vital signs are all fairly normal again,” he commented. “There was no indication whatsoever of any heart problems, and the operation was successful. I don’t understand why this happened.”
“Well, successful or not, she’s unresponsive now,” Melissa snapped.
Burke scowled at her. “I’m well aware of that fact. First thing in the morning I’m ordering extensive tests to determine exactly what’s going on with her.”
“And will you be around to read them? Because with the job action—”
He nodded, impatient as always. “I’ll be here, of course. After all, your mother is my patient.” He sounded irritated, but Melissa was beginning to realize that for Burke, irritation and impatience were probably the norm.
He said to Rena, “You have my pager number. Call me if there’s any change whatsoever in Mrs. Clayton’s condition. I want her monitored closely. I’ll be in the doctors’ lounge for the rest of the night.” He turned to Melissa. “I suggest you go home and get some rest, as well. There’s nothing to be gained by sitting around here.” He headed off down the corridor.
Melissa knew that, logically, he was right. But she also knew she wasn’t about to get in her car and drive home, leaving her mother here in CCU. When Betsy woke up, she’d want her daughter at her side. Didn’t Burke understand that?
If Betsy woke up. Melissa was too much of a realist, too much of a nurse even after all these years, not to fully understand that her mother might well not come out of this. She shuddered and had to struggle against the urge to burst into tears. Worst of all was the memory of how she’d promised her mother everything would be fine.
“I’m not going home. I need to be here when Mom wakes up,” Melissa said to his retreating back.
“Of course you do. Burke has all the people skills of a rock sometimes,” Rena, who had been quietly observing the exchange, remarked. “There’s an empty room just down the hall. Why don’t you try to get some rest? If there’s the slightest change in your mom, I’ll come and get you.”
“Thanks, that’s what I’ll do.” Melissa realized she wouldn’t be able to sleep, but she also realized she needed to be alone, to get her emotions under control and figure out what else she could do to help her mother.
For the remainder of the night, she lay sleepless on the narrow hospital bed, alternately agonizing about Betsy and going over the millions of details she’d have to see to in the morning. Each day the job action continued, the problems she had to contend with would multiply. Why did everything have to happen at once? She’d only been in her position for six months, and those who’d opposed her appointment would be watching gleefully, waiting for her to make some fatal mistake.
Well, they’d better not hold their breath. About her job, at least, she was confident.
At five in the morning she went back to CCU. There’d been no change whatsoever in Betsy’s condition.
“I’m going home to shower and change for work. I’ll be back by six-thirty at the latest,” she told Rena. “If there’s any change, call me on my cell.”
“Absolutely,” Rena assured her.
But Melissa could see by the expression in her eyes that the nurse had no expectations Betsy would wake up while Melissa was gone.
Outside the hospital, the dawn air was blessedly cool, although the clear blue canopy overhead and the coral pink in the east where the sun would soon rise heralded another record-breaking day in Vancouver’s uncharacteristic heat wave. Melissa drove home, showered, yanked another of Barry’s ensembles from her closet, pulled it on and raced back to the hospital to begin a day even more frantic than the previous one had been.
For the next forty-eight hours, Melissa all but lived at St. Joe’s, dealing with one crisis after the next as the job action escalated. She attended meeting after meeting, none of which accomplished much as far as she could see. She held press conferences to reassure the public that emergency services were still available. She frantically called other hospitals to arrange for procedures that couldn’t be postponed.
And through it all, a part of her mind was constantly with Betsy. There’d been no improvement at all in her mother. Burke had done an entire battery of tests, and he’d promised to discuss them with Melissa at noon on Friday.
She was late for their meeting. That morning’s appointments, first with the Ministry of Health and then with the financial committee, both went past their allotted times. It was twelve-twenty by the time Melissa made it to the Coronary Care Unit, where Burke was waiting. He was standing, arms folded across his chest, foot tapping impatiently.
“I’m sorry to keep you waiting, Dr. Burke.”
He didn’t nod or accept her apology, or even indicate that he’d heard her.
Melissa was tired to the bone. She hadn’t had a decent meal in days. She was sick with worry about her mother, and she had three more meetings that afternoon before she could even hope to get to the paperwork that almost buried her desk. She still hadn’t managed to find suitable placements at other hospitals for four urgent surgical patients, three of whom would have been operated on by this same Dr. Burke, who was acting as if his time was of the essence. The patients’ relatives were out of their minds with worry, and their frustration and anger had to be dealt with—by Melissa.
It was hard to be sympathetic to the doctor’s position
when she was confronted hourly with the human misery it created. And how could a man who looked so blasted attractive be so lacking in people skills?
“This office will do,” he said in a stiff tone, ushering Melissa into a small room the nurses used for meetings. He gestured to a chair and she sat down, but he remained standing, which annoyed her further. It was such an obvious way of taking control of the proceedings.
She wasn’t about to let him get away with it. She was a veteran of subtle power plays. The thing to do was take control of the conversation. “So what do the test results indicate about Mom’s condition, and what do you suggest as treatment, Doctor?” She used her most professional tone.
He cleared his throat and shoved a hank of dark hair away from his forehead.
“I’ve evaluated your mother carefully,” he began without meeting Melissa’s gaze. He stared at some point three feet above her head. “As a result of the tests I’ve done, I’ve decided to withdraw all medication immediately.”
“Oh? Why is that, Doctor?” Melissa frowned and waited, not understanding what he was getting at, although a tiny thread of alarm began to wind itself into a knot inside her.
“In my opinion, your mother has suffered irreversible brain damage.”
Melissa heard the words, and her blood seemed to freeze in her veins. She swallowed hard and stared at him in horror, unable to say a word.
“I don’t believe your mother is going to recover or improve. I suggest you begin looking at placement in a care home for her. Not immediately, of course. But there are a limited number of openings in the better facilities, and it would be best to get her name on lists.”
“A...a care home?” Melissa was aghast. She’d trained herself to deal with emergencies in a controlled and rational manner. As an administrator, she’d attended numerous workshops on anger management. But none of the techniques she’d learned even occurred to her now.
“You’re saying—” Rage, red and urgent and violent, began somewhere in her gut and traveled to her brain as if it were a lit fuse linked to nitroglycerine. “You’re saying I should put my mother in a care home? My mother is only fifty-six.” As she got to her feet, she was dimly aware that he was still talking.
“As I mentioned, there are waiting lists, and getting into the best of these facilities may take some time, as I’m sure you’re well aware.” His voice was composed, his manner cold, distant and totally impersonal.
“But—I just can’t believe—this is my mother we’re talking about here, Doctor.” Melissa’s voice was suddenly so loud he jumped. “It hasn’t even been a week since you operated on her, and you’re suggesting placement in a care home?”
Her voice was getting even louder, and it felt wonderful. She let all her feelings surface; they spilled out in a gush of invective. “You arrogant, egotistical, insufferable—why, a veterinarian would show more compassion for a patient than this. How can you possibly be so certain my mother isn’t going to improve? Do you actually believe you’re God, Dr. Burke? Because you sure as hell sound as if you do.”
His expression didn’t change an iota.
“Don’t you have a mother of your own? Don’t you have some concept of how this feels, to be told that—that—” Melissa tried to go on screaming at him, but instead of words, a mental image of her poor mother, helpless and trapped in a coma, frightened and alone in a place Melissa couldn’t go to comfort her, came vividly to mind. A sob caught in her throat. She couldn’t hold it back, and neither could she stop the explosion of tears that burst from her. She covered her face with her hands and wept.
He made no attempt to comfort her. He didn’t even offer a tissue.
Melissa heard the office door open and shut, and she knew James Burke was gone. She sank onto the chair she’d been sitting in, dropped her head into her hands and gave in to the desperate grief and fear she’d been holding at bay for days.
Chapter Six
James hurried past the two nurses behind the desk, studiously ignoring their curious stares. He knew they’d probably overheard some of what had gone on just now with Melissa Clayton, because the office they’d been using was directly across the hall from the nursing station and sound carried in a building as old as St. Joe’s.
He strode down the hall, around a corner and into an empty room. There, he shut the door behind him and locked it, then leaned back and closed his eyes. He was shaking, and his gut felt as though he’d swallowed a vial of acid. He dug in his pocket and popped an antacid tablet in his mouth.
With painstaking attention to every aspect, he went back over the procedure he’d performed on Betsy Clayton, trying to pinpoint anything that had occurred in the OR that might have precipitated the cardiac arrest.
He’d done so countless times in the past two days, and again he couldn’t come up with a thing. The operation had been textbook perfect; the orders he’d given for her postoperative care had been meticulous and detailed.
Whatever had brought on the cardiac arrest and its resulting effects hadn’t been his fault, he assured himself. But old feelings of inadequacy, self-doubt and guilt washed over him.
He went to the sink and poured a glass of water, which he drank in one long swallow. Then he stood at the small window and stared sightlessly at the traffic on the side street below, as old memories rolled through his mind.
He’d been a young and arrogant surgical resident, the darling of the head of Surgery because of his prowess with a scalpel. He’d operated on an eight-year-old boy named Paul Renaud, a simple procedure to replace tubes in the boy’s ears. The irony of the thing was the procedure was no longer done; it was now recognized that such tubes did no good whatsoever.
He hadn’t realized that then, however. Afterward, James gave an order for medication. The child died within the hour from an allergic reaction to the drug. Although there’d been no way of predicting the allergic reaction, James still blamed himself. He’d been so cocksure he’d never for a moment considered the possibility. He hadn’t even thought to ask the mother, though it turned out later that she hadn’t known any more than he had about the boy’s sensitivity to the drug.
Bad as it was, that wasn’t the worst part of the disaster. The true nightmare had come when he’d tried to notify Marie Renaud of her son’s death.
Mrs. Renaud, blue eyed and young enough to be the boy’s sister instead of his mother, either couldn’t or wouldn’t hear what James was saying to her—that her son had died.
“When can I see Paul? I want to be there when he wakes up.”
James had swallowed hard and repeated the fact that the little boy had died.
Marie Renaud had given him a sweet smile and even nodded. “I promised I’d be there when he woke up. Can you take me to him?”
Even now, years later, in a hospital on the other side of the country, James could hear Marie asking repeatedly in her soft, accented English when her son would wake up and when she could see him. Finally, like a coward, he’d turned and fled. The resulting inquiry had absolved him of blame—the drug he’d ordered was a commonplace one, routinely used after such procedures—but James had spent weeks in hell. He’d come close to quitting not just surgery but medicine. It was a turning point in his career. He’d vowed from that moment on that no detail ever would be overlooked.
He’d become a perfectionist, not just about surgery but about everything regarding the safety and health of his patients. Sure, there were times when a patient died. It was inevitable. He’d learned to distance himself emotionally while he told next of kin the bare facts, as he’d done just now with Melissa.
Betsy Clayton wasn’t dead, although she might as well be; she was in a deep coma. In James’s experience, such patients rarely woke up.
As chief operating officer, Melissa Clayton was one of the most powerful individuals at St. Joe’s. She was a woman he’d noticed, admired and applauded for having the same drive, energy and ambition he had. And damn it all, he found her vibrant red hair and tall, slender body dis
turbingly sensual in an understated way that excited and intrigued him; she seemed so totally unaware of her appeal.
Every time he was near her his body reacted. He’d thought more than once about asking her out, but he had a long-standing policy of not dating co-workers, and he suspected she did, as well. He’d never heard of her dating anyone from St. Joe’s, although he knew she was unattached; the gossip mill was up-to-date on who was available and who wasn’t.
He’d dreaded this meeting with Melissa. Yet he’d said only what he believed to be true about Betsy Clayton: that there was no hope now she’d recover; that the extensive tests he’d ordered confirmed that she was in a vegetative coma.
Melissa Clayton had called him arrogant. Insufferable. Had said a veterinarian would show more compassion. But it was her tears that had driven him out of the room, not her accusations. Accusations, he could counter. Tears made him feel impotent and responsible. He saw her face again in his mind’s eye, the stunned, incredulous expression in her hazel eyes before the tears had welled up and spilled over.
They had to work together; he was on the physicians’ action committee. He’d be seeing her as early as tomorrow morning at a meeting. It was essential that they communicate.
Communicate, hell. He was going to have to apologize to her; there was no way they could work together otherwise. The problem was, he had no idea how to go about it. To him, apologies were like Swahili. He knew that some people could speak the language fluently. He, however, had never learned more than a word or two, just barely enough to get by.
Somehow, Melissa made it through the day. She drew on reserves of self-control and competency she’d hardly realized she had, and she delegated everything possible. The one task she had to do herself was a television interview for a local station, explaining the reasons for the job action and the steps St. Joseph’s was taking to minimize the effect on the public. It came at the very end of the endless day, and she got through it, but afterward she couldn’t remember a single thing she’d said.
PATIENT CARE (Medical Romance) (Doctor Series) Page 3