Julie didn’t want to get too close, but he used a small laptop computer to sign in on for their first patient. Sure enough, she had to get close enough to catch the scent of his soap and masculine aftershave and the effect was far too heady for this time of the morning. Fortunately, the young man’s information popped up, distracting her, and Trevor explained the various windows to use and entries she’d be required to make.
“Don’t worry, I won’t make you do this until you feel ready.” He tossed her a friendly smile that put her on edge instead of comforting her. How would she handle the entire orientation at such close range? She needed to adjust her attitude and quick. If he could act detached and businesslike so could she.
Switching to all business, she armored herself with a professional disposition. Besides, Trevor seemed to have already forgotten yesterday’s news, and, even though it cut deep, Julie was grateful for the hiatus.
Trevor stood, laptop in hand, and headed for Exam Room One, where Donald Richardson, a twenty-seven-year-old type-1 diabetic ranch hand, waited. His chief complaint being nasal congestion for ten days and a headache for the past four to five.
After a friendly greeting and introduction of Julie to the patient, Trevor performed a quick examination of his nasal passages. Based on the examination, plus seeing a chart notation from Lotte, it seemed Donald’s temperature was elevated. Trevor told him it looked like he had a sinus infection.
“Take off your shirt so I can listen to your lungs,” Dr. Montgomery said.
Off came the shirt, and Trevor did not look pleased. “What’s this?” He pointed to a colorful shoulder tattoo.
Donald gave a sheepish glance. “My new tattoo.”
Trevor still didn’t look happy, and Julie assumed it was because of the possibility for complications that diabetics might face with body art.
“Did you bring your daily blood-sugar numbers?” Trevor wasn’t going to give the man a break just yet. He pushed some buttons on the laptop and brought up the most recent lab results, then took the small booklet Donald handed him. After glancing at the last couple weeks’ blood sugars, and sliding-scale insulin injections, he shared the info with Julie. She glanced at the computer screen and saw that Donald’s last A1C test was under 7 percent, which was a good thing.
“You know your kidney function has been borderline for a while now, and if you don’t keep your blood sugar under control, getting a tattoo can be dangerous.”
Donald hung his head, as if he was sick of hearing the diabetes story whenever he wanted to do or try something new. “I’ve been keeping it clean and there isn’t any sign of infection.”
“And that’s a good thing. But would you do me a favor, and next time you decide to get a tattoo, or body piercing or anything invasive, would you let me run some lab tests first? The last thing you need is to put your life in danger. If your blood sugar is high, a tattoo can be a playground for bacteria. That bacteria can invade your body and cause all kinds of trouble. Which is exactly what you don’t need.”
“I’ve been doing pretty good with the blood sugars.”
“I can see that. I’m just playing the devil’s advocate.”
From Julie’s assessment, Donald kept his weight under control and looked healthy. But the outside package didn’t always reflect the microscopic goings-on inside the body.
“I understand. You’re just looking out for me.”
“As long as we understand each other.”
“Okay. I promise. But, really, isn’t she a beaut?” Donald nodded at the tropical-inspired tattoo. “Whenever it’s colder than the North Pole up here, I’m going to look at this picture and dream about being in Hawaii.”
Trevor smiled. “That’s another place you’d have to work extra hard to keep your sugars balanced. Hot sticky weather is a playground—”
“—for bacteria. I get it, Doc.”
They exchanged a strained smile, and Julie fought to keep hers to herself.
“Well, the prescription I’m writing for the sinus infection should help, in case this tattoo springs an infection.” He wrote it out, tore it off, and handed it to the younger man. “If you notice any pain, swelling, redness, warmth, streaks or pus on or near that tattoo you let me know immediately.”
“I will, Dr. Montgomery, I promise,” Donald said as he buttoned up his shirt.
“And I gave you seven days of antibiotics for your sinuses. Take all of them. After that, if you aren’t completely cleared up, give me a call.”
“Will do.”
“Oh, and this is Julie Sterling, our new nurse practitioner.”
They gave a friendly greeting, and within seconds Julie nodded goodbye and followed Trevor out the door. Essentially, she agreed with his assessment and plan for Donald. But before she could say a word, Trevor was heading to the next patient’s exam room. He’d been adding all the pertinent data about Donald Richardson into the computer as he went along in the appointment. She wondered how long it would take her to become as proficient with the program.
He entered the next room and immediately washed his hands, as he’d done with the first patient, and made a friendly greeting while doing so. Julie would give Trevor an A for bedside manner—oh, wait, she’d already learned about his bedside manner…a long, long time ago. Man, she needed to erase that picture from her mind. And quick.
*
By lunchtime they’d hardly spoken ten non-medical-related words to each other, concentrating solely on the patient load and treatments. Their bodies being cramped together in small patient-exam rooms kept an unwanted heat simmering beneath Julie’s cool and calculated surface. Try as she might, she couldn’t ignore her reaction to being near Trevor.
At noon sharp, Lotte came waltzing into Trevor’s office, while he was explaining the required codes for specific ailments and treatments and labs. Julie’s head was spinning with intellectual overload and she was grateful when he handed her a printout of the codes. Until their fingers touched and some crazy tingly reaction nearly made her already-spinning head take flight.
“Come with me, Ms. Sterling,” Lotte said. “May I call you Julie?”
“Of course.” Thank heavens the woman was oblivious to anything beyond the clinic, because Julie was quite sure her cheeks had gone pink. She mentally crossed her fingers that Trevor hadn’t noticed.
“Let me show you the lunch room. Did you bring your lunch?”
“Oh.” Julie had been so nervous about facing Trevor again after the bombshell she’d laid on him yesterday that preparing her lunch had been the last thing on her mind. “I didn’t bring one.”
“Then let me give you a rundown of the local cafés.” Lotte pulled Julie by the arm out of Trevor’s office, and he barely glanced up, until Julie looked back and caught him taking a quick glance. Yipes, there went the head-spinning tingles again the instant their eyes connected. But just as quickly his interest shut down and he went back to the computer task at hand.
This all-business routine was wearing thin. Did it also mean he wouldn’t see her as a human being? “I’ll see you at one, then?”
He nodded, not bothering to look up again from his computer. “See you then.”
She detected he was angry with her, and couldn’t blame him, but also wondered if he was at all curious about James.
Lotte must not have realized that Julie had grown up in town and knew the main stretch like the back of her hand, so Julie let Lotte recommend her favorite spots. One of the cafés Lotte had named was new and Julie decided to give that one a try.
For a town like Cattleman Bluff, whose main claim to fame was the longest antler arch in the state of Wyoming—which she made a point to walk beside and then under while crossing the street, admiring the sheer number of antlers and the thick woven arch they created—the main street did seem to have a few new spots. An appealing dress boutique caught her eye, and a bookstore, actually a second bookstore since the first only specialized in used and unique books, went on her list of places to check
out in the future.
The old-style café had a counter and she slipped onto the last available red vinyl stool to make her order.
Halfway through her ham sandwich and cup of homemade vegetable soup she heard the young waitress tell a customer his lunch was ready and waiting with a much cheerier note than when she’d taken Julie’s order.
“Thanks.”
Surprised by the voice, Julie turned to see Trevor accept the sack of take-out food, along with the huge and hopeful smile from the young server.
“Just the way you like it, Dr. Montgomery.”
“You never let me down, Karen. Thanks. Put it on my tab.”
The shapely waitress followed him to the door, and Julie couldn’t help watching them talk briefly together before he left. Dating? Who knew? That was entirely his business, but, since Julie’s pulse had stepped up a beat or two just seeing Trevor relating to the attractive woman, she chided herself for caring.
When Julie finished her tea she asked for her bill.
“Oh. No worries. That’s been taken care of by Dr. Montgomery.”
Julie raised her brows and noticed the waitress’s carefully observant eyes watching her every move. “Oh, well, then, I’ll be sure to thank him.”
As Julie left the lunch counter she could have sworn she heard the young woman mumble, “I’m sure you will…”
Did she think she had claims on Trevor Montgomery any more than Julie did?
There was no way Julie could know the answer to that, but one thing was sure: she’d bring her lunch tomorrow and skip eating at this café in the future.
*
The afternoon appointments were all fairly routine, and, since Julie needed time to tackle the computer charting, Trevor suggested she spend the rest of the day with Lotte and Rita. A relief to Julie, since being forced to watch Trevor all morning had caused a list of unwanted reactions, none of which were proper, so she took the assignment and ran.
Except he showed up in her office looking torn. “I’ve got an I and D in Exam Room Three. You want to take care of it?”
She understood this was an opportunity for him to evaluate her on an incision-and-drainage procedure. “Sure. Is it a boil or an abscess?”
“A boil.”
She dropped what she was doing with Lotte and Rita, and followed him down the hall. He introduced her to Molly Escobar, a fifty-six-year-old librarian who had formed a ping-pong-ball-sized boil in her right armpit. The area in question was red, angry-looking and weeping pus.
Following protocol from her prior clinical experience for this minor surgical procedure, Julie first cleansed the skin with antiseptic and injected topical anesthetic to numb the area before using a scalpel with a sterile blade to make a small incision to allow the pus to flow out. As she worked she kept in mind that a regular boil looked the same as MRSA and the only way to tell the difference was if the usual antibiotics didn’t help clear the infection. She’d save time and start with a broad-spectrum antibiotic active against both staph and strep just in case.
Once she’d drained the boil, and thoroughly cleaned the area, it looked clear of infection and had healthy tissue at the base, so she placed four sutures. Then she put on a thin layer of sterile gauze followed by a sterile dressing, which would need to be changed daily.
“I’m going to have our nurse show you how to change the dressing, and I want to see you back on Monday for a follow-up visit, okay?”
Dr. Montgomery had been as quiet as an overgrown barn mouse watching her every move, connecting with her glances whenever she looked up during the procedure, blinking his approval, evidently never feeling compelled to make any suggestions.
After Charlotte came to take Ms. Escobar to the procedure room, and they were alone, Trevor looked at Julie and smiled. “You have a gentle touch, Julie,” he said, their eyes lingering briefly longer than necessary, and causing an unwanted reaction behind her breastbone.
“Thank you.” She needed to step away from him. Now. “I’ll go input the notes in the computer,” she said, and sailed out of the room.
By 5:00 p.m. the clinic closed, and Julie walked with Lotte and Rita to the parking lot. Trevor was on his way out, too, and, without knowing, Julie had parked next to his car. She glanced at him, disturbed to find his gaze already settled on her, as she opened her door.
“Dr. Montgomery?” a man’s voice called from across the parking lot.
Trevor looked up, smiled, and waited for the middle-aged man to approach. Julie moved around the car to put in her trunk a ream of paperwork given to her by Lotte to study that night. She dallied out of pure nosiness.
“What’s up, Connor?”
As the man got closer Julie realized the guy was dressed shabbily and looked down on his luck.
“I was wondering if you can give me some advice about—”
Lotte spoke up from two cars down; evidently Julie hadn’t been the only one to linger out of nosiness. “Mr. Parker, you know you’re supposed to make an appointment for those kinds of things.”
“That’s okay, Charlotte, go ahead and go home,” Trevor said, dismissing her in a kind way.
Julie was thinking the same thing—the guy should make an appointment, not hit up the doctor for a parking-lot consultation—but decided to keep her mouth shut if she wanted to stick around to find out what was going on, and if she valued her new job.
“Thanks, Doctor. With the cold weather and all, feet in boots all day and half the night—I’m working a second job as a security guard at Turner’s Hardware—I’ve developed athlete’s foot and I was wondering if you have any samples of that cream you gave me last time?”
“I don’t, but I’ll share a little trick. What you can do is urinate on your feet in the shower. Plug the drain so you can soak your feet in it for a minute or so. Doesn’t cost a penny. Let me know how it works.”
The man looked perplexed, but grateful and willing to give the old wives’ tale a try. “Thanks, Doc. I’ll be sure to let you know how it works.”
As the man walked off Julie folded her arms, no longer able to keep her thoughts to herself. “You don’t expect that to cure his athlete’s foot, do you?”
“My grandmother swore by using urine on her cracked feet, even kept a jar of it for her winter-cracked hands, and folks have been recommending urine for foot fungus for years.”
“Topical antifungals have something like forty percent urea in them, and urine has…what? Two point five percent tops?”
“Your point?” One arm on the roof of his car, looking over the top, he nailed her with a perturbed stare.
“Your treatment won’t be very helpful for him. He might need a strong topical fungicide, or possibly an oral-medicine prescription.”
He took his time to inhale, as though patience was his biggest virtue. “Look, the guy’s health insurance has such a high deductible he can’t afford to make appointments. Let alone buy medicine on the chance it may or may not help, or, worse yet, try oral medicine that can cause liver and heart issues as a side effect. The man’s got six kids and a wife with a lot of physical problems. You heard him—he works two jobs. I’m just trying to save him some money, that’s all.” His brows formed a V as he dared her to challenge his wisdom.
Well, in that case… “Okay, I get it.” She started to get into her car as he watched, but couldn’t quite let the provocative subject drop. “Do you keep medicine samples for people like that? Or do you only rely on old homeopathic methods?”
Trevor continued to stare at her as though she was a cattle poacher. “I help when I can, but I’ve also got a business to run and salaries to pay. And the people around Wyoming have used home remedies for years, especially during the long winters when it’s nearly impossible to get to a doctor.”
Her hand flew to her earlobe, her tell for when she backed down. “Point taken.” She slipped inside her car and started the engine, thinking she’d buy some basic pharmacy items and bring them to the clinic for people like Connor whatever-his-l
ast-name-was.
The first day on the job, working with the father of her child, had started out restrained and ended up downright rocky. The last thing she’d expected was ending the day with an argument over whether or not a grown man should urinate on his toes in the shower.
What would tomorrow bring?
Was Trevor ever planning to discuss their situation again, or, as she’d suggested they keep things under wraps, had he taken it completely to heart—meaning forget it ever happened? Well, that stunk if that was the case, and her respect for Trevor Montgomery slid down the honor scale.
Still wanting to end the trying day on a positive note, because that was her tried-and-true survival mechanism, Julie lightly tooted her horn as she drove off. In the rearview mirror she saw Trevor standing, watching her go and finally giving a wave.
It wasn’t the friendliest gesture, or the meanest. Truth was, she’d set the guidelines—“let’s keep things under wraps”—and he’d taken her direction and run with it. Yet the fact he hadn’t asked one question about James today smarted.
With one last glance into her rearview mirror before hitting the street, she consoled herself—at least he’d quit scowling.
CHAPTER THREE
THURSDAY MORNING, TREVOR looked like hell, as if he hadn’t had a second of sleep. The delicate skin beneath his puffy eyes looked bruised, his hair unkempt. He’d obviously skipped shaving.
“Can I see you in my office?” It wasn’t a question.
Julie followed him down the hall, walked past him as he held the door for her, where she could tell he’d at least showered because he smelled fresh, and his clothes weren’t crumpled in any way. Guilt stabbed at her for doing this to him, but how many nights had she lost sleep over her son?
Once inside, he closed the door, stood there and drilled her with his stare. “I need to know about James. From day one.”
Did he expect her to take time away from her patients to tell him her son’s life story right now? “Uh, I’m still unpacking, but I have baby books, with his pictures and milestones, if that would help?”
Hot-Shot Doc, Secret Dad (Cowboys, Doctors...Daddies) Page 4