After stripping and throwing on a pair of thread-worn scrubs, he realized he only had his work boots for shoes. Looking around the room, he spotted some extra-large OR shoe covers and slipped them on over his boots. Tucking in and tying the waistband on his scrubs, he rushed toward Gavin Riordan, the man offering his ER and saving him three weeks’ intensive training in North Carolina. Along with everyone else, he waited at the ambulance entrance for hell to break loose as they all applied personal protective gear.
And there she was again, the nurse, waiting beside Gavin. Her height and oval-shaped face definitely reminded him of his high-school sweetheart. Some sweetheart she’d turned out to be. No sooner had he left for bootcamp then she’d torn his heart out of his chest and stomped on it. Focus, Braxton, focus.
One thing struck him about the ER: it was so much quieter here than in the field. Then, boom, the ambulance entrance doors flew open, and Gavin and the trauma team jumped into action around the gurney.
“Got the call a half hour ago,” the first EMT said.
“It’s a penetrating injury. Gunshot wound to right chest wall with possible pneumothorax,” the second EMT said, while assisting the semi-conscious young patient’s breathing with an ambubag as the team rolled the stretcher down the hall.
Beck remembered the term “the golden hour”, the most important sixty minutes in any trauma patient’s life if he was to survive. Though things might look chaotic, there was, in fact, a planned system by the attending doctor and his team for checking the ABCs—airway, breathing, circulation—and making primary and secondary surveys of the patient.
“No other obvious injuries noted.” The EMT gave them the run-down of vital signs and initial assessment while they made their way down the corridor. “A 16-gauge IV placed in left forearm, infusing normal saline at 150 cc per hr. Pressure dressing applied to point of entry wound.”
Bright motion-activated lighting snapped on the moment they crossed the threshold of the trauma room, illuminating all the gory details. Wine-colored blood covered most of the victim’s clothes. A C-collar had been applied at the scene as he’d fallen out of a truck. They’d attempted to relieve the apparent tension pneumothorax with a needle at the second rib below the collarbone. It may have saved the guy’s life.
On the count of three the team transferred the patient to the larger procedure room bed.
The familiar-looking nurse with the boxy glasses and shy attitude went right to work cutting off the patient’s clothes, using surprising force to rip the shirtsleeves open to speed up the process. Even her mannerisms reminded him of January. But she’d had so much more style than this woman. She had been bubbly and full of life. This woman seemed subdued and almost beaten down. But they called her Jan. Hmm. Could thirteen years change someone that much?
A chaotic dance ensued among two doctors and three nurses. Their hands and bodies worked together, stepping aside, sliding under, reaching over, around, and through to get an airway placed, the patient hooked up to monitors, and a second IV started.
Beck wasn’t sure whether to hold off or jump right in with the team, but followed his gut and helped Jan remove every last stitch of clothing and toss it to the floor. He kicked the wad of clothes at his feet toward the wall to prevent anyone from tripping on it.
Gavin gave instruction that the OR be notified then called out a list of orders, including labs, blood gases, X-rays and two units of blood, while he did what Beck remembered as the primary survey. It was a methodical approach to checking the airway, breathing and circulation. Gavin auscultated the patient’s lungs and mumbled, “Crepitus” then studied the wound more closely. “Luckily for him this bullet nicked a vein and not an artery,” he said, palpating the femoral artery on the same side before he uncovered another gunshot wound lower down the leg.
The patient’s cold, clammy skin made Beck suspect shock.
“Get me a chest tube drain with autotransfusion,” Gavin told the nurse beside him.
Beck knew that meant Gavin suspected hemothorax—blood surrounding the lung instead of air. Beneath the first-aid bandages applied at the scene, a quarter-sized crater erupting with thick dark blood was located in the right upper quadrant and became the center of attention. Until the lungs were stabilized, the second, less threatening gunshot wound could wait.
The overhead monitor alarm beeped rapidly as the initial vital signs registered. The oxygen sats had tanked, BP was 80/40 and the pulse 130. The youth’s heart was working like crazy in an attempt to maintain his body’s circulation, and with a pneumothorax his lungs weren’t getting nearly enough oxygen. If not stopped, it would be a deadly cycle.
“Let’s get that chest tube in now,” Gavin said, searching for and finding Beck. Their eyes met in wordless communication, and Gavin stepped back, allowing Beck to approach the man. Baptism by fire.
Jan magically reappeared and rolled over a tray with all the equipment he’d need. He flashed back to his training, then several tours of duty, and recalled each step of the process of inserting a chest tube. He’d done his share of them in the field. Feeling under a microscope here, with the world watching, he donned sterile gloves and, driven by adrenaline, hoped his hands didn’t shake too noticeably.
After prepping the skin with antiseptic, he draped it with a sterile towel. He palpated the space between the fifth and sixth ribs and reached for the large syringe Jan handed him. He inserted the needle into the bottle of lidocaine she held for him, and administered the local anesthetic, waited briefly then accepted the proffered scalpel and made an incision in the mid-axillary line. She dutifully handed him a sterile package she’d begun to open from the outside, which gave easy access to the inside tubing without contaminating it.
Beck glanced briefly into her eyes just before he took it. For one beat their gazes locked. At close range, her eyes were blue, just like January’s. Damn.
A mini-jolt of adrenaline helped him refocus. Using the rigid guide, he inserted the tube into the pleural cavity and aimed upwards as he slowly advanced it until he felt resistance. He pulled back a tiny bit and clamped the tube. With no sign of blood, the wounded young man had been lucky. Jan connected the tube to an underwater seal before he undid the clamp. A reassuring bubbling sound gave him the confidence to begin suturing the tube in place. Soon, with the trapped air removed and no longer pressing against the lung, the lung could reinflate and the man would be breathing a lot easier.
“OK, let’s get a chest X-ray to check positioning,” Gavin said as he clamped a hand on Beck’s shoulder. “Good job.”
To say Beck wasn’t relieved would be lying, but the knowledge of a job well done admittedly felt good. “Thanks. It’s been a while.”
Jan wrapped adhesive tape around the tube and affixed it to the patient’s chest wall, then Beck looped the chest tube and taped it snugly to the patient’s abdomen before applying the final dressing.
Once Beck stepped back after his part was finished, Gavin took over. He’d located the superficially lodged bullet and removed it, then plopped it into a plastic specimen container held by Jan.
“Fantastical,” she mumbled as she studied the bloody ball of metal while Gavin stabilized the patient and readied him for surgery.
Had she just said fantastical? That was it. The missing link. In the midst of chaos and saving a life, quick memories popped into his mind of the only other person he’d ever heard say “fantastic” that way. If he hadn’t been sure before, he definitely was now.
But this person was nothing like that girl.
Still reeling from the notion that he’d stumbled on his first love, he watched Gavin proceed with a secondary survey head-to-toe assessment for more subtle injuries.
While consciously avoiding any thoughts about his ex-girlfriend, he waited for the chest X-ray films. Beck leaned against the wall and observed the team hovering over the patient, whose vital signs were already improving. He lifted the protective goggles from his eyes where perspiration had started to bead and steam
them up, resting the glasses on his forehead. He glanced around the gurney from person to person, with everyone intent on what they were doing. Excellent teamwork.
Beck noticed a second pile of discarded clothing on the floor next to Jan’s feet. He moved to kick it aside and couldn’t help but notice something out of character for the subdued nurse. Completely out of place on her seriously sensible shoes were bright pink satin laces. A telltale sign of who she really was. So she hadn’t dumped all her flash. His gaze traveled up to her face carefully hidden behind dark, thick-framed artsy glasses. He looked more closely. Her eyes were as bright a blue as they had been thirteen years ago.
How had he not recognized her mouth right off? In high school she’d carefully outlined those soft, well-shaped lips with liner before she’d applied the brightest shades of pink he’d ever seen. It had driven him crazy. She was the last person in the world he’d ever expected to run into here.
For a woman who wrapped herself in the loosest scrubs possible, it was hard to imagine her as once dressing like a birthday present in loud patterns over a curvaceous figure. Short skirts had never looked better than over those legs. But today her legs were covered in baggy, faded scrubs, making it impossible to compare. Yet there were those pink satin laces shining up at him. And she had said “fantastical”.
It all added up to one person. January. And he was still as mad as hell at her.
She caught him looking at her and quickly glanced away. Could she tell that he’d just figured out who she was? Years before, she’d trampled over his heart without so much as a backward glance. He’d joined the army intent on seeing the world and had expected her to wait for him. Maybe it had been a lame plan, but it had been the best he could come up with at eighteen. When he’d gotten out of bootcamp, she’d disappeared. When he’d tracked her down, she’d broken up with him. Over the phone!
The skittish nurse shoved something toward him. He jumped back from sorting through memories to the present. She gave him a kit, avoiding his eyes. It was a Foley catheter kit.
“Make yourself useful,” Jan said, jabbing the plastic-covered box at him then quickly turning away.
He glanced at the naked patient lying on the gurney. The young man was in and out of consciousness, and Beck hoped when he catheterized him, for the patient’s sake, he’d be out of it.
As he opened the sterile package and started to set up, he glanced back at Jan, who was completely wrapped up with hanging a unit of blood. She chewed on her lower lip, like she used to whenever she’d concentrated on anything. How had he missed it? All the parts were there, though skewed a bit by time.
Thirteen years had made some major changes to both of them.
Before inserting the catheter, he looked at her one more time. Sure enough, it was January Stewart…the biggest love and the worst heartbreak of his life.
Jan had managed to avoid Beck after the gunshot-wound patient had been prepped and awaited transfer to surgery. She’d passed him off on a younger nurse who was already captivated by his strikingly handsome looks and who gladly agreed to assist him. As long as Gavin didn’t find out and he got emergency practice, it would make no difference which nurse assisted Beck.
He didn’t react or seem to mind.
Anyhow, there was a group of needy residents with an assortment of patients to keep her busy. And she was.
She’d spent thirteen years putting her life in order. Just because Beck had been her big love in high school it didn’t mean they had anything to reminisce about. Their horrible ending tugged at Jan’s conscience. But now was not the time to relive the past. It couldn’t be changed.
She tamped down the memories and tried not to cringe. Not today. Not when the emergency department was crawling with patients.
Jan escorted her next patient into the last available ER room and handed the young man a gown. “What seems to be the problem?”
“I think I have an infected spider bite, and now it’s spreading.”
He showed her his thigh. She put on a disposable glove and gently touched a red, raised, angry-looking boil. It was warm and definitely infected.
“How long have you had this?”
“About a week now.”
She noticed little pimple-like satellite areas budding around it. “Any fever?”
The patient shook his head no. “But it keeps getting bigger.”
Before she could put the digital thermometer into his mouth, a shadow fell on her.
“Looks like MRSA.”
She glanced over her shoulder and found Beck. Methecillin-resistant staph aureus was a perplexing condition, cropping up in and out of hospitals. How he could make a snap diagnosis like that astounded her. And blurting it out right in front of the patient showed poor judgement.
“I’ll have Dr. Riordan take a look,” she said, dismissing Beck.
“You play team sports?” Beck walked around her and faced the patient.
“I’m on a football team.”
“Anyone else have ‘spider bites’?”
“You know, a couple other guys might, come to think of it. We thought we got ’em on our last away game.”
Beck glanced at Jan. “Trust me, its MRSA. If we don’t treat it properly now, he runs the risk of developing myositis. Rather than wasting time treating with the wrong antibiotic, I’d lance and drain it, get a culture tonight. Save the cost of an expensive antibiotic and a return visit to the ER.”
“We’ll be right back.” Jan strained a smile at the patient, excused herself from the bedside and escorted Beck out of the room by his elbow. “What are you doing?” she said, once in the hall. “The kid hasn’t even been examined by a doctor yet, and you’re already diagnosing and treating him?”
“I’ve been in the military for years and I’ve seen MRSA all over the place. Believe me, it’s a waste of time treating him with antibiotics alone, especially if the staph infection is resistant to it. He’ll just be back in here next week with more of those boils, and they’ll be ten times worse.”
Jan glared at him, until he gave her a sarcastic smile. She hated it when he grinned so smugly like that. Just like the time standing by the lockers in high school after art class when he’d first figured out how much she’d liked him. She spun around and strode down the hall to Dr. Riordan’s office. He’d obviously figured out who she was. Her only line of defense? Avoid him!
“Dr. Riordan, can you do a quick examination of a spider bite?” She glanced down the hall to find Beck already gathering the equipment he’d need to lance and drain the eruption, and her face went angrily hot. She bit back her thoughts and followed Dr. Riordan down to the exam room, hoping he’d put Beck in his place.
After doing a quick assessment and patient interview the doctor said, “Looks like MRSA.”
So much for back-up.
“We can either treat you with broad-spectrum antibiotics, which may or may not help, or we can open and drain the area tonight, stitch you up and send you home. We’ll get culture results in forty-eight hours and make sure you’re on the right antibiotic. Then you can follow up with your primary-care physician next week.”
Jan felt conspired against as she chewed her lower lip and had the patient sign the consent for the procedure. She started to leave the room when Beck rolled his tray of equipment inside.
“Stick around,” he said. “I’ll need your help.”
The exam room took on a red cast as she swallowed her anger and nodded her head, knowing this was a one-man job. As long as he didn’t let on that he knew who she was, she’d play along with his little game, even if it meant her blood pressure getting elevated.
With her throat growing sorer by the minute, and her nasal congestion getting worse, she’d avoid him tomorrow by calling in sick to work.
Beck finished the last stitch and turned to Jan. “You can take it from here.”
She nodded dutifully, but refused to look at him. He smiled at the patient, who thanked him, then left the room.
It
was almost more than he could do not to grab her by the arm and drag her down the hall to some secluded place and tell her exactly how she’d screwed up his life. Oh, but he’d had the last laugh because he’d risen above all the dirt everyone in Atwater had tried to dump on him his whole life. He’d proved wrong everyone who’d said he would never amount to anything. He’d served his country well, seen more countries than most people dreamed about, and now he proudly wore the LAPD badge and served on the elite SWAT team. For someone who’d received the infamous honor in his senior class of being tagged “most likely to wind up in a correctional center” he’d done pretty damn well for himself.
Beck straightened his shoulders and swaggered toward the doctors’ lounge. He needed a drink, but a good strong cup of coffee would have to do instead.
Jan finally had a chance to take her dinner break around eight p.m. She notified Carmen and headed for the nurses’ lounge. Unable to wait one more second to read the special letter, she dug it out of her pocket and ripped it open. This time every year, as promised, the updated letter arrived.
A shining smile from Meghan Jean greeted her inside the envelope. She’d be twelve and a half now, and in seventh grade. Long dark brown French braids rested on her bony shoulders. A handful of freckles were sprinkled across her nose, a nose very much like Jan’s. But the eyes were definitely placed and shaped like her father’s, except their color was blue…like hers.
Dear January,
We’re reporting in on this year’s progress with our daughter. Meghan has joined the track team and also loves to dance. She scored in the top ten percent for her annual scholastic testing and her teachers want to place her in some gifted classes. It seems that out of the blue she has discovered a love of art, and wants to take painting classes. She continues to be a warm and loving girl with a natural excitement and curiosity for life even though puberty is fast approaching. Meghan absolutely hates wearing braces, but we’ve discovered clear wires and sometimes she likes to have bright blue ones applied just for fun. As you know, she’s quite the ham and keeps Daryl and me laughing. We promised her a Disney World vacation this year and she can barely go to sleep each night from thinking about it.
Temporary Doctor, Surprise Father Page 2