She knew Barbara had dumped the woman on her out of spite. Barbara didn't like Casey, and tended to use her shifts as triage nurse to drive the point home. Whenever Barbara triaged, Casey's patient load was Herculean. It also encompassed the far end of a badly laid out hall, so that Casey would suffer the maximum amount of inconvenience.
The Emergency Department, like everything else at Mother Mary, had been designed by architects whose specialty must have been racetracks. Constructed in a long L shape, its twenty-five rooms demanded a lot of running and a constant strain to keep an eye on all the patients.
Well, Casey thought again as she slipped into Mr. Willington's room to give him his pain medicine, at least she got her exercise. Be thankful for small things, her mother always said. Well, this was about as small as it got.
Pulling the cap off the syringe with her teeth, Casey aimed for the right upper quadrant of Mr. Willington's emaciated backside and slid the needle home.
"I'm going to turn off the lights now," she told him quietly, because anything hurt him at times like this. His skin was like leather by now, but he refused to flinch. Casey retrieved her empty syringe and dumped it in the waste, the cap still caught in her teeth like a toothpick. "And we'll see how it does. Would you like me to get your wife?"
"No," he moaned, turning as best he could. "Let her get away from me for a while."
Casey settled him with patient hands, smiling because that was all she could offer him now when the pain medicine wouldn't even really work anymore, smoothing his hair back from a clammy forehead, trying to ease his discomfort as much as she could before consigning him back to the floors that he so seldom left anymore. "Well, you get some sleep," she crooned, already wearing the edge off her molars against the plastic needle cap she'd begun to chew like old gum to work away the stress. "I don't want any wild music or dancing in here."
He managed a small grin at her wan joke. "Not unless I'm feeling particularly frisky."
She flipped off the lights and eased back out the door, hating the futility of aching for him, wishing he'd die quickly so she could stop torturing him.
"Yes, Mrs. VanCleve." Leaning into the room next door, Casey kept her voice level and concerned, even though she had long since decided that the only thing Mrs. VanCleve needed was a high colonic and a fast boot out the door.
For Mrs. VanCleve's part, she was comfortably ensconced on the cart like a Victorian hostess, hair perfectly coiffed and hands weighted down with enough diamonds to support a third world economy. Her nails were blood-red and her lipstick matched. Her eyes were harder than the stones in her rings and brimming with disdain.
"Do you know who I am?" she demanded yet again, her voice scathing.
Casey overcame the urge to say, Yes, of course. I've been in this room every thirty seconds since you walked in the door. I should damn well know who you are by now.
"We've tried everything to reach Dr. Hunsacker," she explained yet again. "He isn't on his beeper, and he's left the other hospital. Like I said, Mrs. VanCleve, since you didn't let Dr. Hunsacker know you were coming in, he couldn't be here to meet you. You can wait for him, or if you'd like, one of our doctors can still see you."
She'd given that speech so many times in the last forty-five minutes she was thinking of printing it on a laminated card, like Miranda rights. Mrs. VanCleve was no more impressed than she had been the other ten or twelve times.
"I will not see some... intern! You get out and find Dr. Hunsacker now! I have a dinner to attend, and I will not be late."
Casey was still counting for patience when Michael screeched to a halt alongside her.
"Casey, Billie Evans is coming in in full arrest."
Immediately Casey lost interest in the society queen with the bladder infection. Without even closing the door, she turned on her tech. Instead of the crutches he'd been working on, he held out a set of scrubs. "What do you mean?"
Scrubs meant one thing. Trauma. Public relations still demanded white uniforms in this part of town, but if the nurses had the time when trauma was expected, they were allowed to change into the more practical scrubs.
"She was hit by a car. 264 just called it in. Five-minute ETA."
Casey grabbed the greens. "Have the secretaries place another call for Hunsacker. And ask them if they'd give me the log times on those calls so I can chart it. Might as well make some use out of all this paperwork. Then get respiratory, lab, and X ray up here. Notify OR."
He ran. Casey moved to follow him.
"Don't you just walk out on me," Mrs. VanCleve demanded.
Casey leveled a set of equally cool blue eyes on her patient. "I have no choice. Someone is dying. Surely you can understand that that has to come first."
"I don't—"
Casey didn't wait for the rest. She was already on her way in to set up for Billie.
She was shaken. Billie was the head nurse down in recovery. Not a popular person, by any means. A past master at the art of territorialism, Billie ran her unit rather like someone with the surname of Bonaparte, alienating everybody within range of her powerful voice and imposing figure. But Billie was one of them. You took care of your own, because nobody else sure as hell did.
The room was set up within three minutes. Respiratory stood by, lab had been called, one of the other nurses had run for blood, and a call was out to the trauma doctors. Fluids hung from poles, their lines snaking down toward the waiting gurney. The plastic morgue wrap had already been stretched beneath the paper sheet, just in case. The code drugs were laid out in neat rows on the shelf, and all the myriad forms waited to be filled out on one of the stands. Now, there was just the waiting.
"Casey?"
Flipping a sterile towel over the instrument tray she'd just opened, Casey turned to answer, and found herself face-to-face with Dr. Hunsacker.
She'd never met the man, but there couldn't be any mistaking just who he was. Leaning in the doorway, his hand on the wall, dressed in rugby shirt and chinos, he looked tousled and handsome. Something out of an old romance, Dr. Kildare, come to heal and comfort.
"Dr. Hunsacker?" she answered, a little surprised at his appearance. A little disconcerted by her own fascination. His looks weren't all that great. Certainly nothing to catalog along with natural wonders. He was tall and blond, with a nicely squared chin, blue eyes, and a jogger's build. Big deal.
And then he smiled.
"Barb told me to look for the cute little redhead with the scowl on her face," he said brightly. "I assume that's because you've had the dubious pleasure of meeting Mrs. VanCleve. Can you tell me what's going on?" He punctuated the question by leaning more easily against the door, assuming a posture of patience and interest. He wasn't going anywhere. He was making it a point to let Casey know that her work here was more important than his.
"She was a little pissed that you didn't meet her," Casey offered.
"I'm sorry it took so long to get here," he apologized, and then flashed those perfect white teeth in a show of sheepish humor. "I forgot to take the beeper into Haagen-Dazs."
It was the smile. Casey could almost hear the delivery nurses sigh four floors away. Hunsacker was nice-looking until he smiled, and then he was unforgettable. It hit you right between the eyes and left you a little dizzy. It made you smile back, no matter what else you wanted to do.
Casey suddenly understood just how he was hooking all those rich patients. He just invited them into his office and smiled at them. She was sure the blatant flattery didn't hurt any, either. The day Barb called her cute would be the first ski championships from hell.
"I sent off a urine specimen when she first came in," she reported, ignoring not only the cozy charm but the fact that Haagen-Dazs seemed to have included bourbon in its list of flavors. She could smell it on his breath. Oh, well, at least it proved he was human. There'd been some question. "Mrs. VanCleve has urinary tract infection symptoms. Burning on urination, frequency, suprapubic cramping. She hasn't let any of our docs see her."
>
Hunsacker rolled his eyes a little. "I know," he admitted, leaning a little closer, allowing a conspiratorial grin. "She can be a real pain sometimes. Well, I'll go in and smooth her feathers. Where's her chart?"
Moving toward the door, Casey pointed past the scurrying staff to the clipboard on room twenty's door. Hunsacker didn't move to give her more room. He seemed to like that close-contact approach to the staff. He was wearing cologne, too. Smoky cologne that smelled really good.
"Code blue, trauma room one. Code blue, trauma room one."
Instinctively Casey looked up toward the dismembered speaker voice. "Ambulance is here," she said, the adrenaline jolting through her. "I'm going to be tied up for a while."
Hunsacker waved off the disclaimer, his eyes avid at the sight of the assembled trauma staff. "You'll probably be having more fun than I will."
Personally, Casey agreed with him, but she didn't know him well enough to say it. Besides, the approach of pounding feet and a laden ambulance cart already had all her attention. She turned away from Dr. Hunsacker and forgot him.
For years Mother Mary had been a solidly third-rate hospital run by the only fiscally naive order of nuns in St. Louis. Staffed with ex-interns unable to find a home in any accredited residencies, its emergency room had garnered more disdain than chiropractic centers and laetrile clinics. Surrounding hospital staffs had dubbed the place M and M, not so much for the candy as Morbidity and Mortality, the twins of medical failure. The desperate and the uninformed went to Mary Mother's emergency room. The same was true of the staff.
All that had changed when the financial crunch had hit the medical community.Bowing to the inevitable, the good sisters had handed over the reins of power to a lay board untroubled by matters of compassion and spirituality. The combination of ruthless administration and safe parking had seen the hospital shoot past the two near contenders and survive when several others had failed. Now Mother Mary boasted an open heart unit, three MRI scanners, the largest pediatric psych center in the county, and a newly remodeled and expanded ER to up the trauma rating and attract those all-important rescue helicopters.
The luck was all on Billie's side when she came in. The emergency room was at full operating capacity, everyone present spoke a variation of the same language, the trauma surgeons on call weren't busy at a benefit of any kind, and the blood bank was stocked. There were enough nurses on to handle a trauma and a surgical team standing by in case she made it that far. Which Casey realized was just a message that it was Billie's time to die. Because she did.
"Dead feet," Abe Belstein pronounced as he walked in the room right behind the priest.
Casey had seen them the minute Billie had been rolled in. One of the classic signs of futility, the waxy, almost yellow cast to the feet of a trauma victim, kind of the sign that the body had already given up on servicing them, it was only going to be a matter of time before everything else quit, too.
Everything else was already long gone. The team tried to reinflate Billie's collapsed lung with chest tubes, forced her to breathe through the endotracheal tube in her throat, squeezed blood into her chest with MAST trousers, x-rayed everything with a bruise, and shot her with enough chemicals to get a truck in gear. They pumped in bloods and fluids and pumped out the same blood and never once got more than a marginal heart pattern.
Billie's eyes were open and flat, already opaque and anonymous. Her skull was shattered and her chest in pieces. Whatever car had hit her had sealed her fate on the spot. The frantic lifesaving measures they took in that room were for principle, not for effect. Nobody liked Billie, but they fought for her.
"What's the status on the car?" Casey asked the paramedics thirty minutes later as she copied off times from her scribbled notes before calling the medical examiner. The room was empty but for Casey, the paramedics, and Billie. Thick with the smell of blood, strewn with piles of used equipment and packaging, and spattered with any number of bodily fluids, the scene looked like the aftermath of an explosion.
Casey was as blood-spattered as the room and twice as disheveled. Her feet hurt even worse. She was chewing hard on another needle cap and she had an empty, ashes feeling in the pit of her stomach as she stepped over puddles of blood to get to her chart.
"No car, no witnesses. She was just found on the side of Rott Road," the paramedic answered as he cleaned off his equipment. "Evidently she tried to get across the street."
Casey nodded absently. "Evidently she didn't make it."
He didn't even pause from his work. They'd shared too many of these scenes. "Bert's here already. Ernie stayed back at the scene."
Bert and Ernie, the two county detectives who always seemed to be called out on Casey's shift. A Mutt-and-Jeff team that had survived every Sesame Street slur they'd encountered. Ernie even had the hand puppet in his car. Casey liked them.
"Well, the evidence is as plain as the tracks on her face."
Alongside her the door inched open to the hallway. Casey looked up, not wanting any visitor wandering in this particular wrong door. If wasn't a visitor. It was Dr. Hunsacker.
He never even looked at Casey. His eyes were on the body on the table. "Somebody said that was Billie Evans."
Casey took a quick look over her shoulder. She'd seen it often enough. Whatever it was that set a person apart disappeared in death, so that features took on an unnerving sameness. A person who didn't know would have to look twice to prove Billie's identity.
"Yeah," she acknowledged. "Hit and run."
Not moving from where he stood just in the doorway, Dr. Hunsacker shook his head slowly. "That's too bad, too bad. Although, I'm not sure I wouldn't want to die the same way."
Casey stared at him. "Hit and run?"
It took Hunsacker a moment to pull his gaze from Billie's still form. When he did, he proffered another sheepish smile. "Surprised," he said. "I'm not the kind to eke out every minute of life just to be breathing, ya know? I think I'd be the kind to opt out fast."
Casey wasn't sure what to say. She didn't know Hunsacker well enough yet to know how to answer. He didn't seem in the mood for black humor, and that was all she had left.
"Do you ever get used to it?" he asked, looking back at where Billie lay.
Casey took another look. Nothing had changed. It was a scene like a hundred she'd faced that year. "Yeah," she admitted with a little surprise, and felt even worse. It made her realize just how burned out she was getting, to have nothing more to say for someone she'd known.
"Six, nine, thirty-two, ninety-five, eighty-eight! Eighty-eight! Eighty-eight!"
Nothing broke a mood quite like a jumpy psychotic. Thankful for the interruption, Casey quickly gathered her notes together. "Oh, hell," she groused. "I was hoping the Lithium fairy had already scooped him up."
Hunsacker straightened to let Casey pass. "Mrs. VanCleve's still here, too."
That almost stopped Casey right beneath his outstretched arm. She didn't want to say something like "Oh, shit," to a doctor she hardly knew. With cops or paramedics it was different. They understood. They expected it. Doctors who catered to rich patients might not see it the same way.
"I'm sorry," he apologized with that smile. "I would have had her out of here before you got out, but there wasn't anybody to help."
Casey blinked up at him, walking out into the hall to deposit her work before calling the officials. "Help?" she asked. She was as surprised that he couldn't get any of a half-dozen women who were even now ogling him from different distances, as that he needed help at all. A little hand-holding, a quick prescription for antibiotics and Pyridium, and Mrs. VanCleve should have been out the door. In fact, Casey had spent the whole code counting on it.
Letting the door close behind him, Hunsacker nodded, the hint of melancholy that had crept into his expression in that room disappearing. Once again he was the bright boy. "I need to do a pelvic."
"Casey, medical examiner's on line one," Barb announced from the edge of the hall. "State San's on
line two. They don't want Mr. Ricks, and you still haven't filled out the AMA form for that little kid whose parents dragged him out of here."
The noise level was, if anything, higher. Barb stood there implacably, hands on slim hips, a small, feral, supremely unhappy woman who was three years out of training and already soured, her ire all Casey's tonight.
Casey looked longingly at the chair and knew she was never going to feel it against her backside. Mr. Ricks was now doing primary numbers, and the lights showed that she had three new patients she hadn't seen yet. And she still had to finish with Billie.
"Pelvic?" she echoed instead, eyes up to Hunsacker, unable to quite keep the exhausted challenge out of her voice. "What for?"
Some conditions needed pelvics. Some didn't. Mrs. VanCleve didn't. And Casey didn't want to do one, especially with that woman. Not even if Dr. Hunsacker were Mel Gibson and took off his shirt to do it.
"I do pelvics on all my patients," Dr. Hunsacker answered easily, as if that would be all Casey needed to know.
Casey heard the steel beneath all that velvet. "Did I miss something?" she asked anyway. "I thought there weren't any gynecological symptoms. The UTI symptoms were fairly specific, and the urinalysis was diagnostic."
"And I want to do a pelvic," he said.
"Casey, come on!" Barbara shrilled from the far end of the hall. "Take your calls. The ME's called back twice!"
Casey struggled to control the sudden burst of irrational anger. It was just all the work, all the headaches, Billie lying in there like a slab of beef without dignity. It was just that Hunsacker didn't need to do a pelvic any more than Casey needed to ask Mrs. VanCleve's opinion on nursing procedures, but he'd end up doing it anyway. With Casey.
A Man to Die For Page 2