“Last summer, my plane crash-landed not far from town,” he said idly as he tugged on his coat and gloves. “During those minutes of terror, I realized a couple of things. The first was that life is precarious and far too short.
“The second was that when my time came, I didn’t want to have more regrets than I already do.” He met her gaze. “In case you don’t know, they don’t make the best companions.”
He walked outside, hoping that time alone would make her rethink her decision. Otherwise he would be taking a lot of cold showers and spending a lot of time shoveling snow.
“What’s going on around here?” Miranda asked on Thursday afternoon.
“What do you mean?” Dixie asked, somewhat puzzled. As far as she knew, everything was running as usual.
“Dr Cameron has been walking around like a bear with a sore head for the past two days. Any particular reason why?”
“Not that I can say,” she prevaricated.
“Then would you mind finding out what bee is in his bonnet? Jane and I are going to go on strike if he doesn’t straighten up.”
Remorse filled Dixie. She knew exactly why Mark was being difficult. In deference to her wishes, he’d backed away from her and the frustration was driving him mad.
“I’ll talk to him,” she promised, although she didn’t know quite what to say. “I don’t know if it will do any good, though.”
“As long as you try,” Miranda said gratefully. “That’s all we ask.”
Dixie leaned back in her chair and stared through the window. Mark wasn’t the only one in their small office who was frustrated. She’d replayed their conversation until it haunted her. After two days of thinking, hashing and rehashing her options, it was quite plain that ignoring her attraction to Mark topped her long list of regrets.
It would have been far simpler if she hadn’t known the feeling was mutual, although even if he hadn’t said a word she might have guessed. His smoldering gaze, his quirky little half-smile, and the occasional questioning eyebrow reflected his thoughts perfectly.
She was in deep trouble.
Although he hadn’t said another word, her own conscience was wearing her down. What would it hurt to be with a man who looked at her as if the sun rose and set in her? Why couldn’t she enjoy the attentions of an attractive man? She hadn’t taken any vows of celibacy.
As for her limited stay in Hope, some of her friends had fallen in and out relationships in less time.
So why was she holding back? A relationship with Mark was the very thing she wanted, the very thing she dreamed of having, regardless of how far it progressed.
She answered her own question. Chemistry wasn’t enough. She wanted the love, the passion, the soul connection between two people. Other people had those things and she wanted them, too. Never having received or experienced that special bond before, she refused to short-change herself by accepting anything less.
And yet, for those first years after her parents had died, she had dreamed…Dreamed of being back with them, feeling her mom’s warm hugs and hearing her dad’s teasing comments and off-key singing about his little Dixie. Later, those dreams had come less frequently, but when she felt so low that she thought she’d never smile again, she’d dust off those dreams, clutch them to her chest and promise herself that she’d have those again. Someday.
Miranda knocked on the door. “Sorry to interrupt. I know you’re between patients and doing your paperwork, but a patient just came in who concerns me.”
Eager to concentrate on something other than her personal dilemma, Dixie asked, “What’s wrong?”
“It’s Opal Landers. I’ve known her for years and she just isn’t acting right. She seems disoriented and unsteady, which is surprising because she was just here a week ago and was perfectly fine.”
“Maybe Dr Cameron should examine her.”
“He went to the hospital about an hour ago and isn’t back yet. Maybe I’m overreacting, but I don’t think Opal should wait, unless you say so.”
Dixie rose, tucked one crutch under her right armpit and headed for the door. “Symptoms?”
“Her pupils are reacting unevenly, she’s unsteady on her feet and she’s complaining about a headache.”
“Blood pressure?”
“Elevated, but not through the roof. Something is going on, though I don’t have anything to go on except my instinct.”
Dixie had learned not to discount a nurse’s observations, especially one with Miranda’s experience. “How old is she?”
“Seventy-two.”
“Any signs of trauma?”
“I thought of that so I checked. None.”
“Did you ask her?”
Miranda nodded. “She denied it. So did her daughter.”
“Does she live alone or with her family?”
“Alone, although Karen Haffner, her daughter, usually spends the morning with her.”
Dixie paused outside the door. “OK. Let’s take a look.” She opened the cubicle door to find a white-haired lady sitting on the exam table and her fortyish daughter occupying a nearby chair.
“I’m Doctor Albright,” Dixie introduced herself as she entered the room. “Dr Cameron went to the hospital and because we’re not sure how long he’ll be delayed, Miranda asked me to check on you. Do you mind seeing a different doctor today?”
“Of course not, dearie,” Opal said in a quivery voice.
“Now, what can you tell me?” Dixie asked as she began to check her patient’s neurological status.
“My mother’s been acting strange all morning,” Karen reported. “Before I brought her here, she started walking as if she were drunk. And she’s developed a tremor in her right hand.”
Dixie had noticed it, too, including the way Opal avoided her gaze.
“I have a headache and need to rest,” Opal interjected tartly. “After that, I’ll be as good as new.”
Karen ignored her mother and continued. “She got up, ate breakfast like always, insisted on carrying her own laundry downstairs—”
Opal sniffed. “I’m still capable of throwing my own clothes in the washing-machine.”
“I know you are, Mother,” Karen said tiredly. “I’m just trying to help.”
“Did you take any medication this morning?”
“My vitamins, blood thinner and a cholesterol pill.”
Dixie continued her exam, gently running her fingers over Opal’s scalp. To her surprise, when she touched an area on the top of Opal’s head, the older woman winced.
“Mrs Haffner,” Dixie said offhandedly, “would you mind stepping outside for a few minutes while we finish your mother’s exam?”
Although clearly puzzled and surprised by Dixie’s request, Karen rose. “OK,” she said, sounding wary. “I’ll wait in the hall.”
Dixie fixed a smile on her face, though she found the situation troubling. She had a feeling that Opal might be more forthcoming if she could speak freely. “Thanks. We won’t be long.”
As soon as the door latch snicked behind Karen and left the three of them alone, Dixie went straight to the heart of the matter. “I notice you have a sore spot on the top of your head.”
Opal waved away her comment with one age-spotted, arthritic hand. “It’s nothing.”
Dixie gently parted the lady’s hair to find a purplish bruise about the size of a golf ball. “This looks extremely painful.”
“It is. I bumped myself.”
Dixie exchanged a glance with Miranda. “How?”
“Does it matter?”
“Yes, it does,” Dixie replied gently, already wondering if Opal’s symptoms were due to a possible subdural hematoma.
Opal sighed. “It’s really quite silly. I’d opened the silverware drawer to put away the utensils and I dropped a spoon. After I picked it up and started to straighten, I forgot about the drawer and ran my head into the corner.”
Opal sounded so disgusted with herself that Dixie believed her. She had seen the V-shaped mar
k and, with abuse of the elderly not being as uncommon as one might expect, she was relieved that Opal’s case didn’t fit in that category. Now she only had to treat the injury, not an entire family situation.
“Did you black out?”
“No. The lights turned dim and my head hurt like the dickens, but I was fine. A little sick to my stomach maybe, but land’s sake! My head didn’t even bleed, so I don’t know what all the fuss is about.”
“Why didn’t you tell your daughter what happened?”
“Because she’s been after me to move into one of those assisted living homes. I tell you, it’s a ridiculous idea.” Opal’s affront was obvious. “I’m perfectly able to care for myself and I already have a home. Why should I give it up?”
“Maybe she doesn’t want you to be alone in case you have an accident.”
Opal’s faded brown eyes reflected worry. “You’re not going to tell her, are you?”
“You need a CT scan, which is a fancy X-ray of your skull,” Dixie explained. “Your daughter will want to know why.”
“So would I. I’m still capable of making my own decisions,” Opal said waspishly.
“Of course you are,” Dixie soothed. “The scan will tell me if you damaged something inside your head. Your scalp didn’t bleed, but your unsteadiness and trembling could be signs that you’re bleeding inside your skull.”
Opal’s eyes widened, as if the idea fell completely out of the realm of possibility. “Are you sure?”
“No,” Dixie said honestly, “which is why we need a scan to see what’s going on.”
“All right.” She nodded, then closed her eyes. “This won’t take long, will it? At four, I always watch my TV show.”
If Dixie’s suspicions were correct, Opal wouldn’t watch the television for several days. “I’d plan on being at the hospital for a couple of hours.”
“Hours? Well, I suppose I have nothing else to do.” Opal’s voice faded and she closed her eyes. “Suddenly, I don’t feel very well…”
In the next instant she stiffened and her extremities began to jerk. At the same time she rigidly arched her back.
Dixie grabbed onto Opal to keep her from falling off the table. “She’s having a seizure. Call 911, find an endotrach tube, oxygen, and page Dr Cameron, stat.”
CHAPTER SEVEN
“AMBULANCE is on the way.” Miranda hung up the phone and began rummaging through a cupboard.
“Fine, but where’s my tube?” Dixie asked, trying to keep the older lady from literally jumping off the table. She was doing everything medically possible, given the circumstances, but knowing that didn’t lessen her impatience over the lack of equipment and variety of drugs she was accustomed to having at her fingertips.
“Sorry. I only have an oropharyngeal airway.” Miranda brandished it in the air.
“I’ll take it.” Actually, Dixie thought it might be more beneficial at the moment. Not only would the device allow them to mechanically ventilate Opal if necessary, it would also act as a bite block. Because she couldn’t force it into Opal’s mouth without potentially causing her to vomit or aspirate, Dixie waited for the right second to insert it.
“Come on, Opal,” she urged. “Open wide.”
When the right moment came, she slipped the airway between Opal’s teeth and positioned it past her tongue.
Miranda handed her a blanket, and while Dixie covered their patient the nurse pulled a small cylinder of oxygen out of the cabinet. “Do you want me to set this up?”
“Yes.”
Miranda spoke as she adjusted the valves on the oxygen tank. “Why is she having a seizure?”
“I think she has a subdural hematoma and it’s putting pressure on her brain. I don’t suppose we have any saline or lactated Ringer’s to set up an IV line.”
“Sorry. We did at one time, but it got outdated and the doctors decided not to replace it.”
Dixie made a mental note to discuss that issue with Mark. “Do we have any diazepam?” she asked, referring to the drug that was a combination of fast-acting sedative, anticonvulsant and muscle relaxant.
“In the other room.”
Dixie debated her options. The medication was best administered via IV, but since they didn’t have IV access…No matter. If need be, she could get around it. “How long until the ambulance arrives?”
“A couple of minutes.”
Minutes, thank goodness. “What about Dr Cameron?”
“I dialed his cellphone, but he didn’t answer.”
“Doesn’t he carry a pager?”
“I tried that, too, but he doesn’t usually carry both and he said to use his phone if we needed him. I’d better alert Jane so, if he calls, she’ll know what to say.”
“Tell her that if he hasn’t answered in a couple of minutes, keep trying. Meanwhile, get the diazepam.”
Miranda obeyed instantly. Dixie stayed at Opal’s side to monitor her. She could do little else until the seizures stopped or the proper equipment arrived. As for Opal’s flailing limbs, restraining her wasn’t an option—Dixie could only make sure that the woman didn’t hit anything or fall onto the floor.
She adjusted the blanket to keep it tucked around the elderly woman’s petite form, although it was a somewhat futile effort. Maintaining Opal’s body temperature was a small thing to do, but very necessary.
For the next several minutes Dixie impatiently watched both her patient and the clock. Just when she wondered if everyone had deserted her, the door opened and Mark strode in.
“Jane said we had a problem,” he said without preamble.
“It’s Opal Landers.” Dixie explained the situation, finishing with, “The ambulance is on its way. Do you have a neurosurgeon in Hope?”
He shook his head. “We’ll have to airlift her to another facility. How long has she been like this?”
Dixie glanced at the clock again. “Some minutes.”
“Why wasn’t I called?” Before Dixie could answer, he glanced around the room. “Where’s Miranda?”
“In the med room. She’ll be—”
Miranda rushed in, an ampule in her hand. “Got it.”
Mark flashed his light in Opal’s eyes. “Left pupil is fixed and dilated. She’s not going to come out of this on her own. What are you waiting for? Draw up the diazepam.”
“We were just getting ready to do that,” Dixie said sharply, not appreciating Mark’s attitude, “before we were so rudely interrupted.”
She met his gaze across the exam table and raised one eyebrow. He didn’t respond, except to hold out his hand for the syringe Miranda slapped in his palm.
“Hold her arm,” he ordered.
All three of them held Opal’s arm while Mark injected the drug directly into a large vein. When he spoke, his voice was even, but Dixie could sense his irritation.
“Why didn’t anyone call me?”
“We tried,” Miranda said defensively, “but—”
“But nothing. I shouldn’t have to learn what’s going on in my own practice as I walk in the door.”
“She did try,” Dixie said, adding her support to the nurse, who was clearly offended by his accusation.
“The recording said your phone wasn’t switched on,” Miranda added. “I tried your pager, too.”
“I had other calls, so you must have dialed the wrong number.”
“I don’t know what to say,” Miranda replied stiffly. “I tried.” Her set jaw indicated that her patience had come to an end.
Dixie’s own patience was hanging by a thread, but yelling at him in the middle of Opal’s emergency wasn’t appropriate or professional. When the time came, however, Dixie intended to be first in line to give him a piece of her mind.
Meanwhile, Opal needed their attention, not their bickering. “Shouldn’t the ambulance be here by now?” she asked impatiently.
As if on cue, the door opened and two paramedics strode in. Eager to get her hands on the equipment they carried, Dixie barely recognized Annie and
Mic.
“This is becoming a habit,” Annie said with a smile as she set her box at her feet.
“Tell me about it,” Dixie replied, before she described the situation they’d just walked into. “The injection we gave her is taking effect, so start an IV with normal saline, not dextrose. I want the ER staff to be able to use phenytoin.”
Annie nodded, as if aware of the incompatibility between that particular anticonvulsant drug and the sugar solution.
“She may seize again before you get back to the hospital, so give another dose of diazepam, IV push,” Dixie ordered. “If you’ll hand over an endotrach tube, I’ll insert it.”
By now Opal had lapsed into unconsciousness, so the group quickly started to work. Annie proficiently took care of the IV line, Mic monitored Opal’s cardiac rhythms and vital signs and Dixie inserted the airway tube with Mark’s assistance. Meanwhile, Mic called out the numbers, which, for the moment, weren’t too bad. So far Opal was holding her own, but that could change in an instant.
Eager for Opal to be in the ER rather than their little examination room, Dixie announced, “Let’s go, people.”
Mark turned away from the wall phone. “I notified the ER. They’ll run the scan as soon as you guys get there,” he said to the paramedics, before he addressed Dixie. “Jared will call us when Radiology is finished.”
They transferred Opal to the ambulance gurney. While Annie and Mic wheeled their patient toward the exit, Dixie nudged Mark. “How well do you know her daughter, Karen?”
“Well enough to know she’ll be upset by the news.” He paused. “Do you want me to talk to her?”
She was surprised that he’d asked. She’d almost expected him to take charge of that job, too. Yet he hadn’t, so she decided to be magnanimous. “I’ll do it, but she might be more comfortable if you came along. If you don’t mind.”
Their entourage had barely entered the hallway when Karen rushed forward. “What’s wrong with my mother? Why the ambulance? How is she?”
“She’s in a serious condition,” Dixie explained as the paramedics disappeared from view. “She had a seizure, probably due to her head injury. I suspect she’s bleeding inside her skull, but we won’t know for certain until we look at her CT scan.”
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