Critical Care: 1 (Mercy Hospital)

by Candace Calvert

Healing the healers, they called it, the basis for the work of volunteer teams that waded into horror zones after events like 9/11, the killer tsunami in Indonesia, and the devastating aftermath of Hurricane Katrina. And a Sacramento, California, trauma room after a warehouse fire that killed seven firefighters.

  Claire fought the memories. Yes, the counseling teams made sure that caregivers took care of themselves too, assessing them for burnout and signs of post-traumatic stress. Like difficulty making decisions, sleeplessness, nightmares, and relationship failures. Claire knew the symptoms only too well. She’d struggled with most of them herself these past two years, exactly the reason she’d run away from that Sacramento hospital—after refusing its offer of stress counseling—and never looked back.

  But here she was at another ER door, peeking inside through a narrow panel of bulletproof glass. And now she was responsible for helping these people deal with everything she was trying so hard to forget and expected to offer the kind of counseling she’d never accepted herself. Beyond ironic—impossible and completely at odds with her plan.

  Claire raised her palm and pushed the door inward.

  Heal my heart and move me forward. She’d prayed it every single day.

  So why was her life slamming into reverse?

  The essence of Sierra Mercy ER hit Claire’s senses like an assault. Sounds: anxious chatter, a burst from the overhead PA speakers, beeping of electronic monitors, inconsolable crying, and painful screams. Smells: nervous perspiration, stale coffee, surgical soap, bandaging adhesive, the scorched scent of sterile surgical packs . . . and of burned hair and flesh.

  No, no. Claire’s stomach lurched as she clutched her briefcase like a shield and scanned the crowded room for the charge nurse. Find Erin Quinn. Concentrate on that.

  She took a slow breath and walked farther into the room, searching among the eddy of staff in multicolored scrubs—technicians, nurses, and registration clerks. She forced herself to note the glassed-in code room, a small central nurses’ station and its large dry-erase assignment board, the semicircular arrangement of curtained exam cubicles with wall-mounted equipment at the head of each gurney, and the huge surgical exam lights overhead.

  Claire tried to avoid the anxious faces of the family members huddled close to the tiny victims. Because she knew intimately how much they were suffering. No, much worse than that. I feel it. I still feel it.

  When she’d agreed to do this for Merlene, she’d hoped this smaller ER—miles from the Sacramento trauma center and two years later—would be somehow different, but nothing had changed. Especially how it made Claire feel, the same way it had in those weeks after Kevin’s death. Unsure of herself for the first time in her nursing career, she’d been antsy, queasy, and clammy with doubt. Dreading the wail of approaching sirens and jumping at each squawk of the emergency radio. No matter how hard she tried, she couldn’t shake the irrational certainty that the very next ambulance stretcher would be carrying someone she loved, someone she’d be unable to save, and . . .

  A cry in the distance made Claire turn. Her breath caught as the young charge nurse opened a curtain shielding a gurney.

  A child, maybe three years old, rested upright in a nest of blue sterile sheets, tufts of his wispy blond hair blackened at the tips—some missing in spots—reddened scalp glistening with blisters. One eye had swollen closed, and his nose was skewed a little to one side by the clear plastic tape securing a bandage to his cheek. The other blue eye blinked slowly as if mesmerized by the drip chamber of the IV setup taped to his arm. An oxygen cannula stretched across his puffy, tear-streaked face.

  Beside him, a stainless steel basin, bottles of sterile saline, and stacks of gauze squares sat assembled on a draped table. Burn care: control pain, cool the burn to stop it from going deeper, monitor for dehydration, and prevent tetanus and infection. All the bases covered. Unless the burns are horrific and complicated, like Kevin’s. Unless there is profound shock, heart failure, and . . . No, don’t think of it.

  Claire exhaled, watching as Erin Quinn pressed the button on a blood pressure monitor and efficiently readjusted the finger probe measuring the child’s lung status. She made a note on a chart and moved back to the bedside as the child stirred and cried out.

  “Mommy?”

  “Mom’s getting a bandage on her leg, Jamie, remember?” she explained gently, then caught sight of Claire and acknowledged her with a wave. She called to another nurse across the room. “Sarah, can you finish the ointment on Jamie’s scalp? watch him for a few minutes?” After giving a brief report to the petite blonde nurse, she crossed to where Claire stood.

  “Good, you found me,” Erin said, noting Claire’s name badge and offering a firm handshake. Strands of coppery hair had escaped from her ponytail, and her blue scrubs were splotched with snowy white burn ointment. She nodded as Claire glanced once more at the injured boy. “Second-degree burns. No explosion trauma, otherwise he’d be on a chopper ride to Sacramento. But Jamie’s got asthma, and the smoke stirred things up. So . . .”

  “He needs close observation,” Claire finished. “I understand.”

  Erin smiled. “Hey, I really appreciate your coming here. We’ve had a horrible shift, and my staff are workhorses, but the Hester child was a real heartbreaker. We worked a long time to save her, but it didn’t happen. And only last weekend we had the first drowning of the season. Junior high boy fishing on the river. Overall my crew seems to be coping fairly well, but today might be that last straw, you know? So I have a couple of issues I’d like to discuss with you. I can spare about ten minutes to fill you in. Will that be enough to get you started?”

  “Yes . . . okay.” Claire tried to recall the details of her review. How much could she offer here? One person couldn’t do more than a brief assessment and let the staff know more assistance was available. At least she’d found the self-help pamphlets. “But first I should tell you that I left a message for the hospital social worker because if an actual debriefing is needed, then a mental health professional is required. That’s policy.” She swallowed, hoping she sounded more confident than she felt. “The debriefing should be done tomorrow or the next day.”

  “What?” Erin shot her a look that clearly implied Claire was the one who needed mental help. “Tomorrow? I called you here because we need help now. Didn’t Merlene tell you that?” She pressed her fist to her lips. “Look, I’ve had a lab tech faint, the media’s harassing family members in the waiting room, and an agency nurse threatened to walk out. Walk out, when I’m short-staffed already! I’m sorry if I seem testy, but I’m responsible for the quality of nursing care here. My team needs help, and I’ll do everything it takes to make that happen. Merlene told me you were a trained peer counselor. Aren’t you?”

  She hated herself. Erin Quinn was right. Claire needed to do whatever she could for these people. Somehow. She reached into her briefcase and grabbed a sheaf of glossy pamphlets. “Yes, I’ve been trained. And I can start an initial assessment, get things going in the process. I promise I’ll do as much as I can to help, and . . .” Her voice faltered as heavy footsteps came to a stop behind her. She fought an unnerving sense of déjà vu and impending doom.

  “Help?” A man’s voice, thick with sarcasm, prodded her back like the devil’s pitchfork.

  Claire turned, several pamphlets slipping from her fingers.

  It was time to officially meet the newest threat to her plan, Dr. Logan Caldwell.

  Chapter Two

  Dr. Caldwell knelt down a split second before Claire did, and their fingers brushed as they reached for the same pamphlet. She pulled back, her face flushing. “I’ve got them, Doctor. I . . .” Her voice failed as she met his eyes.

  Logan Caldwell’s eyes were impossibly blue. Intense, almost crystalline, like the still surface of Lake Tahoe after a first snow. Fringed with black lashes, they seemed mismatched with his dark brows, curly hair, olive skin, and wide-bridged nose. And now they were narrowing, with tiny crinkles forming at the
edges, as he began to . . .

  Laugh? Claire heard him chuckle deep in his throat. He’s laughing at me? She clenched the handle of her briefcase.

  “I guess you figured out why you’re here,” Dr. Caldwell said, his tone making it clear he recognized Claire from their earlier skirmish in the corridor. He held out the pamphlet, then tipped his head, trying to read her name badge. He skimmed her fawn linen business suit. “So what are you, a sales rep?”

  What am I? Claire’s lips pressed together. How dare he. He was leaning so close now that she could smell him—surgical scrub soap, coffee, and a trace of some woodsy cologne that ought to come with a surgeon general’s warning. Masculine and intentionally knee-weakening, she suspected. Maybe. For any woman but her. Claire snatched the pamphlet and stood. “No. I’m a registered nurse with the education department.”

  He gathered the remaining papers and stood as Erin Quinn attempted introductions. She was interrupted by the loud squawk of the base station radio announcing incoming ambulance traffic. A cardiac patient? Hard to tell; the report was garbled by static.

  “Claire Avery,” Erin continued, “this is Dr. Caldwell, our ER director.”

  “Logan,” he said, shifting the stack of pamphlets to one hand and extending the other toward Claire. “I’m not much on formality.”

  “Logan, then.” Claire felt his hand engulf hers as she looked up—way up—into his face. The man was huge, easily towering over her own five feet eight inches and making her feel small for the first time in a long while. She hated it.

  She straightened her shoulders, lifting her chin and stretching taller. Then pulled her hand away. “I’m here because I was told you needed some help.” As quickly as I can; then watch me run the other way, Goliath.

  Logan lifted the sheaf of pamphlets and scanned a cover. His dark brows furrowed and he searched her eyes warily. “‘Healing the Healers’?”

  Erin intervened. “She’s with the CISM team. I told you I requested that.” She glanced at the treatment cubicles and then toward a closed door marked Do Not Enter at the far end of the trauma room.

  Claire’s stomach sank. No doubt it was a temporary morgue, where they’d placed the little girl who’d been killed. It reminded Claire of the painful realities of every ER—body bags, lists of personal belongings, and impossible explanations to family members forced to wrap their arms around the clinical facts of death instead of around their loved ones. Don’t make me do this. Not again.

  Erin nodded with certainty. “I’m asking for Claire’s help with our staff. Because this day care incident’s been tough on all of us.”

  Claire studied Logan’s expression and knew Erin was wasting her energies. She’d dealt with this kind of hard-driving, unbending, and callous physician before. Like the doctor who’d repeatedly questioned her competency in the weeks after Kevin’s death.

  “Tough?” Logan shook his head. “This is what we do, Erin. Tough comes with the territory. And death is always a factor. Do you see me crumbling here?” He smacked the pamphlets against the leg of his scrub pants and frowned. “The only kind of help we need here is more staff, more warm bodies. Real nurses. Not administration’s attempt at some . . . touchy-feely counseling.”

  Touchy-feely? Real nurses? Claire dug her nails into the leather of her briefcase. She reminded herself she’d soon be back in the education department and out of here for good. Otherwise, she’d have to make this man, giant or not, eat his words.

  “Here,” he said, handing Claire the pamphlets, then rubbing the side of his jaw. The hollows of his eyes were shadowy dark. He looked suddenly weary, a caregiver nearing the end of a bruising shift. If he’d been someone else—anyone else—Claire would have felt compassion. She’d been in that situation herself plenty of times. “I’m sorry, but we just don’t need—”

  The base station radio crackled with static and then shrilled an update on the incoming ambulance traffic. Four minutes. Sixty-year-old female in full cardiac arrest.

  Erin widened her stance, and Claire half expected her to raise her fists like a boxer awaiting the first-round bell. Claire smiled, feeling a rush of admiration for this feisty redhead so competent at running her ER . . . and determined to handle its stubborn director.

  “I’m showing Claire around for a minute,” Erin told him, “and then I’ll be there for the cardiac code. We need this help.”

  Logan’s mouth twisted into a smile, and the corners of his tired eyes crinkled again. “Sure. Why not? Keep the educator around. Maybe her pamphlets double as defibrillator pads.” He chuckled and began walking away.

  He stopped to look over his shoulder, his changed expression leaving no doubt that his amusement had vanished. “But have her start with the registration staff. I can’t afford distractions right now.”

  The registration office, which looked out onto the emergency department waiting room, was a cluster of windowed cubicles filled with computers, copy machines, and incredible stacks of clipboards destined for avalanche.

  Claire headed to the first open door, trying to convince herself that she hadn’t been thrown out of the ER by Logan Caldwell. CISM policy clearly indicated staff contact was to be made away from the action, so this sequestered niche—which smelled blessedly like coffee and printer ink instead of soot and scorched hair—might be the best place to get her feet wet in the staff assessment process. It was a long way from the horror and heartbreak. Far safer. And that suited Claire just fine. All she had to do was let these office people know that help was available. Though she couldn’t imagine they’d be at risk for traumatic stress.

  “Hello?” she called, peeking around a column of wall-mounted plastic files labeled HIPAA, Emancipated Minors, Dog Bite Reports, and Workers’ Comp.

  “Come on in.”

  Claire stepped inside the cluttered space, then smiled at the sight of a tiny clerk leaning back in her chair, feet propped on a stack of copier paper boxes, and holding a Tupperware bowl. Her gray-streaked black hair was looped in long braids across her head and sported at least three ink pens, one topped with a jiggling plastic Cookie Monster. On the desk beside her computer a collection of framed photos of children flanked a ribbon-tied canning jar overflowing with mustard flowers. The clerk’s name tag, studded with service pins, read Inez Vega.

  “I hope I’m not disturbing you. I’m Claire Avery, and—”

  “No, no,” Inez said quickly, sitting upright and setting her food aside. “Erin said you were coming. And it finally settled down enough so I could take a little break.” She smiled, revealing a glimpse of a gold-rimmed front tooth. “Been quite a day. I feel so bad for the nurses and Dr. Logan. I’m glad you’re here to help them.”

  Claire looked past her into the sparsely populated waiting room. A woman rose from her chair to push an elderly man in a wheelchair to the adjacent registration cubicle. “But things are better now?” she asked, knowing from the looks of the waiting room that it had to be true. And sensing, for the first time in an hour, that this wasn’t going to be so bad after all. Maybe Erin had underestimated her staff. “No more injuries from the day care?”

  “Oh no. That’s finished. There’s nothing serious waiting right now.” Inez glanced at her computer screen. “Just a lady who tore her acrylic fingernail, that old gentleman with gout, and—”

  Before she could finish, a middle-aged woman appeared at the window and tapped anxiously.

  “Oh, dear, excuse me.” Inez opened the window.

  Claire stepped back to allow them privacy, but she could see that the woman was distraught. Her mascara was streaked, clothes rumpled, and her reddened and swollen eyes fixed on Inez like she was her last sliver of hope in the world.

  “I’m sorry to bother you.” The woman placed a small satin-trimmed lavender blanket on the counter in front of Inez. “You probably don’t remember me.”

  “I do, Mrs. Hester,” Inez said, one hand moving discreetly toward a box of Kleenex.

  Hester? Claire’s breath snagge
d. The dead child’s name.

  “But I thought you’d gone home.” Inez’s voice lowered to a whisper. “After your family . . . spent time with Amy, I thought you went home. Do you want me to call the nursing director?”

  “No, don’t bother her. You can help me.” Mrs. Hester lifted the blanket and clasped it to her chest for a moment, her eyes filling with tears. “This is my granddaughter’s blanket. She calls it her baba, and—” a tear slid down her face—“she can’t sleep without it.”

  Claire’s chest squeezed tight.

  “She usually takes it to day care, but I was replacing the satin trim—purple’s Amy’s favorite color.” Mrs. Hester raised the blanket to her face, and a low sob escaped her lips. “It smells . . . like her. Oh, please. Please, she needs this. Will you make sure she gets it?” Before Inez could answer, the woman reached through the window and grasped her hand. “They’re sure she’s dead?” she whispered, her voice raw with desperation. “My baby’s so still when she sleeps. They’re sure?”

  No . . . Claire swayed against a wave of dizziness, clutched her briefcase to her stomach, and backed out of the office and into the hallway. She leaned her shoulder into the cool, enameled wall, squeezing her eyes shut against a rush of agonizing images: her mother standing beside Kevin’s body, his leather-strung cross dangling from her fingers; her father’s confusion, repeated questions, and finally his guttural, anguished sobs . . . stunned disbelief morphing into terrible, final truth. “My son’s . . . gone?”

  Claire opened her eyes and scanned the hallway, desperate to leave but knowing she couldn’t. She took a slow, halting breath, then pulled the pamphlets from her briefcase. Why am I here? I don’t have a plan for this.

  After contacting every staff member from the list Erin supplied, Claire reviewed her CISM notes. She nodded. Peer counseling, if performed within several hours after a critical incident, might mitigate the effects of post-traumatic stress. And it was voluntary; she could offer assistance but not insist any staff member accept it.