Critical Care: 1 (Mercy Hospital)

by Candace Calvert

  Claire dragged her pen under several key words, underlining them three times with the same red ink she’d used on her lists of career plans. She was relieved that so far the staff—from the physician’s assistant in the adjacent urgent care clinic to the admitting clerks—seemed to be in fairly good shape, considering. Even Inez Vega, who’d thanked Claire for the pamphlet and put the baby blanket into a bag to give to the nurses. She’d sighed with relief, along with Claire, when the Hester family’s pastor hurried through the waiting room doors.

  The laboratory technician Erin said had fainted had admitted, with some embarrassment, that her swoon had been caused by a newly diagnosed pregnancy, not emotional trauma. And the agency nurse who’d threatened to abandon her shift hadn’t. But she’d told Claire in no uncertain terms that she would be speaking with her supervisor regarding unacceptable working conditions at Sierra Mercy Hospital. Hinting, of course, that the conditions had everything to do with one Dr. Caldwell.

  Claire glanced away from her makeshift desk in the ER utility room and toward the open door of the code room only yards beyond. The resuscitation had been continuing for more than forty minutes, and even from a distance Logan looked powerful and in control. She watched his big shoulders hunch abruptly, his head lowering as he leaned over the waxy, still body of the unconscious woman on the gurney. Grade school teacher, an admitting clerk said. Collapsed on a playground full of kids. Claire’s throat tightened, thinking of Kevin’s fiancée, a school counselor. Gayle. Who’d dressed for a funeral instead of a wedding.

  Logan pressed his fingertips against the side of the teacher’s neck, checking for a carotid pulse as he watched the rhythm on the cardiac monitor. He grabbed the paddles of the defibrillator, pressed them against her chest, and delivered a shock. Her body jerked and was still; then he checked the pulse again, nodded, and waved his arm.

  There was a corresponding flurry of scrubs as nurses and technicians responded, pulling medicine vials from the crash cart, running monitor strips, and tearing open bags of IV fluids. Claire didn’t have to hear it to know Logan was shouting orders or that this woman’s life hung by a slender thread. Just as Kevin’s had that awful day.

  Images rushed back faster than Claire could filter them. Sounds too. The ones that still filled her nightmares: sirens, clattering buckles on an ambulance stretcher, the stuttering rip of trauma scissors against a hopelessly charred uniform, and a futile hiss of oxygen. Her escalating horror in searching for her brother’s heartbeat—wrist, neck, finally by pressing her stethoscope against his blistered chest—and finding none. Then her own voice screaming, screaming . . . Oh, please. No. This department was stirring too many memories; she had to get out.

  Claire forced herself to her paperwork and wrote some notes for Merlene Hibbert, the chaplain, and the social worker. She looked up as someone spoke from the doorway.

  “Claire?”

  “Yes, come in.” Claire smiled at a petite woman in her midtwenties wearing a rumpled scrub dress printed with angels. Her shoulder-length blonde hair was tucked haphazardly into a huge clip, and freckles dusted the bridge of her nose. Her fair lashes were barely visible, making her look wide-eyed and childlike. Claire had noticed her taking over Jamie’s burn care and then again in the code room. A nurse—an incredibly efficient one from what she’d seen. Thankfully she was the very last person on the interview list. This nurse was Claire’s ticket out. “You’re Sarah, right?”

  “Sarah Burke,” she answered, extending her hand. Her fingers trembled slightly as they met Claire’s and then steadied into a firm grip. Her other hand clutched a Diet Coke can. Caffeine, emergency department lifeblood. Claire understood. “I know you were looking for me earlier, but . . . I haven’t had time for a break.” She gave a short laugh and patted the pocket of her scrub jacket. “Good thing I’m packing M&M’S.”

  “You bet.” Claire knew all too well the demands of a busy shift and how things like meals and even bathroom breaks got pushed way down the priority list. Adrenaline was a rugged enough taskmaster without the infamous Dr. Caldwell. “So how did things go with the resuscitation?” Claire asked, moving slowly according to protocol. She’d start with the current situation and feel her way toward the critical incident with the day care children.

  Sarah sighed. “She’s on a ventilator, but the heart rhythm finally looks decent. It kept going back into pulseless V-tach, so we gave a bunch of meds: epi, amiodarone, magnesium . . . bicarb. Shocked her a lot. She went to CCU on an amiodarone drip.” She glanced down at her slim fingers and shrugged. “Out of our hands now.”

  Claire turned toward the code room, eerily empty now that the resuscitation team had moved the patient to the CCU. An elderly housekeeper wearing a knee brace over purple denim scrubs pushed a broom to clear the residue of lifesaving procedures: discarded tourniquets, syringe caps, iodine swabs, gelled defibrillator pads, and monitoring electrodes. The patient’s clothing, snipped from her body by the paramedics, lay in a heap in the corner of the room. It looked like a soft pink tweed pantsuit, carefully chosen for a day ending in a way this teacher would never have dreamed.

  Claire looked away, fighting the image of Kevin’s uniform suspenders and his pewter cross on its knotted leather cord lying on a sooty pile in that Sacramento trauma room.

  “I know you want to help us,” Sarah said. Her voice was husky, soft. “But I don’t have time for—”

  The PA crackled overhead and Sarah jumped, startling as if stung and sloshing her Coke onto her scrub dress. The system droned a simple page, and her shoulders relaxed. “Sorry,” she murmured, her face coloring as she turned back to Claire.

  Sarah set the can down and reached for the paper towel holder on the wall, snatching a handful and mopping at the front of her scrub dress. “Really. I’m already late for my overtime shift upstairs. Besides, I’m fine. Did someone say I wasn’t or something? Not Dr. Caldwell?”

  “No,” Claire said quickly, reminding herself that peer counseling was free of fact-finding or implied blame. Not that there had been anything amiss. It was simply a release valve for staff, a pulse check for the caregivers. Acknowledge, validate, reassure. “I’m just here to see if there’s anything I can do to help any of you.” She paused and smiled gently. “The explosion at the day care, the injured children, and the one who died . . .” She watched Sarah’s eyes for a reaction. “It’s normal to feel strong emotions related to that, even days afterward, so I’d like to offer—”

  “I’m fine,” Sarah interrupted, reaching for her drink. “I’ve been in the ER for a couple of years now. Nothing gets to me much anymore.” She took another halfhearted swipe at a soggy angel before folding the towel and pressing it to her forehead. “Can I just go now?”

  Claire touched her notes, making certain she’d covered all the bases. “Would you mind telling me what your part was in the day care incident today?” she asked, knowing that having a person retell the event allowed the related emotions to surface in the process. Exactly why she never talked about Kevin—to anyone. “Were you assigned to the child who died?”

  “Yes,” Sarah said, her eyes meeting Claire’s directly for the first time. “But I was also part of saving the kids who lived. That’s what I’m remembering. Only that. Look, I’m a nurse.” She shrugged and tossed her empty can in the wastebasket. “I do what needs to be done. Then I come back the next day and I do it all again. Except for those lucky days when I get to do it for two shifts in a row. And that’s today. Honestly, I’m fine and I’ve got to go.” She smiled ruefully. “Literally. I’m heading to the bathroom next door.”

  Claire smiled back, despite a sinking feeling that she’d done nothing to help this woman. Offered her exactly . . . zip. But Sarah seemed to be made of stronger stuff than most. Some people were. What was it that Logan Caldwell said earlier? “Tough comes with the territory”? Yes, and maybe Sarah was simply asking the same thing he had: “Do you see me crumbling here?” It was possible that Sarah Burke and Logan Caldwell
were simply two tough cookies. Who was Claire to argue with that?

  “May I at least offer you a pamphlet?” she asked. “Maybe some tips for taking care of yourself: exercising, eating right, avoiding alcohol?”

  “No thanks.” Sarah gave Claire a thumbs-up. “I’m good.”

  “But . . .” Claire waved the trifolded paper at the nurse’s retreating back and watched until the angel scrubs disappeared down the hallway.

  It was her farewell salute to Sierra Mercy ER. Back to the plan for her future.

  Half an hour later, Claire finished her notes and gathered her notebook and papers, realizing as she tucked them into her briefcase that she was totally exhausted. Bone-deep, like she’d just finished one of her long runs through the oak-studded foothills. Nerves, she supposed, from being in an ER after dreading it for so long. Still, she hadn’t done so badly, had she? It was after four o’clock, and all that was left was to leave a reassuring voice mail for the hospital chaplain. She could do that from the education department.

  An earlier conversation with Merlene made Claire fairly certain she’d scored points by going the extra distance in ER. Not that she was going to make it a habit. But the director of nursing’s opinion might help in Claire’s bid for the full-time clinical educator position. In truth, it could all dovetail nicely with her plans.

  Claire turned toward the sound of footsteps, which was followed by the rich, enticing aroma of coffee.

  Erin Quinn stood in the doorway. “Figured you could use this,” the charge nurse said, stepping in to hand her a plastic-topped cardboard cup. “Raspberry mocha.”

  “Wow, wonderful. Thanks.” Claire noticed that Erin’s ponytail was gone, allowing the nurse’s copper hair to spill casually across her shoulders. She’d pulled a zip-front white hoodie sweatshirt over her scrubs and carried a red stenciled canvas tote over her shoulder. End of the day for Erin too.

  Claire spotted the familiar green label on the coffee and grinned. “Starbucks? Where’d you find something like that in a joint like this?”

  “Gift from an ambitious pharmaceutical sales rep,” Erin explained, then shook her head. “A real sales rep. Look, I’m sorry Logan called you a rep and made fun of your pamphlets.”

  “Not a problem,” Claire fibbed with a wave of her hand. The last thing she wanted now was a discussion about Logan Caldwell. She’d survived her first brush with Dr. McSnarly relatively unscathed and was finally just minutes from her last walk through this department. “It all worked out,” she reassured Erin with a genuine smile. Then she tipped her head sideways, studying the artsy stencil on Erin’s tote bag. It was sort of like a genie lamp—no, more like the old Florence Nightingale nurse’s lamp but with the symbol of a cross in the handle. “What is that?” she asked, pointing to the white design.

  “Huh? Oh, this.” Erin slid the strap off her shoulder and turned the bag so Claire could see. “I designed it myself. Sketched my grandmother’s graduation lamp. I’ve even put it on some T-shirts.”

  Claire looked closer. A Florence Nightingale lamp overlaid with a cross.

  Erin pointed to the design. “It says, ‘Faith QD.’ You know, medical shorthand for ‘every day,’ the way medicines and treatments are ordered. Kind of a play on words.”

  “Pretty ingenious,” Claire said, impressed. “But what’s it for?”

  “It’s a new idea I’m trying out,” Erin answered, her green eyes lighting up. “A nondenominational Christian fellowship group for nurses, aides, techs, doctors, anyone really. Nothing that could be viewed as pushy or preachy. But something to sort of jump-start our days. Anyway, we’ve been meeting in the chapel fifteen minutes before our shifts start. Logan calls it my God huddle, but—” She glanced at her watch. “Oops.”

  “Gotta go?”

  “Brad’s picking me up. New guy, and he doesn’t get it that a charge nurse’s shifts don’t run like clockwork. I’m breaking him in gently.” She touched Claire’s arm. “Hey, I appreciate your doing the peer counseling today. Really. And if you want to stop by Faith QD, you know where to find us. Just say the word and I’ll order you a T-shirt.” She hoisted the tote over her shoulder and strode away, leaving Claire feeling suddenly very alone.

  She took a sip of her coffee, savoring the berry-sweet cocoa flavor and wondering how this gutsy and dedicated charge nurse’s idea for a hospital fellowship would play out. Claire frowned at Logan’s cynical and sarcastic remark. God huddle. But then, Claire already knew Erin well enough to believe she’d move ahead with it, no matter what the insensitive ER director thought.

  And Claire was just as sure that she wouldn’t be joining the Faith QD gatherings. No need to gird your loins to write policy manuals or help develop nursing procedures. Thank heaven she was on her way back to those tasks right now. Out of the ER and away from Logan Caldwell. A winning combination.

  As Claire stepped out of the utility room and walked past the temporary morgue, she noticed its door was ajar. It was only a crack and barely wide enough for a faint light to escape from the inside, a quiet vacuum now. The Do Not Enter sign was still in place, but no doubt the poor child had finally been moved. That would help put things back to normal for the staff, if there ever were such a thing as normal in ER.

  Oh, great. Claire stopped short in the trauma room as she recognized him.

  The ER director, seeming even bigger if possible, stood there in street clothes, chambray shirtsleeves rolled back over tanned forearms, faded jeans, cowboy boots, and a pair of sport sunglasses dangling from a blue cord around his neck. His dark hair looked damp, like he’d just showered. Logan Caldwell, standing beside the gurney of Jamie, the little burn victim with asthma.

  He glanced up from the sleeping child, his impossibly blue eyes meeting hers. “Hi, Educator,” he whispered. “Got us healed yet?”

  Chapter Three

  Claire hated it that her feet carried her forward as if she had no will of her own, a moth headed for a complete and thorough scorching. Tired or not, she wasn’t about to let Logan have the last jab without putting up a struggle. She stopped at the side of the gurney opposite him and bit back a sigh. It would be easier if he weren’t standing there with a little boy’s fingers holding on to his. And far less distracting if this medical director didn’t look like he’d just walked off an action-hero movie set.

  “I thought you went home,” Claire said, noticing a smear of burn ointment on Logan’s muscular forearm as he slid his fingers from Jamie’s.

  The child dozed, lashes feathery against his cheeks, his breathing mercifully peaceful and rhythmic. His blond hair was still dark at the tips, damaged from the fire’s intense heat. Claire’s chest tightened as she remembered the story of the fire captain who’d carried this boy from the burning day care. Firefighters. Heroes—my biggest hero—always.

  “I stopped by the CCU. To see that patient, the teacher.” Then Logan answered Claire’s next question before she could ask it. “She’s awake. And giving orders.” He shook his head. “Told me to get a haircut.”

  Claire smiled, equally pleased with the teacher’s clinical improvement and her feistiness toward the imposing Dr. Caldwell. Not that he looked so imposing standing watch at a child’s bedside.

  “I thought I’d stick around until Jamie is moved to the room upstairs. He only has his mom, and she was at the day care too. She’s been admitted already.” Logan glanced at his watch and frowned. “But looks like Jamie won’t see her until the new shift finishes report. I want to be sure he’s got humidified oxygen at the bedside and respiratory therapy available in case his asthma flares up.” He leaned over the bed, closer to Claire, and smoothed the child’s sheet.

  Claire watched him, more than a little surprised at the act of tenderness. Could this be the same man who’d so dispassionately said, “Death is always a factor”?

  “Why the delay?” Claire asked. “This boy’s stable and comfortable. Shouldn’t he have gone to his room long before now?”

  Her question was m
et with an awkward silence. Then Logan gave a short, brittle laugh. “Yes, Sarah Burke was all set to take him upstairs before her shift ended. But she—” he paused with a faint smirk—“was delayed by peer counseling.”

  Claire bristled but found herself strangely relieved to be back in familiar territory. Just because he was concerned about an injured child didn’t mean the man had been reformed. “Look,” she said, lowering her voice as a nurse guided a patient to an adjacent cubicle, “administration threw me in here today. No warning. No choice. I wanted to be here about as much as you want me here.”

  Logan said nothing for a moment while he studied her, almost as if he were seeing her for the first time. Claire wasn’t sure, but there may have been a smile playing at the edges of his mouth. She brushed a tendril of hair from the side of her neck, suddenly self-conscious as Logan’s gaze followed every millimeter of the movement.

  “Good,” he said finally, the suggestion of a smile gone. He nodded as if they’d sealed a deal. “Then we’re in agreement after all.”

  “Agreement?”

  “That this CISM business is counterproductive.”

  She stared into his face, wanting nothing more than to nod furiously and retrace her steps out of this place. Back to the education department, where she had protocols to write and a procedure demonstration to outline, tasks that would take her closer to her goal of being hired to a full-time educator position. Not add to her bouts of insomnia. Logan was actually making it easy for her. Wasn’t he?

  He leaned toward her again, his whisper conspiratorial. “So what would it take?”

  “What do you mean?”

  “To satisfy administration. Sign us off here.” Logan sighed. “I’m all for doing whatever it takes to make my team the best it can be, but in my experience, there’s nothing worse than dwelling needlessly on tragedy.”