Prescription for Love

by Radclyffe

  “Can I help you?” Susan said in a welcoming tone.

  “Yes,” Abby said, extending her hand over the counter. “I’m Dr. Remy.”

  “New hire?”

  Abby half laughed. “Yes, I’m—”

  A red phone on the counter rang and Susan said, “Hold on,” and picked it up. She stood quickly. “I’m sorry, got an ambulance coming into the bay right now. If you want to get started, we could probably use a hand. The PA on duty just headed up to the ICU to see someone with ARDS.”

  “Of course.” Abby slid her briefcase over the top of the counter onto a shelf and tossed her blazer after it. “What is it?”

  “Tractor versus motorcycle. One patient—the motorcyclist.” Susan dialed the phone and spoke as she waited. “Head trauma, probable internal injuries…Mary Kate, it’s Susan. We’ve got incoming.”

  A second later the overhead blared.

  Code Blue, STAT, ER. Code Blue, STAT, ER.

  Abby frowned. “No trauma alert?”

  “No trauma team.” Susan came out from behind the counter and motioned to Abby. “Follow me, Doc.”

  No trauma team. Welcome to small-town medicine, USA. Abby hurried after her, passing cubicles along both sides of the hall, most standing open, a few with the curtains pulled closed, presumably with patients inside. Susan pointed to a metal rack next to two swinging double doors, and Abby paused to pull on booties, a green cover gown, and a paper cap. Beyond the doors, the trauma bay was twice the size of the cubicles they’d passed, with a treatment table akin to an OR table occupying the center. Equipment cabinets filled two walls, and a long counter for charting and paperwork filled a third. The shelves were piled high with stacks of IV bags, dressings, cutdown trays, and the usual paraphernalia of a mini operating room. A red crash cart with drawers resembling a carpenter’s tool chest, only this one filled with drugs, stood ready. At least this looked like they might be equipped to handle an emergency.

  Susan quickly spread a clean sheet over the thick gel mattress pad on the table and checked that the adjustable foot- and headrests were locked. Abby spied a wall switch and flicked on the big round light hanging down from the ceiling on a flexible arm.

  “Respiratory?” Abby checked the drawers on the crash cart to familiarize herself with the equipment. All neat and orderly and well-stocked. She pulled out a laryngoscope and several sizes of breathing tubes.

  “They’ll respond to the code,” Susan said, briskly and efficiently checking the IV bags that hung ready from the poles on either side of the bed. Normal saline and Ringers lactate, already attached to sterile tubing.

  “Right.” Abby hadn’t been in the position of not knowing the routine since she’d been a first-year resident. She was used to being in charge. When Presley had called to say she needed someone to take over and expand their emergency services department, she’d jumped at the job. She’d had offers to stay in the city, but many of the other parents advised that Blake would do best if he could start fresh. She’d hoped to have a little more time to settle in, but here she was. “Surgery?”

  “I saw Flann’s car in the lot. She’ll be here.”

  Susan’s casual assurance didn’t quell Abby’s rising anxiety. Where she had trained, the surgeons were always available 24/7, and by now the trauma bay would be teeming with nurses, residents, trauma fellows, and technicians. And here she stood with a nurse and no idea where to find anything. She’d spent the last year as the senior fellow in a level one trauma unit. This hospital was far from that. She braced herself for the coming chaos. Hopefully, they’d have the personnel to handle a serious trauma.

  “What have you got, beautiful,” a husky female voice called from the doorway.

  Abby stepped aside as a sandy-haired woman in green scrubs barreled into the room. Even though she was average height and size, she seemed to fill the space. Maybe it was the energy pouring off her that electrified the air.

  Susan responded. “Motorcycle versus tractor. Motorcycle lost.”

  “Don’t they always?” The woman shook her head and pulled on booties. “ETA?”

  “Ought to be pulling in right about now.”

  “Perfect. I’ll be able to get my eight o’clock started on time, then.”

  The woman glanced in Abby’s direction and shot her a cocky smile. “New nurse?”

  Abigail forced a smile. And so it began. Surgeons never changed. Always swaggering, often condescending, and, unfortunately, necessary. She held out her hand. “Doctor. Abigail Remy.”

  A smooth, firm hand enclosed hers. The dark gaze slid over her face, and a slow smile formed on a broad, shapely mouth. Good-looking and she knew it. Abby suspected this was the point where most women surrendered their panties. She tried not to swoon.

  “Flannery Rivers. I guess the new residency program is starting a little bit early.”

  Abigail kept her smile in place with effort and withdrew her hand. “Actually, no. I would be the ER chief.”

  The playful warmth in the brown eyes chilled. “Really. And here I thought that was my job. I guess I missed the memo.”

  Abby hesitated, considering whether to take up the gauntlet. Susan appeared to be watching them with the avid interest of a spectator at the US Open, her head swinging back and forth between them. Abby had no desire to be the talk of the entire hospital by lunchtime, although she probably couldn’t change anything at this point. Still, this was no place and no time to butt heads over who was going to be in charge. She planned to be, but she’d just have to update Dr. Rivers on the details later. “I’m sorry if communications have gotten twisted. I gather a lot has been happening pretty quickly here.”

  “You might say that.” Flannery reached for her cap, as if to pull it off. “I guess you don’t need me here, then.”

  “Actually,” Abby said, “I don’t know the code team. You should lead it.”

  Flannery looked surprised and maybe a little chagrined. “Right, sorry. Sometimes I trip over my ego.”

  Abby was just as surprised at the admission. Points to Rivers for good sportsmanship. Not many surgeons had the confidence to laugh at themselves, or admit their egos often outweighed their body mass. “Comes with the territory, doesn’t it?”

  Flannery laughed and the cocky light returned to her eyes. “Absolutely.”

  “Here they come,” Susan announced at the same time as a heavyset redhead pushed a portable X-ray machine into the room.

  “Thought you might need me,” the X-ray technician said, puffing slightly.

  “Thanks, Kevin,” Flannery said.

  On his heels, two paramedics steered a stretcher through the open bay doors. A thin blonde in her forties balanced on the side of the gurney, bagging the patient, while a wiry Hispanic man guided them up to the bed, calling out, “Twenty-year-old white female. Unresponsive at the scene, vital signs erratic. Present BP 80/40, heart rate 130, Glasgow 10. Second liter of saline running in now, fractured right leg, right temporal contusion, breath sounds decreased on the right.”

  “Meds in the field?” Susan called, jotting notes on a chart.

  “Two milligrams of IV morphine.”

  “I’ll get bloods for type and cross and labs,” Susan said, tying a tourniquet around the patient’s right arm.

  Abby edged up to the left side of the gurney across from Flannery, who had a stethoscope pressed to the girl’s chest. She felt the trachea—midline—and visually assessed her torso and limbs. Her left arm was angled unnaturally in the midforearm, and her hand was gray and blue.

  “Get ortho,” Abby directed, and then stopped herself. She glanced at Flannery. “Fractured left humerus, possible compression syndrome. We need an ortho guy and possibly a vascular surgeon.”

  Flann nodded. “That would be me.”

  “Which?”

  “Both for now.”

  Abby pressed her lips together. No orthopedist in-house. No vascular surgeon. Probably no specialists of any kind in-house. One surgeon to rule them all. God, w
hat had she stepped into?

  Chapter Two

  Flann ran through the routine of assessing the patient, the steps so familiar she could do them in her sleep. There had been a few times during her residency when she had. All the same, in the back of her mind, her father’s voice reminded her to always expect the unexpected. Every case was unique, no matter how many times she had seen the battered bodies, the traumatized tissues, the unforgiving march of disease. Routine was her biggest ally and her most dangerous enemy, the sword with two edges she wielded in her daily battles. She checked pupils, reflexes, breathing, and heart rate. She palpated the abdomen, percussed for fluid, searched for signs of rupture and internal bleeding. Ran her hands down the extremities, over the pulses in the groin and behind the knees and feet. As she worked, so did the others, monitoring vital signs, throwing X-ray films up on the light box, regulating the respirator, and monitoring blood gases. Everyone did their part, that’s what made them a team. Her team. Her domain.

  As she worked, she was aware that the team had subtly changed. Abigail Remy worked across from her, their hands nearly touching at times—inserting IVs, catheters, and tubes; checking and rechecking the minute-to-minute vital signs for instability or improvement. They’d barely spoken, but she already knew so much about the new ER chief—her focus, her sure movements, her calm and purposeful directions spoke of confidence and intelligence and control. Still, Remy was no surgeon, and a stranger. And she was undoubtedly the harbinger of change. She was taking one of Flann’s jobs, after all, or so it appeared.

  Under other circumstances, she’d have been more than happy to make Dr. Remy’s acquaintance. She’d only had a few minutes before entering crisis mode to assess her, but those few seconds had been enough to deliver a one-two punch. Abigail projected a lethal combination of beauty and power in a captivating female package that Flann had never been able to resist. Shoulder-length golden hair, wavy and thick, that could only be completely natural; green eyes so pure Flann could almost smell the spring leaves; and a body even the loose cover gown couldn’t quite conceal, full and curved in all the right places. Anywhere else, any other time, and she would already be thinking about the first date.

  Fuck it all. Not this time.

  Flann strode to the light box and scanned the row of X-rays: skull, C-spine, chest, belly, arms, legs. Abigail appeared beside her, tilting her head as she studied each one. Even her silence vibrated with cool confidence.

  Abigail extended a finger toward the chest X-ray, her subtly manicured nail gleaming with clear polish. “Blunting of the costophrenic angle right there.”

  “Yeah, I see it,” Flann said. “Lung fields are clear, but that could be blood.”

  “You have ultrasound, don’t you?” Abigail asked.

  Flann cut her a glance. “We are operating in the twenty-first century here.”

  “I’m very glad to hear that.” Abigail’s smile was thin. So far the resuscitation had gone well, everyone doing their part and all the critical bases being covered. Still, the absence of in-house specialists, especially neurosurg and ortho, was a potential disaster waiting to happen. “Want to get ultrasound to check the belly?”

  “Would be quicker if I did a cutdown.”

  “If she’s ruptured her diaphragm above the liver, there might not be free blood in the cavity.”

  Flann upgraded her opinion of the new ER chief. The term rankled, but she set her irritation aside for now, even if taking orders from a medical doctor was not in her makeup. “Good point.” She looked over her shoulder. “Susie, honey, can you get Terry down here super quick.”

  “Sure thing, Flann,” Susan called, and reached for the phone.

  “Honey?” Abby murmured.

  Flann grinned, perversely glad she’d irritated her just a little bit. “Part of my Southern charm.”

  “I didn’t realize you were Southern.”

  “Through and through, on my mama’s side.”

  Abby blew out a breath. “The charm might be open to question.”

  “Give it time.”

  Abby laughed reluctantly. “MRI?”

  “CAT scan. We’ve been trying to get an MRI suite for a couple of years. You know what they cost.”

  “I’ll let Presley know it’s a priority.”

  “Presley?” Flann knew exactly who Presley was—her soon-to-be sister-in-law and the new CEO of the SunView Regional Medical Center-New York Division. She wondered how well Abigail knew her.

  Abigail gave her a long look. “Presley Worth. I understand she’s marrying your sister.”

  “I’ve heard that rumor.” Flann shook her head, still checking the films. “Unless Harper comes to her senses.”

  Abigail stiffened. Really, could she be more of an ass? “You don’t approve?”

  Flann grinned. Got her again. Remy was fun to tease. “Actually, I do. Harper is really happy, so not for me to point out the error of her ways. How do you know Presley?”

  “We’re sorority sisters.”

  “Ah. That’s some kind of lifelong secret society kind of thing, right?”

  Abigail didn’t bother pointing out she and Presley came from different worlds and had formed a friendship despite that. The ultrasound tech appeared in the doorway, giving her an excuse to escape Flannery’s uniquely irritating company. She’d rarely met anyone so irreverent, arrogant, and she would’ve said insufferable, if there hadn’t been those moments every now and then when Flannery acted against type. When the conceit dropped away, something genuine and surprisingly intuitive snuck through. And now was not the time to be thinking about Flannery Rivers. In fact, anytime would probably be dangerous.

  Abby focused on the ultrasound monitor as the tech coated the probe in clear gel and ran it over the young woman’s abdomen.

  “Got something here,” the young Hispanic woman noted. She slowed the movement of her probe and gently pressed in small circles over the right upper quadrant of the abdomen.

  Abigail pointed. “Right there. Is that a fluid collection above the right lobe of the liver?”

  “Mmm,” the tech said absently, outlining the extent of the abnormality with swift, careful strokes of the probe.

  She was good.

  “What’s your name?” Abigail murmured.

  “Teresa Santiago.”

  “I’m Dr. Remy—Abby. That’s nice work.”

  The tech smiled. “Thank you.”

  Flann loomed over Abby’s shoulder. “Probably a small tear in the liver capsule. Fluid in the chest could be an effusion.”

  “There might be a rupture,” Abby said. “That might be blood.”

  “Terry,” Flann said, “can you get the diaphragm any clearer?”

  “I don’t see a tear,” Terry said after a second. “But if it’s small…” She hunched a shoulder. “No, nada.”

  “What do you think?” Abigail said. “Wait and watch?”

  Flann mulled it over. Her first instinct was to explore the abdomen. She was a surgeon. She always wanted to operate, and in this case, there was good reason. Blunt trauma severe enough to rupture a lobe of the liver could have torn the intestine free from the abdominal wall or ruptured a kidney or the bladder, or lacerated a blood vessel. In the operating room with the belly open, she could check visually, get a look at the diaphragm, and take care of any minor damage before it became life-threatening. If they waited, continued bleeding into the chest could compromise the patient’s respiratory system, and she was already at risk of developing adult respiratory distress syndrome.

  “If she’s bleeding,” Flann said, “she could go downhill fast.”

  Abby nodded. “Agreed. But an incision in her belly means a longer hospital stay, and”—she went on when Flann made a disparaging snort—“a belly incision is going to make it harder to wean her off the respirator.”

  Flann wasn’t used to consulting with anyone other than Harper or her father on medical care. She trusted their judgment as much as her own. She didn’t know Abigail Remy,
but everything about her said she was sharp, and Flann’s ego didn’t extend to endangering the patient’s welfare because she couldn’t listen to someone else’s opinion. Compromising, she said, “Let’s get her down to CAT scan, and we can get her belly done after we take a look at her head. As long as her vitals are stable, I’m happy to wait a little while.”

  “Good, I agree.”

  “Susie,” Flann said, “have you got the CT tech in yet?”

  “He just texted from the parking lot. He’ll be waiting.”

  “All right,” Flann announced to the room in general, “let’s roll her down.”

  Another nurse had joined the team sometime in the midst of the action, and he and Susan prepared the patient for transport.

  Abby glanced at the clock. Twenty to eight. “Don’t you have a case?”

  “Yeah.” Flann sighed. She hated delaying a patient who’d been waiting days, possibly weeks for surgery. Ira Durkee was already in the holding area, expecting to go to surgery any minute, and now he’d be sitting there for a few more hours. “A colon resection.”

  “I can take the patient down,” Abigail said. “If there’s any change, I’ll call up and let you know.”

  Flann shook her head. “Can’t do it. If I’m in the middle of my case, I can’t leave.”

  “Do you have a resident who can—” Abby took a breath. She really wasn’t in NYC any longer. “Right. No residents. Partner?”

  Flann grinned. “I’ve got a great first assistant. But there’s no one else with the hands to handle this if we need to explore.”

  “Well, then,” Abby said, “I guess you better let the OR know you’re going to be late.”