First Do No Harm

by Emily Smith

  “I’ve got to go suture. I’ll find you after?”

  Cassidy nodded, allowing the corner of her mouth to rise just a little.

  * * *

  Two a.m. in the hospital is usually the witching hour, that calm before the storm. The phrase “it’s always darkest before the dawn” often comes to mind, in the most literal sense. Patients are sleeping. Staff are scant, and the ones that remain are usually talking quietly over their computers, sipping on cold coffee from the night before. Sometimes the soft buzz of an electric floor cleaner can be heard in the distance, but otherwise, the hour is usually hushed. Not tonight, though. Every floor of Boston City was lit up, a multitude of staff members lining the stairwells as patients were passed down step by step on backboards and in chairs. The ones on ventilators and life-saving drugs went down the single working elevator, but this took time as well. Outside the hospital doors, a parade of ambulances waited to take patients to area hospitals. It was now 87 degrees in the ER and probably much, much hotter on the higher floors. Pierce, Cassidy, and their colleagues were exhausted, dehydrated, and more than ready to go home.

  By four a.m., the last ambulance carrying the last patient flipped on its lights and left the parking lot. The hospital was empty, save for the staff who’d stayed behind to help.

  “Kind of eerie, isn’t it? Like one of those post-apocalyptic movies or something.” Pierce found Cassidy sitting in the nurses’ station, holding a Diet Coke limply in one hand, dark circles under her eyes. Cassidy’s flair of jealousy earlier had surprised her. Especially over Margot, of all people. With her hair that changed color daily, her nose ring, her overly peppy demeanor, Margot was the antithesis of Pierce’s type. It was absurd to think Pierce could be interested in her. Actually, it was absurd to think Pierce would ever be interested in another woman ever again. She did feel badly about it though. The unsettling hurt in Cassidy’s eyes stabbed Pierce directly in the heart like a thousand tiny needles. She wanted to take that pain away from her, as quickly as possible.

  “I don’t know. I think it’s peaceful. My mom’s a teacher, and on the last week of summer before school started, she used to take me with her to help set up her classroom. The halls were empty. Everything was clean and waiting and ready. It reminds me a little bit of that, actually.”

  “You always find the good in things. I love that about you.” Pierce found herself stuttering a little with the word, as if it might give way to what she really felt for Cassidy. The urge to confess she was totally in love was building like a pressure cooker, threatening to explode any second. She had to meticulously think through everything she said for fear those words would find an escape route and slip out before she was ready—or worse, before Cassidy was ready.

  “Listen. I’m sorry I went all Single White Female on you earlier. I promise I’m not an inherently jealous person.”

  “And I’m sorry if I gave you any reason to feel insecure, Cass. I’m telling you, nothing is going on between Margot and me. I want this with you. Indefinitely.”

  Fuck. The word was just short of “forever.” Essentially a fucking synonym. Pierce might as well have proposed right then and there for all the crazy she was letting out. She couldn’t backtrack. She just had to play it off and hope Cassidy hadn’t noticed.

  “Indefinitely.” Cassidy’s face brightened even over the shadows under her tired eyes. So she had heard Pierce. And she didn’t seem to mind. In fact, she seemed…happy.

  “Let’s go for a walk.” Pierce took Cassidy’s hand and led her out of the ER and down the hall to the elevator. They took it to the sixth floor, which on a normal day was the inpatient neurology unit. But that morning, it was silent. Clean. Empty. Custodial staff had gone through and straightened up the debris left from the evacuation. Beds were made with crisp hospital corners. Computers were off. Only the dim lights from the generators remained.

  “What are we doing here?” Cassidy asked.

  “I wanted to see if you were right.”

  “Right about what?”

  “If this is peaceful or creepy.” Pierce looked around. “There is something kind of nice about it.”

  “Like the week before school.”

  “Exactly.”

  They stood in silence for a while, taking in the quiet, reveling in the stillness after a night of madness. Moved by the nothingness that somehow felt like everything all at once, Pierce put her hand on Cassidy’s waist and stepped closer to her, gently pressing her lips against Cassidy’s. Cassidy grasped the back of Pierce’s head, pulling her in farther, and Pierce’s torso warmed from her neck all the way down between her legs, where the heat built into a blazing need. No one else was in sight. Cassidy stepped back just far enough, taking Pierce by the hand and guiding her into the deserted patient room directly behind them. Pierce felt the flashover through her entire body as Cassidy placed a palm on Pierce’s chest and pushed her onto the empty bed. She climbed on top of her, straddling Pierce’s narrow hips, her hands still balancing on Pierce’s chest.

  “I’ve been wanting you all night,” Pierce mumbled.

  “Good.” Cassidy grinned and pulled her scrub top over her head so painfully slow Pierce grimaced. Underneath was a red bra adorned with lace, revealing just enough of a crest of cleavage to leave Pierce writhing beneath her. Cassidy always seemed to be wearing sexy underwear. She said she liked how it made her feel, knowing it was under her scrubs every day. Pierce nearly bit her own finger off out of frustration when she heard this and remembered it often when she slept alone at night.

  It was still sweltering on the sixth floor, but it had become impossible to differentiate this from the heat building between their bodies. Still pinned under Cassidy’s small frame, Pierce reached and stroked the skin under Cassidy’s neck, down to the small peak of breast just begging to be released from the confines of her bra. Cassidy moaned and reached behind her, unclasping it and tossing it to the corner. Watching Cassidy undress had pushed Pierce over the edge of the cliff, and she ground her waist into Cassidy’s, hoping for some sort of relief. Cassidy took one of her own nipples between her two fingers and pinched, throwing her head back, her long hair moving across her shoulders. She slid her hands under Pierce’s shirt, untucking it from her pants, and feathered her fingers down Pierce’s belly.

  “I need you,” Cassidy said, climbing off Pierce in one smooth motion and tugging at her own pants, until she was completely naked. Pierce rose to kiss her, commanding Cassidy’s mouth with her own and shifting her much-larger body on Cassidy’s.

  “No.” Cassidy put both hands on Pierce’s shoulders, but Pierce didn’t have time to be perplexed. Cassidy pushed her back down onto her back and resumed her position, where she began to ride Pierce, her hips bucking to meet Pierce’s. “I want to be on top.”

  Pierce felt the blood drain out of her face and probably to other places in her body that needed it more, and a loud, involuntary groan rose from somewhere visceral.

  “Whatever you want.”

  Cassidy put both hands on Pierce’s stomach this time and braced herself, bucking harder and faster until Pierce was sure she was about to cum. They hadn’t known each other long. But they already knew each other well. And Pierce recognized that look—the way Cassidy’s eyes rolled back in her head, the pitch of her breathing, the rhythm of her hips. And then, the explosion, a fit of release, a few choice expletives from her girl-next-door mouth. And finally, the collapse. Cassidy’s body went limp like a marionette and collapsed in a beautiful, lifeless heap onto Pierce’s chest, where she promptly fell peacefully, soundly asleep.

  Chapter Fifteen

  Sometimes it was almost too easy for Cassidy to forget about the past. She was, after all, just a normal, healthy twenty-seven-year-old. She was a physician, in her dream specialty, living in the best city in the world. And she’d fallen in love with a sexy, brilliant PA who was more than Cassidy could have ever dreamt even existed. On most days, life was good. Very good, even.

  On others
, she was reminded it was also too short.

  The next patient on the “to be seen” list was a fourteen-year-old girl named Carly Mattson. Her chief complaint was “fever.” But on further investigation into her medical records, Cassidy learned Carly had a history of acute lymphoblastic leukemia. Usually, a quick glance at the EMR for meds, allergies, and current medical problems was all Cassidy took the time for. But that day, Cassidy pored over every note she could find on Carly before she even went to see her. Carly was diagnosed with ALL at age ten. After a couple of rounds of chemo, she was deemed cancer free. Six months ago, she came down with what her parents thought was a simple virus. But blood tests revealed a spike in her white-blood-cell count, and the cancer had returned from its dark hiding place. She was currently on her third round of an experimental chemo regimen Cassidy had never heard of. Most of her treatment was through a children’s hospital in Philadelphia, where her cutting-edge oncologist resided. But when Carly’s temperature reached 104 that afternoon, her parents panicked and rushed her to the closest ER—Cassidy’s ER.

  Cassidy took a deep breath, trying to brace herself for the emotional cataclysm that would follow every minute of this case. She considered trying to hand it off to someone else. But that would mean offering some kind of explanation she wasn’t ready to give.

  “Hello, Carly. I’m Dr. Sullivan, the ER doctor here.” Cassidy spoke before looking directly at the young girl sitting in the bed at the back of the exam room. When she did, what Cassidy saw was a pale, fragile child, whose eyes were sunken with fever and whose mouth was pasted dry. Almost immediately, it was Cassidy in that bed. Seventeen-years old, fighting for her life. Carly’s parents, almost as pale and fragile, flanked her bed. Tears were left straggling in her father’s eyes, and Cassidy could tell from the way the parents looked at each other that they’d been fighting. Cassidy took another deep breath, grateful for the paper mask covering her mouth to hide the terror and uncertainty on her own face.

  “Hi.” Carly’s voice was strained and weak—the voice of someone in the process of giving up.

  Cassidy fought to bring herself back to the moment, trying to remind herself she was not in this hospital bed. Carly was. And she needed someone. She glanced at the bedside monitor, taking a mental inventory of her vital signs. Carly’s heart rate was far too fast. Her oxygen levels were dipping lower than Cassidy liked. And her temperature had reached nearly 105, in spite of a hefty dose of Tylenol.

  “Tell me what happened today.”

  “I just haven’t felt very good. Yesterday I had a sore throat and a headache. Then I got the chills, and my temp was over 103. I have a cough now, and my lungs hurt.” Carly paused, seeming to have expended all of her energy. “And I’m scared.”

  “She’s going through chemo right now.” Carly’s mother, whose name Cassidy didn’t bother to get, jumped in nervously. “Her oncologist is Dr. Walter Hofstra at CHOP. It’s an experimental treatment. Some combination of 5FU and Nivolumab, or something…Some kind of immune modulator…oh, I can’t remember…I’m so sorry.”

  “Mrs. Mattson. It’s all right. I can get all the specifics from CHOP. That’s very helpful. You just focus on being here for Carly right now.”

  “What’s her white count?” Mr. Mattson said.

  “Stop, Tom. Let the doctor speak.”

  “I’m just trying to find out what’s going on,” he snapped back. “She’s my daughter too.”

  Apparently Cassidy had been correct about the fighting.

  “Guys, that’s enough. I’m fine. Honestly.” A freezing-cold chill shot down Cassidy’s spine. It was like being in a nightmare where you find yourself trying to run from something horrible, but your legs just won’t move.

  “We don’t have the labs back yet. But I promise as soon as we do, I’ll let you know.” Cassidy returned her attention to Carly. “Is it okay if I take a listen?”

  Carly nodded, and Cassidy placed her stethoscope to Carly’s back. In the middle of the first breath, Carly erupted into a fit of violent coughing, her heart rate on the monitor racing faster. Cassidy didn’t know what was making Carly so sick. But whatever it was, wasn’t going to be good.

  “Fuck.” Cassidy was so fixated on her computer screen she didn’t notice Pierce had come up behind her.

  “What’s wrong?”

  She turned to Pierce’s comforting face, and for a moment, the horror that had accompanied the day ebbed just a little. “Nothing.”

  “Come on. That didn’t sound like nothing. What are you looking at?” Pierce leaned over Cassidy’s shoulder and squinted. “Shit. That’s like the lowest white count I’ve ever seen.”

  “0.2. She probably has five working white blood cells right now.” Cassidy’s forehead fell into her hands.

  “Neutropenic fever?”

  “Yeah. She’s fourteen. ALL. On some weird experimental chemo. Fever of almost 105.”

  “Jesus.” Pierce put her hand on Cassidy’s back. The warmth emanating off Pierce’s skin did little to thaw the freeze that had settled into her bones. “Let me know if you need anything, okay?”

  Cassidy wanted to tell Pierce she did need something. She needed to tell her she was that little girl not so long ago, to say that she’d almost died, and that she worried every day that the cancer might just be lying dormant, waiting for everything in her life to be utterly perfect before shattering it into dust. But she couldn’t. If Pierce had that information, she’d worry. She’d treat her differently. And if the monster did return…Pierce didn’t deserve that.

  The next time Cassidy returned to Carly’s room, she was in full protective equipment, from her gloves to her gown to her hair. It wasn’t to protect Cassidy. It was to protect Carly, whose immune system had essentially been obliterated by the life-saving chemo drugs.

  “We don’t know what’s causing the infection,” Cassidy said. “But her…” She quickly corrected herself, turning and addressing Carly directly. “Your white blood cell count is very, very low. Which means—”

  “I know what it means. I’m neutropenic. I have nothing to fight this thing with,” Carly said sharply.

  “Yes…”

  “What is the white count?” Mr. Mattson asked.

  “0.2.”

  “Jesus…” Mr. Mattson’s eyes widened, but his wife remained silent, shaking her head. “This can’t be happening. She was doing so well with this new treatment.”

  “The most important thing right now is to get these antibiotics going while we figure out what the source is. But I need to know where you’d like Carly treated. Obviously, Philadelphia is a long way away. We could potentially arrange for transfer there, but it won’t be quick or easy. And with her vital signs and labs looking the way they do, it could be dangerous as well. I’d feel much better if she stayed here at Boston City,” Cassidy said.

  “But Dr. Hofstra is at CHOP,” Mrs. Mattson protested.

  “I know.” Cassidy moved to her side and put a reassuring hand on her shoulder. She found that touching patients could be the difference between good medical care and a soul being comforted. Sometimes, it took only a simple gesture to make someone feel like they weren’t in this alone. “And I promise you, I’ve been in touch with Dr. Hofstra all day. He knows all about Carly and what’s going on. He also feels it’s best if she stays here for now. We have some great pediatric oncologists, and when she’s stable, if need be, we can send her to CHOP.”

  “I don’t know about that,” Mr. Mattson shot back.

  “Maybe she’s right, Tom.”

  “She needs to be with Dr. Hofstra. They know her there. They’re the best. And what if she needs a bone-marrow transplant? Do we really want that done here?”

  “Dad. You don’t know what’s going to happen. Can you both please just stop fighting for a little while?”

  The Mattsons looked at each other with what appeared to be a beat of tenderness and then turned back to their daughter. Cassidy had watched this very scene play out in her own life seve
ral years ago, and it had ended with a nasty divorce and endless resentment. That was, if Carly even survived this illness.

  “Let’s just work on getting her admitted here. One step at a time,” Cassidy said.

  “I don’t want to go all the way to Philly,” Carly said, her voice stronger than it had been all day. “My friends won’t be able to visit me, and besides, I like Cassidy.”

  Cassidy warmed for the first time in hours. “I like you too.”

  “If I stay here, will you come visit me?”

  “Absolutely.”

  The Mattsons exchanged glances again, then nodded simultaneously. “She’ll stay. As long as Dr. Hofstra is involved.”

  “He will be.” Cassidy offered a cordial smile and started to leave.

  “And Doctor?” Mrs. Mattson said softly. “Thank you.”

  * * *

  If Pierce didn’t know better, and really, she didn’t, she could have sworn Cassidy was avoiding her. After their brief exchange at Cassidy’s computer earlier in the day, Pierce had hardly seen her. They passed in the halls and shared a smile when they did, but Cassidy didn’t seem to be seeking Pierce out like she usually did. Maybe she was just busy. Or maybe Pierce was being paranoid. Or, most catastrophically, maybe Cassidy’s feelings for her were fading. She had realized quite early on that the heat between two people that boiled so hot and spread so quickly could also burn out. And she lived with a relatively periodic fear that Cassidy would do just that. Pierce was supposed to come over after her shift that night. Whatever was going on, they could talk about it.

  “Hey.” It was nearly ten p.m. when Cassidy finally approached Pierce. But her tone was tentative and morose, her words unusually curt.

  “Hey. How’s your day been?”

  “Oh, you know. Fine. Listen, about tonight. I think I just need a night to myself. Is that okay?”