by R J Nolan
A gurney banging against a wall broke Jess out of her contemplations. She cursed under her breath when she realized Roberts had walked past her while she was lost in thought.
"Dr. Roberts," she called after him. Jess caught up with him just as he reached the elevator. The doors slid open.
"What?" he asked in an impatient tone.
"I'd like to talk to you for a minute," Jess said.
"Fine." Roberts motioned for the people in the elevator that was waiting to go ahead without him. He turned back toward Jess with a scowl.
Now that Jess was facing him this didn't seem like such a great idea. She was unexpectedly tongue-tied. That in itself was so unlike her. I knew this was a bad idea.
"Is there a problem?" Roberts asked. "I'm needed back on the psych floor."
Jess scrambled for something to say. She cursed herself for not thinking this out before she approached Roberts. "Do you think the record of the patient you just saw should be flagged for possible drug seeking behavior?"
"Yes. I already told your resident that."
"Okay. Good. So how is the new psychiatrist working out?" Great segue, genius. "Um... Dr. Donovan... Right?" Like you don't know exactly what her name is.
"Kim is settling in fine," Roberts said. His confusion was plainly written on his face. "Was there something else you wanted?"
"No. That's it. Thanks." Jess turned and quickly walked away. Great, you looked like a total idiot. That's why you never do this. You're terrible at it. Stick to business. Last thing you need is to become interested in someone you work with. It worked out so well last time, she sarcastically reminded herself.
Kim picked up an empty tray and headed for the food line in the cafeteria. She glanced up when she heard her name called. She smiled and waved when she spotted Brenda, a psychiatric nurse-practitioner she worked with on the psych floor. She made her selections, and then headed for the table where Brenda sat.
"I see you decided to descend from the ivory tower today," Brenda said.
Kim laughed as she took a seat at the table. Brenda was a feisty, middle-aged black woman. She had taken Kim under her wing.
"It does feel good to get off the floor for a little while. See how the other half lives... so to speak," Kim said. That was one of the reasons Kim liked rotating in the ER. It could be isolating to spend an extended period on the psych ward.
"Ready to face the loony toons in the ER next week? And I don't mean the patients!" Brenda said.
Kim laughed. "I'm sure I can handle whatever they throw at me."
"I know you can," Brenda said. "Well, I need to get back to the floor. Group starts in an hour. I'll see you upstairs." She gathered her tray and with a wave headed for the exit.
Kim watched for a moment as Brenda walked away. It was hard to believe she had been at LA Metro for three weeks already. The time had just flown by. Although she was busy getting to know her fellow psych staff and settling in, she thought of the beautiful ER chief often and the brief time they had spent together on her first day. She had never reacted so strongly to anyone as she had Jess McKenna. The thought of her first rotation in the ER next week filled her with equal parts of anticipation and trepidation.
Enough of that. Kim turned her attention to the chart she had brought with her. She glanced up when a shadow covered her work.
"Hey, Kim. Mind if I join you?"
Kim smiled at Chris Roberts. "Hi, Chris. Have a seat." Despite her poor first impression of Chris when he had bad mouthed Jess McKenna, he had turned out to be a good co-worker. She had worked closely with him during her first week and found him to be very helpful and pleasant to work with. "How did the ER consult go?"
Chris scowled as he set his tray down and slid into the chair next to Kim. "Same incompetence as usual down there. They shouldn't need a psychiatrist to tell them some junkie is drug seeking. You'd think McKenna could train her residents better than that."
Kim forced her expression to remain neutral. I bet there was more to the consult than that. What is it with him and Jess McKenna? She still wasn't sure if his dislike was of the ER in general or Jess in particular. He had been covering the ER for the last two weeks and done nothing but complain about it.
Chris pulled the ER pager off his belt and shut it off. At Kim's raised eyebrow he said, "I'm on my lunch break."
Although irritated by Chris's behavior, Kim knew there was nothing she could do about it — yet. No wonder there are problems between the ER and psych. "Well, the good news is today is your last day. I'll be taking over on Monday," Kim said.
"Ah... that reminds me. Be on your guard when you get down there. I don't know what she's up to, but McKenna stopped me as I was leaving the ER just now and asked about you."
Concern flared for a moment, then Kim shrugged it off. It wasn't uncommon for people to be curious about new staff members. "What did she want to know?"
"That's the strange part. She asked how you were working out. I've never heard her ask about anyone new before. That's why I wanted to warn you to be careful when you're covering the ER consults."
A sinking sensation in the pit of her stomach made Kim queasy. Don't jump to conclusions. If she found out about what happened at Memorial, so be it. You didn't do anything wrong. She pushed away her tray no longer having any appetite. "Okay. Thanks. I should probably head back to the floor."
Chris put a gently restraining hand on Kim's arm when she started to stand. "Hang on a sec," he said.
As she resumed her seat, Kim gazed at Chris questioningly. Faint warning bells started to ring when he stared at the table, and then began to shift nervously.
"I know it's short notice on a Friday night." Chris looked up and met Kim's eyes. "Would you have dinner with me tonight?"
Kim sighed to herself. He had already tried the "let's get together as new colleagues" bit last week. You should have told him then instead of just saying no thanks. The one thing Kim had never been was closeted. She didn't flaunt her sexuality at work, but never hid it either. For the first time she hesitated, then immediately berated herself for doing so. This isn't Memorial. Philip not only knows but supports you.
"If you're busy we can make it another time," Chris said, misunderstanding her lack of response.
Kim mentally cursed Dr. Pruitt for making her unsure of herself. Just tell him. "Thank you, but no." Kim held up a hand to keep Chris from interrupting. "Let me be honest with you. I'm a lesbian."
Chris's mouth dropped open, then he looked down at the table. His expression went totally blank.
Kim braced herself for his reaction.
Chris finally looked up. "Didn't see that one coming." He shook his head and his smile reappeared. He seemed to regain his equilibrium. "Are you sure?" he asked with a teasing glint in his eyes, though he sounded half serious.
Kim laughed, more relieved than she cared to admit. "Positive." She stood and picked up her tray. "I really should get back up to the floor."
"Okay. I'll see you up there later," Chris said. He grinned up at Kim. "Oh, and if you should ever change your mind about the guy thing..."
Kim was glad Chris was taking her revelation so well. She shook her head and laughed. "I wouldn't hold my breath if I were you."
Making her way out of the cafeteria, Kim's thoughts once again turned to Jess McKenna. Why is she asking questions about me? Kim resolutely pushed away her worries. Regardless of what Chris thought, maybe Jess was just curious about a new colleague.
Kim pushed through the cafeteria doors. As if conjured by her thoughts, she spotted Jess about to enter from the other side. "Hello again, Dr. McKenna," she said with a friendly smile.
Jess looked momentarily startled, then her face resumed its normal placid expression. "Dr. Donovan," she said before moving to continue on her way.
"Could I speak to you for a minute?" Kim asked quickly before Jess could walk away.
Jess moved away from the swinging doors and back into the hallway outside the cafeteria. Once she was out of
the way of traffic, she turned to Kim. "What can I do for you?"
"I wanted to let you know I'll begin covering the ER on Monday."
"Yes, I saw your name on the schedule," Jess said.
Knowing what Chris's attitude was like when he covered the ER, Kim felt the need to assure Jess that she did not feel the same. She met Jess's eyes. "I'm looking forward to working in the ER. I've always found it an interesting and challenging place to work."
A brief half smile flashed across Jess's face before she resumed a businesslike expression. "Your help will be a welcome addition to the ER."
Before Kim could respond, Jess's pager went off. Taking it off her belt she glanced down at the display. "I have to go." Jess didn't immediately walk away.
It seemed as if Jess wanted to say something more but her pager beeped again.
"I'll see you on Monday," Jess said. With a brief nod, she turned and headed down the hallway at a fast walk.
Kim watched Jess go as she played over in her mind the fleeting smile that had transformed Jess's face. It had softened her features for just a moment. What was quickly becoming her new mantra echoed though her mind. Stick to business.
CHAPTER 3
JESS STEPPED INTO the center area of the nurses' station and beckoned to Aimee Phan. The first-year resident hurried over. "As soon as Dr. Donovan gets down here —"
Penny called out a greeting to Dr. Donovan.
Jess glanced up at the clock and was pleasantly surprised. Today was Kim's first day covering the ER. She's prompt. I'll give her that. The page to psych had gone out less than ten minutes ago. It was not uncommon for a patient to wait an hour or more before someone from psych finally put in an appearance.
"Good Morning, Dr. McKenna, Dr. Phan. What can I do for you?" Kim asked with a friendly smile.
"Dr. Phan will fill you in on the patient," Jess said. She motioned for the resident to go ahead, and then stood by to listen while the resident gave the patient's basic history. Jess watched Kim's reactions. It had been her experience that none of the psychiatrists had any interest in working with the ER residents.
Aimee quickly finished up her presentation of the patient.
"I think the best way to start is with a full patient mental status examination," Kim said. "Have you ever done one, Dr. Phan?"
Aimee shook her head. "Just the basic questions that are part of a history and physical."
"This is quite a bit more detailed than that. Let's go see your patient and I'll walk you through the assessment procedures."
"Great." Aimee smiled broadly. "Thanks, Dr. Donovan."
Jess nodded to herself. Better and better. She was pleased to see that Kim had not blown the resident off and taken over the case. And best of all, she was providing a teaching experience to Aimee.
"Dr. McKenna, will you be joining us?" Kim asked.
Jess momentarily lost her train of thought when her eyes met Kim's. Focus, McKenna. "No. You and Dr. Phan seem to have everything under control."
Kim nodded, then turned toward the resident with a smile. "Dr. Phan, lead the way."
Jess watched as the two women walked away. Her first impression of the new psychiatrist was a very positive one.
Jess stood outside the curtained bed. She was watching Kim coach Aimee Phan through the patient exam process. Jess was impressed by Kim's handling of the resident. She allowed a rare smile to cross her face. She's a good teacher.
Kim gently patted the elderly patient's arm before turning her attention to Aimee. "If you need anything else just let me know."
"Thanks, Dr. Donovan," Aimee said with a smile.
Kim stepped over to the closed curtain surrounding the patient's bed and turned to slip through the opening.
Jess stepped back just before Kim plowed into her. She grimaced when she heard Kim's gasp of surprise. "Sorry about that. Didn't mean to startle you. I didn't want to interrupt," Jess said.
"That's okay. Were you waiting for me or Dr. Phan?"
"I was waiting for you. I wanted to catch you before you headed back to psych." So far, Kim had managed to surprise her. Regardless of that, Jess's previous experience with psych led her to expect problems. Most of the psychiatrists couldn't wait to get out of the ER. If you didn't catch them before they left the floor, it could be quite some time before they returned. Even if you managed to catch them, it didn't mean they were going to offer their help graciously. She's been great so far. Give her a chance. "I've got a patient I'd like you to talk to and evaluate. I think he could benefit from some outpatient counseling."
Kim smiled. "Sure. I'm happy to help any way I can. What have you got?"
Jess's tension eased. Now this is more like it. She turned and led Kim out into the hall. They headed toward one of the private exam rooms. Jess stopped outside the door.
"Patient is a fourteen-year-old male. He presented with several infected cuts on the inside of his right forearm. He claimed a cat scratched him. While there are four parallel cuts, they are too deep and symmetrical to be animal scratches. I examined his other arm and he has quite a few similarly inflamed but healing cuts on that arm as well. I think we're dealing with self-inflicted wounds. From the look of the cuts I think he might be just starting out. I didn't find any scarring that suggested previous cutting."
"Are his parents here?" Kim asked.
"His mother is in the waiting room. He refused to have her present during the exam."
"Okay. I'll tackle him first, and then his mother."
"You need any backup?" Even as she asked, Jess knew it wasn't needed. It was just an excuse. She was curious to see more of Kim in action.
Kim smiled at the offer. "Thanks, but no. He shouldn't be a problem. You've already treated the infected cuts... Right?"
Jess was surprised by the feeling of disappointment Kim's refusal invoked. She handed over the chart in her hand. "Yes. He's good to go after you're done with him."
Kim gave a quick nod of acknowledgment and pushed open the exam room door.
Jess remained outside the door for several moments after Kim disappeared inside. She was trying to sort out the long dormant emotions coursing through her. As had previously been the case, she was aware of the strong attraction she felt toward Kim. It was now tinged with a growing respect for the psychiatrist. Jess pushed aside the unwelcome introspection. Now is not the time or place for exploring feelings.
Jess's attention turned firmly back to work when she spotted Karen Armstrong, one of the first-year residents coming down the hall. Might as well get this over with. "Dr. Armstrong," Jess called out. Jess frowned to herself when the resident visibly hesitated before making her way over. Yeah, you know what this is about. "I want to talk to you," she said when the resident reached her. "Let's go into the lounge."
Jess followed Karen into the staff lounge. She motioned for her to have a seat at the table. "You weren't at morning conference," Jess said. This was not the first conference the resident had missed.
"I had to take my daughter to daycare, and then drop off my husband at work. My husband's car is still in the shop."
"I'm not interested in excuses," Jess said, her tone calm but firm. "This is the fourth morning conference you've missed in two weeks. As we discussed before, attendance at morning conference is mandatory for first-year residents."
"I'm doing the best I can," Karen said, her stress apparent in her voice.
"You need to do better. You're only in the second month your residency and already falling behind."
"I can't make them repair the car any faster." Karen jerked her stethoscope from around her neck and slapped it onto the table.
Okay. Time to get serious. Jess had not wanted to turn this into a formal counseling session but Karen wasn't giving her any choice. "It's not just conferences. It's not fair to your fellow residents when you come in late or leave early. It doesn't get any easier as you go along. You need to get a handle on things now." Jess sighed to herself. Karen had a lot of potential, but she always se
emed to have some problem that prevented her from fulfilling her responsibilities. "Do you want to stay in this residency program?"
Karen blanched and her hand clenched around her stethoscope. "What? Of course I do."
"Then I suggest you make some alternate arrangements so you arrive on time. I expect you to be at every conference for the rest of the month." Jess met Karen's gaze directly. "You should consider this a formal counseling session. If necessary, the next step will be to officially place you on probation. I will see you in conference tomorrow morning."
Jess knew she had been harsh, but hoped the resident would respond to the wake-up call. If she let Karen's behavior continue unabated now, it would carry throughout her residency. By the stunned look on Karen's face she had definitely made an impression on her. Without another word, Jess stood and made her way toward the door.
Kim made her way toward the staff lounge for a much needed cup of coffee. Unlike her colleagues, she had decided to remain in the ER as much as possible. It was only her first day and she already realized how bad things were between psych and the ER by the staff and residents reaction to her presence and help. The residents in particular had at first seemed shocked, then extremely grateful of her offer to work with them on the cases they presented. Philip had been right about the conflict between the two departments. If anything he had underestimated the depth of the problem. I definitely need to talk to Philip.
Kim pushed open the door to the lounge. She noticed Karen, one of the residents she had met earlier sitting at the table. Kim nodded to the resident and walked over and made herself a cup of coffee. Once she had her coffee, she approached the table where the resident sat.
