L.A. Metro

by R J Nolan

  Jess snatched the patient's chart off the counter. She strode up to Kim and Bates.

  Bates was not discussing the case with Kim. He was busy trying to chat her up.

  Irritation warring with outright anger, Jess cut him off mid-sentence. "Thank you, Dr. Bates. Dr. Donovan and I have this under control."

  Jess motioned down the hall. "Dr. Donovan, if you'd follow me." She turned on her heel and quickly walked away, pleased when Kim followed without a word.

  This case was going to take a skilled clinician and someone good with children. Jess couldn't think of anyone better qualified than Kim.

  Jess stopped opposite the door to one of the private treatment rooms.

  "Sorry about Bates."

  Kim waved off the apology. "What have you got?"

  The release of a tension she had not even been aware of eased the set of Jess's shoulders. Right to business. And she's not even supposed to be here. Too bad she doesn't cover the ER all the time.

  Reaching up and rubbing the back of her neck, Jess sighed. This case had her worried. "Patient is a nine-year-old female. She presented as an accidental poisoning. According to the mother, the girl mistakenly took a whole bottle of the mother's sleeping pills. The mother claims her daughter mistook the red pills for candy."

  A frown marred Kim's face. "Is she developmentally delayed?" She pulled a notebook from her pocket to record the salient facts.

  "Not that I've been able to determine."

  "Who found her?"

  "Her father. Apparently, she didn't come down for dinner and he went up to her room. She was sitting in bed. The empty pill bottle was sitting on her nightstand. He asked her about the bottle and she admitted to — in his words — eating them."

  "So she was awake and alert when he found her?" Kim asked.

  Jess nodded. "And she was still alert and responsive upon arrival in the ER. Best I've been able to establish there was about ten minutes between her swallowing the pills and her father discovering she had taken them." Jess raked her fingers through her hair. "We did a gastric lavage, followed up by activated charcoal." She hated having to subject a young child to such an invasive procedure but had not had any choice. "There were approximately twenty pills in her stomach contents." While she knew the scenario presented by the parents was possible, it wasn't very believable.

  As if reading her thoughts, Kim said, "Doesn't sound very plausible to me, especially considering the patient's age. A nine-year-old would know what a pill bottle is versus a package of candy. Not to mention the obvious, a child of nine can or should be able to read." Kim stared at the door of the treatment room as if she could see inside. Her brow furrowed. "How did the parents present?"

  "That's what bothered me, aside from the obviously less than believable story," Jess said. "The mother appeared distraught, but her behavior was off. She fawned all over her daughter, but it came across as just going through the motions. There was no genuine emotion behind it that I could see."

  "What about the father?" Kim asked as she continued to scribble notes.

  "The father seemed truly upset and scared. The other thing that struck me was the little girl. The whole time her mother was holding her, she never took her eyes off her father. She didn't seem to take any comfort from the mother at all. Her body posture was stiff and distancing."

  Jess shook her head. "I don't know, maybe I'm seeing something that isn't there." She blew out a breath and stuffed her hands in the pockets of her lab coat. "But I can't get past the gut feeling that this was if not an outright suicide attempt, it was certainly a cry for help."

  Kim lightly touched Jess's arm. "I trust your instincts." She shoved her notebook in her pocket and then scrubbed her hands over her face. "Which begs the question, what would drive such a young child to do something like this?"

  "Exactly. I'm concerned that she may be actively suicidal." Jess sighed. "I tried talking to the little girl but got nowhere." Jess had seen for herself how good Kim was with children. "Would you evaluate her and see if you can get the real story?"

  "Sure," Kim said with a smile.

  "Let me know what you find out." Jess rubbed her neck. "Fair warning. I've already told the parents that I'm requesting that pediatrics admit the girl overnight for observation. The mother was not happy." Having the girl admitted to pediatrics was the only option at this point. "Unless you decide she needs to be on a psych hold, then we'll need to get her transferred to a hospital that has psych facilities for children."

  "Okay, I'll —"

  "Dr. McKenna!"

  Terrell rushed toward them.

  "We just got the call. We have multiple traumas coming in. First ones are five minutes out. Cement truck versus a bus."

  Adrenaline pumped through Jess. "Call everyone together. Get both trauma bays set up," Jess said. They were most likely in for a long night.

  Terrell raced off to do Jess's bidding.

  Jess glanced at the treatment room door, where the little girl and her parents waited, and then back at Kim.

  "Go. I've got this under control," Kim said.

  "Find me when you're done," Jess said. She turned and sprinted down the hall.

  Brightly painted animals chased across the walls of the small room. The muted light above the bed illuminated the diminutive figure in the bed. In stark contrast to the glaringly lit, harsh, sterile ER, the pediatric floor room was warm and welcoming.

  Kim was sitting on the edge of the hospital bed. "Now you're never going to do something like that again... right?"

  "I promise, Dr. Kim."

  "Good girl." Kim gently patted Charlene's leg. "You're really going to like Dr. Kate."

  Tears welled in Charlene's eyes. "But I like you, Dr. Kim."

  "I know, sweetie, and I like you too. But remember what we talked about? How Dr. Kate is a special doctor that only takes care of children? I promise, she's going to take good care of you. You can talk to her and tell her anything that is bothering you. Okay?"

  Charlene sniffed. "Okay." Her gaze darted toward the door. Tension suddenly radiated from her.

  Kim turned to see what had caused the reaction. She smiled when she spotted Jess standing in the doorway.

  "Oh good. You got my note." Motioning Jess in, Kim said, "Charlene, do you remember Dr. McKenna?"

  Charlene inched closer to Kim. She nodded slowly, fear written clearly on her face.

  A brief flash of dismay marred Jess's face. She quickly replaced it with a smile. "Hi, Charlene." Her tone was calm and soothing. She reached into the pocket of her lab coat and pulled out a small, stuffed frog. "I brought a friend along. I'm really busy downstairs and I was wondering if you could keep him company for me?"

  Ah, Jess. You act emotionally distant, but what a soft heart. Kim knew how difficult it must be treating children in the ER. The invasive procedure Jess had performed on Charlene, although for her own good, had to have been emotionally hard on Jess.

  The smile started small but quickly grew when Jess handed over the stuffed animal. Charlene ducked her head not quite willing to meet Jess's eyes. "Thank you," she said in a quiet voice.

  Jess smiled. "You're very welcome." She turned her attention to Kim. "Can I talk to you?"

  Kim stood and moved around Charlene's bed. "Why don't we step outside?"

  Charlene clutched the frog in both hands. Tears trembled at the edge of her lashes.

  The reaction was not lost on Kim. She sat back down on the girl's bed and took a much smaller hand in one of hers. "Hey now, none of that." Kim gently stroked the girl's hair. "It's okay. I'll be right outside the door with Dr. McKenna for a few minutes. I won't leave until your dad gets back. Okay?"

  Charlene gave her a watery smile and nodded.

  "Good girl."

  "How's she doing?" Jess asked as soon as they were out of earshot. Her gaze darted around the area, checking to make sure they would not be over heard.

  Kim positioned herself where she could keep an eye on Charlene through the open
doorway. "She's scared and confused. But she's going to be okay. I contacted a colleague, Dr. Kate Dean.

  She's part of a private practice group. Her specialty is working with children in crisis. Kate agreed to see Charlene tomorrow."

  Jess's eyebrows shot up. "How did you get the parents to agree to that?" Having dealt with the parents, the mother specifically, Jess knew what a hard sell that must have been. Especially since the mother claimed it was an accidental poisoning.

  Kim let out a heavy sigh. "It wasn't easy. Mrs. Kessler kept insisting it was all much ado about nothing. It was just an accident." Kim nodded at Jess's disbelieving grunt. "I couldn't make a dent with Mrs. Kessler and Charlene wouldn't talk with her mother there. I finally managed to convince Mr. Kessler to talk to me alone." Kim met Jess's gaze. "You called it right. He was really scared. I told him this was a cry for help from his daughter. Once I started talking about what might happen next time if he wasn't lucky enough to be there... he crumbled and told me what really happened. I got the rest of the story from Charlene."

  "I knew it wasn't an accident," Jess said. "Why the hell did they make up that story?"

  "Mrs. Kessler convinced her husband that family services would take Charlene away if they found out she took the pills on purpose."

  Jess scowled. "Damn. So she is actively suicidal?" It was so hard to believe with such a young girl. What the hell is going on with this family? She shifted position so she could look into Charlene's room. The little girl was lying quietly in the bed, playing with the frog.

  "No. It wasn't an accident," Kim said with a shake of her head. "But it wasn't a true suicide attempt either. Charlene took the pills knowing that her father would come looking for her in a few minutes when she didn't come down for dinner."

  "But why? Why would she do that?" Jess blew out a breath. "It's not something I would expect a nine-year-old to even think of."

  Kim's scowl matched Jess's earlier one. "That's because she didn't. Charlene's best friend's older sister gave her the idea. Told her it was a way to make her parents pay attention to her."

  Jess scrubbed her hands over her face. "Maybe you better start from the beginning. What the hell is going on with this family?"

  "Okay. It's complicated. Parents are getting a divorce. They didn't think Charlene knew — she does. Mom has a boyfriend, and so does Dad. They —"

  "Whoa... wait, back up. Mother has a boyfriend and Dad has a girlfriend..."

  Blond curls bounced when Kim shook her head. "Nope. I told you it was complicated. Mom has a boyfriend and Dad has a boyfriend. Though not the same man," Kim added with a slight grin.

  Jess rolled her eyes. Cripes. Complicated indeed. "Okay, I'm with you so far."

  "Long story short..." Kim snorted. "Or as short as I can make it. Mrs. Kessler wants a divorce, money, no responsibility, and plans on sending Charlene to boarding school. Mr. Kessler wants Charlene but is petrified that if his wife finds out about his boyfriend, he'll never get to see her again. Charlene is caught in the middle. She wants to be with her dad. She's terrified of being sent to boarding school. She is totally dominated and controlled by her mother. Mrs. Kessler is using Charlene as a pawn to manipulate her husband."

  Wow. She got all that in less than two hours? "What a mess!" Although appalled by the situation, Jess was very impressed by Kim's expert handling of a bad situation. Despite the parents' problems, Kim had convinced them to get Charlene the treatment she needed. She's good. Though, obviously not the person to try and keep secrets around. A shaft of apprehension struck. Jess shook the troubling feeling away.

  "Tell me about it," Kim said. "Cases like this are why I know I would never make a good child psychiatrist. I'd be too focused on strangling the parents."

  Jess gave Kim's shoulder a quick squeeze. "You're a great psychiatrist — period. I didn't get a chance to say anything earlier. I don't know how you ended up covering the ER this afternoon instead of Roberts, but thank you. I really appreciate your help."

  Kim smiled brightly. "Thanks, Jess. But I have to admit in this particular situation, it was easier than usual. Mr. Kessler was desperate for someone to talk to. Usually it would take weeks to pry out this kind of information."

  Jess nodded and offered a warm smile. "Well, I better let you get back to Charlene. Where are the parents anyway?"

  "Mrs. Kessler went home. Mr. Kessler is getting something to eat. He's going to stay the night with Charlene. I promised I'd stick around until he got back." Kim glanced at her watch. It was well past shift change. "Are you working a double again?"

  "No. Thankfully, all the patients we got from the crash were minor injuries. I just wanted to follow up with you before I headed out."

  Kim hesitated just a moment before asking, "Thor at daycare today?"

  "Yeah. I need to get him before they close." Jess grinned. "I'll tell him you asked about him. He's looking forward to our jog on Saturday." And so am I.

  A delighted smile lit Kim's face. "Me too."

  Jess spotted Mr. Kessler heading for them. "I better go. Thanks again." With a quick wave, Jess turned and walked away. I wonder if I could convince her to cover the ER full-time?

  CHAPTER 15

  STEPPING BACK INTO the ER proper, Jess let the sights and sounds ease her lingering tension. A brief smile played across her face when she spotted what had become a familiar sight in the ER over the last week. Kim. She was sitting at the computer workstation. Just the thought of her was enough to wash away Jess's remaining stress.

  Jess stopped and leaned against the counter of the nurses' station. "Dr. Donovan," she said by way of greeting.

  Kim looked up from the chart she was working on and smiled. "I was beginning to think you weren't working today."

  "Believe me, I'd have much rather been here than where I was."

  Eyebrow quirked in question, Kim asked, "And where was that?"

  "Quarterly budget meeting... chaired by Dr. Rodman."

  Kim's face scrunched up as if she had bitten into a lemon. "You have my sympathy."

  Jess knew that Kim's initial encounter with Rodman had left her with a less than stellar impression of the man. A small laugh escaped. Jess quickly squelched it when she noticed Penny watching from farther down the counter.

  Jess glanced up at the patient status board. "Have things been pretty quiet?"

  "So far." Kim mock scowled at Jess. "Nothing compared to last Friday."

  "That did get a little out of hand," Jess said with a grimace. Kim had never explained why she covered the ER in Roberts's place last Friday, but Jess had been grateful for her presence.

  Kim's hands went to her hips. Her eyebrows shot up. "A little!"

  Jess held up her hands in surrender. "Okay, it was total pandemonium." After a fraternity initiation gone bad, the ER had been swamped with inebriated college students, their parents, and the police. It was not something that psych would have normally been called to the ER for, but Kim had pitched right in. Her help in keeping the chaos under control and counseling parents and students alike had been invaluable. Get her off this subject, or you'll never convince her to cover the ER full-time. "Are you busy right now?"

  "I need to finish up this chart, then I'm free. What can I do for you?"

  "I have something I'd like to talk to you about," Jess said.

  "Okay." Kim smiled. "I want to discuss something with you as well. Give me a minute to finish up here, and I'll be right with you."

  "We can talk in my office as soon as you're done." Jess forced herself to stand still and not fidget while she waited for Kim to finish up. If she wanted a job like this, she would have taken a position in a psychiatric ER. Jess pushed away the pessimistic thought. Just ask her. Part of Jess's anxiety stemmed from not wanting to damage their blossoming friendship. Not only did they work very well together, but the time they spent together outside the hospital was also coming to mean more to Jess than she had ever expected. She didn't want Kim to feel obliged to accept her request because they wer
e friends.

  Jess led the way down the hall to her office. She was just opening the door when a loud rumbling sound intruded. She turned to look at Kim with a raised eyebrow.

  "I was running late this morning and didn't get any breakfast." Another loud rumble issued from her stomach. Kim blushed. "I haven't had lunch yet either."

  "We can talk later." Jess stepped just inside her office doorway and turned back to face Kim. "You want to meet back here after you get some lunch?"

  Kim started to speak, then hesitated.

  Jess tensed in anticipation. She's going to want us to go to lunch together.

  The smile dropped off Kim's face. Shoulders drooping, she took a step away from Jess. "I can just grab something from the vending machines and eat in your office. That is if you don't mind me eating while we talk?"

  With an inward scowl, Jess forced herself to relax. Would going to lunch be such a bad thing? The sight of Kim's withdrawal filled her with a sense of determination. Sam was right. People were going to gossip no matter what she did. To hell with them. I can have lunch with a colleague if I want. "I haven't eaten either. Why don't we head to the cafeteria? We can talk while we have lunch."

  Kim's mouth dropped open. She stared at Jess for several moments.

  Jess quirked her mouth in a little half smirk. "You okay? Do I need to get the crash cart?"

  Eyes sparkling, Kim grinned. "Maybe just a little jolt to get my heart going again." She playfully shoved Jess's shoulder. Her eyes widened at the realization of what she had just done. She quickly pulled back and cautiously glanced around. Kim's expression turned serious. "Are you sure? I don't want to start any gossip."

  Beautiful and thoughtful. Jess smiled. That wasn't so hard. With each passing day, her trust of Kim grew. "Yes. I'm sure. Let's go."

  Kim followed Jess, allowing her to choose their table in the cafeteria. Realizing what a big step Jess had taken in asking her to lunch at work, Kim wanted her to be as comfortable as possible.