A faint, hoarse voice replied. “Yeah.”
Every bump and joggle of the gurney caused the patient to cry out in pain as they exited the elevator and rolled him closer to the ER. Sadistic as it seemed, Beck was glad to hear them as the man’s cries were a good sign, proving he still had some fight left in him.
“Vital signs stable with elevated blood pressure 155 over 90, pulse 110, and respirations 24, with good oxygen levels.”
Gavin met them at the entrance to the ER and the EMT repeated his information as they speed-walked the patient to an available procedure room. Gavin dismissed a medical student and a first-year ER resident who’d fallen in step with them. “We’ll handle this one.”
After a complete physical assessment of the patient, including a neuro check and a slew of verbal orders, including multiple X-rays, he glanced at Beck. “We need IV access to prep him for surgery and to give pain meds.” He turned back to the patient. “You’re not on blood thinners, are you?”
The guy mouthed, “no.”
Gavin turned back to Beck. “With his compound fractures, he’ll need antibiotic therapy, too.”
Gavin walked Beck to the side of the room and lowered his voice. “You’ve done central venous line insertions, right, Beck?”
Beck turned his head and lowered his voice so the patient couldn’t hear. “Only jugular sticks, and nothing like the procedure you do.”
“You’ve seen me start a few of these babies the last couple of days. What’s that saying? Watch one, do one, teach one?”
Beck raised his brows and nodded.
“That’s what you’re here for, right? To update and enhance your experience?”
“On the frontline our goal is to keep the patient alive long enough to get them transported to the field hospital. I can stick a jugular or femoral with the best of them, even do intra-osseous hydration, but this is out of my experience.”
“You’ve got great hands. I’ve watched you. You can do this. You’ve watched one. Now it’s time to do one. Next week you can teach the interns.” Gavin smiled and winked. “Come on, I’ll talk you through it,” he went on in a raspy whisper.
Beck hesitated. If the central venous line wasn’t inserted properly it could puncture the lung or the subclavian artery, which could cause hemorrhaging. Did he want to risk it for experience?
“Look, I’ve got five or six other guys chomping at the bit to do this. I’m offering it to you. It’s your call.”
Beck’s first inclination was to let the intern or resident do the procedure, but the adventurous part of him, the part Gavin had just challenged, thought, Why not?
All Gavin had to do was look at Jan and on cue she went right to work gathering the supplies.
“And I’ll give you my best nurse to assist. Hell, she could perform a subclavian in her sleep. She’ll anticipate your every need, and I’m here as back up if you run into a problem.”
Gavin was offering a once-in-a-lifetime chance. He decided to take it. Beck nodded and walked toward the gurney. He looked at the semi-conscious patient. The last thing he wanted to do was make matters worse for the guy, but Gavin believed in him and any experience here at Mercy Hospital was a bonus and could save a life in the field.
With the patient’s neck in a cervical collar, the jugular approach was definitely out, which left the subclavian route, a procedure he was much less familiar with. His brain jumped to hyper-speed, running through the procedure he’d never actually performed himself but had observed frontline doctors and Gavin do.
Recalling how his advanced medic courses had made training even more challenging by first having the medics run a mile, dive under low shelters and start IVs in near darkness while holding the fluid bags with their teeth, he figured this couldn’t be much more difficult. The jugular lines he’d trained on, though on sedated goats, had to be performed in equally chaotic circumstances while being timed with a stopwatch. And in the field the only way to check if you’d made it into the right vein was to lower the IV bag and check for backflow.
It would be a huge risk, but Gavin believed in his skills, and life was all about taking chances if you wanted to grow.
All things considered, the controlled atmosphere and bright lighting, with Gavin’s back-up and Jan’s assistance, this procedure should be far less complicated. Still, his confidence wavered and he took a deep breath to steady his hands. He used the only technique that ever got him through battles: tune out the rest of the world—focus on the patient, one procedure, and one chance at success.
OK. He was ready.
Beck cut open the patient’s shirt and exposed the area he’d be working on. He washed his hands while January tilted the head of the bed slightly toward the floor to make sure the central veins were filled.
While he gowned up and put on gloves, Jan used the antimicrobial wash to cleanse the skin.
Jan also wore sterile gloves and she handed him the local anesthetic in a syringe with a small needle. He’d concentrate deep at the middle third of the clavicle to find the vein for cannulation, so he started superficially injecting the anesthetic there and worked outward along the entire length of the bone. Gavin nodded his approval.
Without having to ask, Jan handed him a longer needle and he injected a second round of medicine deeper into the flesh to ensure a pain-free procedure. Drawing on strict training, with each injection he aspirated to make sure he hadn’t punctured the vein.
She handed him the guidewire and Gavin helped him check both the stiff and floppy ends while waiting for the anesthetic to numb the skin. He spoke quietly into Beck’s ear, telling him the next step of the procedure.
Beck reached for the scalpel Jan provided and used it to nick the skin just enough to make sure the cannula would fit. He firmly palpated for the pulse, then used the introducer attached to a syringe and guided it carefully into the deep part of the clavicle, aiming toward the sternal notch.
He encountered resistance. The last thing he wanted was to run into trouble with an audience. He lifted his gaze toward his attending doctor.
Gavin spoke up. “Walk the introducer down just a bit.” Beck complied. “That’s it,” Gavin said.
He followed Gavin’s instruction until he had passed the blockage and could easily advance the introducer again. Steady suction on the attached syringe revealed a flush of blood when he entered the vein. He deftly removed the syringe from the introducer, feeling a bit like a circus juggler. Gavin had gloved up and reached in to help him handle the exchange. Beck used his thumb to prevent back-flush of blood from the introducer entrance.
Again, as though reading his mind, Jan was right there, handing him the guide wire to insert into the introducer. He took great care to make sure the wire didn’t uncurl past the sterile field. Gavin hovered, ready to jump in if anything went wrong, and held a portion of the wire that threatened to touch outside the field.
Once satisfied he was in the right place, after checking the markers on the guide wire and leaving just a bit protruding from the insertion site, Beck glanced at Gavin, who nodded his approval.
“Looks right,” Gavin said.
Beck removed the introducer over the guide wire. Jan handed him the cannula, already having removed the plastic end-stop, and he inserted it over the guide wire until it was level with the skin. Once confident all was well, and getting a nod of approval from Gavin, he removed the guide wire and left the cannula in place. He passed the withdrawn wire to Jan, who was waiting to receive it. In the field, he’d had to do everything in the procedures himself, and having her assistance was a luxury he greatly appreciated.
Jan had flushed the connecting line with saline and her steady hand reached toward his to attach it snugly to the cannula. A quick flash came to mind of the famous Michelangelo painting of The Hand of God where fingers almost touched. January was the only other person who knew about his passion for art. Hell, they’d discovered art together.
He quickly refocussed when she handed off the line and he co
nnected it. When she passed him the needle and sutures, he took another breath, glad to see something that was easy for him to perform. He dutifully stitched the cannula in place flush to the skin through two separate holes in small plastic wings.
He let out his breath, not having been aware he’d been holding it, and allowed himself a mental pat on the back at a job well done. He passed a subtle smile January’s way. She nodded her approval.
While he disposed of the extra suture and the needle, Jan cleaned and swabbed the skin and applied a small dressing.
Shortly after that the portable X-ray technician came to take a quick radiograph of the chest. They stepped outside and Gavin slapped him on the back.
“That was smooth,” Gavin said. “Just like a pro. Have you ever thought about becoming a doctor?”
Beck laughed. “Never.” He grinned but quickly stopped when he noticed the dagger looks from a couple of interns. He shifted and glanced at Jan down the hall, disposing of the equipment and trash. “She was a huge help.”
Gavin grabbed his arm and pulled him closer. “The nurses here at Mercy are exceptional, and Jan is one of our best.” He glanced with a mischievous twinkle in his eyes at Carmen. “Whatever you do, don’t let her know I said that.”
Beck chuckled and nodded. “Not a chance.”
Gavin barreled toward the obviously unhappy interns. “Follow me to my office.” They did what they were told.
Five minutes later the X-ray revealed that the subclavian line was in the right atrium instead of the superior vena cava. Beck had advanced it too far. Once again, under Gavin’s tutelage, they went back to the patient, snipped the sutures and withdrew the line approximately 5 centimeters. They took another X-ray, which revealed proper placement, before suturing the line in place again.
Shortly thereafter the patient was transferred to surgery and Gavin once again arranged for Beck to scrub in and observe.
Excited about the OR opportunity, Beck couldn’t help being a bit disappointed when he realized he wouldn’t be seeing Jan again the rest of the shift. She’d teased him earlier and he was hoping for that shot at another date, but now it would have to wait.
Taking the hallway steps two at a time, rather than wait for the notoriously slow elevator, Beck was halfway to the second-floor surgery suites when his cellphone rang.
It was Jan.
CHAPTER FIVE
FULLY submerged in the extra-long bathtub, Jan stared through the water toward the ceiling. Everything looked distorted and dreamlike. The thick silence brought her peace and helped tamp down the growing apprehension in her gut. She wanted to inhabit this other-worldly place for as long as her breath could hold.
Beck would arrive at 7 p.m. tonight, her Friday night off, and he deserved to know about their child. How exactly was a person supposed to casually tell someone long after the fact, “Thanks for stopping by and, oh, yeah, we had a baby together twelve and a half years ago.”
She emerged through the water’s surface into a sitting position, gasping for air, with her hair dripping down her neck and her heart pounding against her sternum. What had she been thinking when she’d invited him over?
She pulled the plug and stood, wrapping herself in a huge bath towel. In her bedroom, her citrus flower-patterned top and cropped pants lay waiting across the bed. What was appropriate to wear on an event of this magnitude? A flash of black funeral attire appeared in her mind.
Beck deserved to know the truth, but would she have nerve enough to tell him tonight?
An hour and a half later she put the finishing touches on the simple dinner she’d prepared. The chicken, artichoke hearts and rice casserole in the oven smelled inviting, but the tennis-ball-sized knot in her stomach promised to keep her from enjoying a single bite. She paced the kitchen, chewing a fingernail, mumbling her over-rehearsed version of how and why she’d never told Beck about their baby.
I knew how important your dream of seeing the world was, and I’d only found out I was pregnant the day before you were to leave. I couldn’t bear ruining your chance of leaving Atwater for good, and I didn’t want you to be distracted during bootcamp.
The excuse sounded flimsy and lame to her, so how would it sound to him? If he gave her the chance to say more, she’d tell him the role her mother had played in the final decision. First she’d reminded Jan how hard her own life had been as a single mother. She’d thrown statistics in her face about poverty and teenage pregnancy. Then she’d sworn she wasn’t going to tie her life up raising a grandkid, and had told her that thirty-four was far too young to be a grandmother. She’d pleaded with January to consider her future, the career in entertainment she’d always dreamed about. “How can you show up at auditions with a child groping at your legs?” When Jan had suggested that maybe Beck’s parents would help out, her mother scoffed. “You want your baby raised in the house of an alcoholic child abuser? That bastard father of his beats the hell out of Beck.”
Jan was such a dreamer she’d never had any idea Beck was being abused. She’d always believed him when he’d shown up bruised and abraded and said he’d been in a fight. She’d naively assumed it went along with his bad-boy persona. Never did she fathom his own father was the beast he’d battled. No wonder he couldn’t wait to get away.
It didn’t take long for Karen to realize that she hadn’t weakened Jan’s resolve, so she lied and blackmailed her daughter into thinking Beck could go to jail for having sex with a minor. She called it statutory rape and said it didn’t matter that the sex had been consensual. Too young, frightened, and, let’s face it, dumb to know the reality of “unlawful sexual intercourse,” she did what her mother said. Years later, on a hunch, she researched it and found it was only a misdemeanor and a fine, and rarely did police arrest teens for consensual sex. Only in extreme age differences and with females fourteen or younger did they pursue the males. Knowing Jan would defend Beck at all costs, her mother had lied about the law and manipulated her once again. When she’d finally confronted her mother about it, Karen laughed it off and reiterated, “It was for your own good.” Jan didn’t talk to her for an entire year after that. Then her mother married and moved away.
Was there a chance that Beck would buy her pitiful excuse for robbing him of a major decision in his life? Maybe if she killed him with kindness and used the old velvet-hammer approach she’d survive the night. At this stage in life she didn’t dare hope for forgiveness, just closure.
Riding a surprisingly strong wave of disappointment, she accepted that after tonight she’d cure Beck of wanting to rekindle their old friendship. Hell, he’d never want to see her again.
The doorbell rang. She bit through her fingernail with a loud click, making her tooth hurt.
Beck stood on the doorstep and sniffed, hoping he hadn’t overdone his aftershave. The last thing he wanted was to be obvious about his intentions. He’d had to change his day off to be here, even worked all last night and half of this morning to make things work out. Thanks to his fatigue, he’d depend on adrenaline to carry him through tonight. He’d purposely steered clear of Jan all week, choosing to pick up his ER hours during the day shift on his days off instead of coming in evenings. Spending too much time around her confused him, and he needed to stay focussed.
Long ago, on his first leave from the military, he’d come back for her and she’d disappeared. Karen Stewart’s stone-faced lie hadn’t fooled him. He’d known she’d had plans for her daughter and hadn’t wanted her hooking up with him, a loser, but he’d loved her and deserved to know where she was. Then he’d gotten the call.
Beck worked the muscle in his jaw so hard it threatened to cramp. If he could keep his conscience from messing up his plans, the evening promised to be an adventure. Revenge sex. Hmm. It had a nice ring to it.
The door opened and a burst of color in the form of Jan’s scoop-neck blouse took him by surprise. She’d put on make-up, too, and on that pretty face the effect was staggering. But the thing that knocked him off balance wa
s the obviously missing glasses, and the shining, sea-blue eyes looking directly at him. Those same eyes used to plunge deep into his soul. A pang of longing threatened a desire to abort his plan. He shrank back a bit, wondering if she could still read his mind like she used to.
Beck looked away, pretending to be distracted by the passing car with muffler problems.
“Hi,” she said, sounding breathy.
“Hey,” he said, returning his gaze to the lure of her eyes. Think of something to say, idiot. “These flowers match your top.” He reached into his leather jacket and handed her a small bouquet, which was slightly battered from being stuffed inside. Riding a motorcycle wasn’t always convenient, yet he’d purposely decided to ride instead of drive his car tonight. It felt more in tune with his intentions.
Jan gave a pleased smile, sniffed the bouquet, and stepped aside so he could enter.
Stay on point, he scolded himself when he softened at the sight of her living room. If he’d had to imagine what the new January’s condo would look like, this would be it. Neatly upholstered furniture, splashes of colorful pillows and throw rugs and carefully chosen paintings reflected this cautious woman, as opposed to the free-spirited girl he’d once been in love with. Cautious because she’d been kicked in the teeth by life? A small ache in his chest made him wish he could go back in time. But this woman, the new January, had awakened the sleeping giant, and he’d found himself yearning for something more. No longer fluff and flash, she’d matured into substance and reality, and it only made her more attractive.
But he had a mission tonight.
While she tended to the flowers, his eyes came to rest on a glass box perched on a bookshelf.
Immediately recognizing the object almost threw his breathing out of kilter. Inside the small glass case was an acrylic painted paisley egg on a tiny stand. The eggshell he’d designed in the elective art class he’d taken on a dare in eleventh grade. The class where he’d first met January. They’d eyed each other for half the semester. Being the school social queen, she’d gone on and on about how talented he was when she’d seen his mid-term project. She’d giggled about her own clumsy pattern, and compared it to his “work of art,” as she’d called it. He’d never done anything artistic before, but he’d enjoyed every day of that class, especially after finding January. Her encouragement, along with the teacher’s, had given him the courage to explore a whole new side of his personality—the artistic side. Or the pansy side, as his father used to deride him. Art was a secret pleasure he enjoyed and kept hidden from his coworkers to this very day.
Temporary Doctor, Surprise Father Page 7
