by Laura Iding
“Well, maybe it won’t be as bad as what we’re imagining,” Andrea said reassuringly. “After all, it can’t be that unusual to lose patients on the trauma service.”
Hannah tucked her stethoscope into her right-hand pocket and then shut her locker. Christopher hadn’t died because of anything they had or hadn’t done. But M & M rounds were as much about teaching and learning what, if anything, they could have done differently.
During her student days she’d observed enough presentations to know some of the more experienced surgical residents loved to put the new surgical interns on the spot by asking really difficult questions.
She swallowed hard, vowing to brush up on every single aspect of Ehlers-Danlos syndrome. And pray that no one would ask why she’d started CPR and cracked his ribs. The sick feeling in her gut intensified.
“Don’t think about it,” Andrea advised. “Really, I shouldn’t have even brought it up. Even if you do end up presenting your case, it probably won’t happen until next week. You’ll have plenty of time to prepare.”
She nodded, knowing that a few days didn’t matter much in the big scheme of things. Hannah made a mental note to ask Jake about it later. She’d rather ask one of the other attendings, but Jake happened to be the one on service when Christopher had died. For now, they had to hustle or they’d be late for rounds.
Jake was waiting for them in the central nurses’ station on the general-surgery floor. Hannah couldn’t help noticing the way he avoided her gaze when she and Andrea walked up to join the group of residents who’d already gathered there.
When the last resident, Dave Harrison, hurried in, Jake frowned and glanced pointedly at his watch. “You’re late,” he said flatly.
“Sorry, Dr. Holt,” Dave said earnestly. “Traffic was awful.”
Jake’s scowl deepened. “This is Chicago, Harrison. Traffic is always awful. Get your butt out of bed earlier.”
Dave flushed and nodded. “Yessir.”
Hannah felt bad for Dave, yet at the same time she was relieved to know that she and Andrea hadn’t been the last ones to arrive. Better for her if she could manage to stay on Jake’s good side.
If she hadn’t ruined that chance already.
“All right, we have twelve patients to do rounds on today, so let’s get going. We’re going to start with Mr. Anderson, in room twenty-three.”
Jake strode down the hall toward Mr. Anderson’s room and they all hurried to keep up with him. As she’d been the one on call and covering all night, she knew that Jake was going to ask how things had gone so she pulled out her three-by-five note cards and began thumbing through them.
Mr. Anderson’s nurse joined them outside his room. Hannah quickly filled in the rest of the residents on how the patient’s finger-stick glucoses had been running higher than normal so she’d increased the amount of insulin he was getting. Jake nodded, agreeing with her actions, and then directed most of his questions to the nurse. “Make sure he gets out of bed to walk today,” he said sternly, before heading to the next room.
Hannah’s relief was short-lived. She soon learned that every single order she’d written while being on call the night before was reviewed and rehashed not just by Jake but by the rest of the team.
Thankfully, for the most part everything she’d done for the general-floor patients was deemed appropriate. So they moved on to the ICU to look at the sicker patients.
Jake headed to Mr. Turkow’s bedside first. This time she didn’t need her note cards, because she was intimately familiar with the case.
“He was weaned off the vent last evening and had a good night,” Hannah said as Jake logged on to the computer. “His labs are stable, there’s no sign of bleeding. I think he can probably be transferred to the regular surgical floor today.”
“Hmm,” Jake murmured, his gaze focused on the computer screen where he reviewed Mr. Turkow’s detailed medical information. “Dr. Stewart, do you want to explain why you ordered a subtherapeutic dose of antibiotics for this patient?”
Sub-therapeutic? She frowned, trying to remember what she’d ordered. “I ordered a hundred and ninety milligrams of Zithromax when his cultures came back last evening.”
“He’s only on a hundred milligrams of Zithromax,” Jake corrected sharply. “You ordered the wrong dose and you’re lucky the patient hasn’t suffered an adverse effect as a result.”
“I didn’t order the wrong dose,” she responded defensively, her cheeks burning with acute embarrassment. She specifically remembered looking up the antibiotic to make sure she was ordering the correct dose. She grabbed Mr. Turkow’s chart and flipped open to the antibiotic order form. Her heart sank when she realized what happened.
Her writing had been sloppy and the nine had been mistaken by both the nurse and the pharmacist for a zero. She’d written the order as she’d been receiving a page about another patient and had rushed through it.
“I...can see the wrong dose was entered in error. I wrote for the correct dose of one hundred and ninety milligrams, but the nurse and the pharmacist both thought the order was for one hundred milligrams.”
“Next time, make sure your orders are clear, Dr. Stewart,” Jake said bluntly, his expression hard, as if those moments between them in the call room had never happened. Or maybe he was punishing her for that kiss. “Sloppiness can kill a patient and will not be tolerated. Understand?”
Numbly she nodded. Jake had made it perfectly clear that not only was there nothing personal between them but that she’d have to work harder than anyone else in order to earn his respect on a professional level.
She couldn’t afford the smallest mistake if she wanted to succeed in this program.
CHAPTER FIVE
MAYBE he’d been a little too hard on her, Jake thought with a twinge of regret as he watched Hannah leave the ICU after they’d finished rounds. For a split second he considered going after her, but then the logical side of his mind quickly overruled the emotional impulse.
Following Hannah was exactly what had got him in trouble earlier that morning. Going to her call room because he’d known she was upset had been incredibly stupid. Taking her into his arms to offer comfort had been even worse. How on earth he’d managed to pull away from her, when he’d wanted nothing more than to make love with her again, he’d never know.
Over the past twenty-four hours they’d worked together, he’d realized she couldn’t have set him up at the bar. For one thing, no one had known his plans to accompany Gregory Matthews on his yacht for the day. Plus, he’d asked his administrative assistant to check the welcome-reception list and discovered Hannah had, in fact, declined the invitation. Yet in the moment in her call room, when she’d responded so passionately to his kiss, the flash of doubt had returned.
If she hadn’t known who he was a few days ago, she certainly did now. And he couldn’t ignore the possibility she was still interested in using the physical attraction between them to advance her career.
He needed to stop caring about her on a personal level. If Hannah was upset by having her mistakes pointed out to her, she shouldn’t have applied to a competitive surgical residency program. And she’d better grow a thicker skin.
Patient care was his priority. Every doctor in the hospital had to learn from their mistakes. The sooner she realized that, the better. She was no different from anyone else.
And maybe if he told himself that ten more times he’d find a way to believe it.
Pushing away thoughts of Hannah, he glanced at his watch as he headed back down to the trauma bay. His shift would officially end when he reported off to the next attending, and since a trauma call had come in a few minutes ago, he knew his colleague, Steven White, would be there. Jake was still on call for the rest of the week, so he’d be due back for evening rounds at five-thirty.
Not much time off work, but enough to run home, maybe hit the gym for a few hours before coming back to the hospital.
When he poked his head into the trauma bay, he fro
wned when he saw Hannah there, standing off to the side, watching a patient being resuscitated from what appeared to be a cardiac arrest.
“What are you still doing here, Dr. Stewart?” he asked in a low voice so as not to disturb the staff running the code blue under the direction of Steven White.
She didn’t even glance at him. “Observing.”
Her tart tone made him grind his teeth in frustration. He could see that much for himself, but what he didn’t understand was why. “Residency rules require that you leave the hospital by noon on the days you’re post-call.”
“I’m aware of the residency rules, Dr. Holt,” she murmured, her gaze glued to the staff working on the patient. “And in case you haven’t noticed, it’s not quite noon yet. I have fifteen minutes to observe.”
Fifteen minutes. He couldn’t believe what he was hearing. Hannah had to be exhausted. He knew she hadn’t had much sleep last night. Hell, he’d only managed a total of four hours himself, and he hadn’t been first call. It seemed ridiculous to stand around observing when she could be at home, asleep. Was she really this dedicated to learning? Or was she simply putting on a good show for the attending physician’s benefit?
For his benefit?
“Your dedication to learning is duly noted, but your shift is over, Dr. Stewart. Go home.”
She glanced pointedly at the clock and then focused her attention back on the CPR efforts of the trauma staff. Her unspoken message was clear. She would leave the hospital when required and not one minute sooner.
He couldn’t explain why her defiance annoyed him so much. “If you’re doing this for my sake, don’t bother. You won’t get extra-credit points from me.”
That comment finally broke through her wall of indifference and she turned on him, her blue eyes glittering with icy frost. “I’m observing this resuscitation effort for my sake, not yours. And I fail to see why you care how I spend my time, Dr. Holt.”
He slammed a lid on his temper with an effort. “I don’t care how you spend your time,” he said, even though it was a blatant lie, because for some strange reason he did care. Far more than he should. “But I’m responsible for making sure our residents follow the eighty-hour work rule. I refuse to allow you or anyone else to jeopardize our program.”
“I won’t jeopardize your program,” she said flatly, turning away.
Maybe, maybe not. He crossed his arms over his chest and waited beside her, as he couldn’t interrupt his colleague in the middle of the code. But he kept a wary eye on the clock. If Hannah thought he was going to allow her special favors, she’d better think again.
The resuscitation was winding down when suddenly Hannah spoke up from beside him. “Oh, look, it’s noon. Guess I’d better get home. Have a great day,” she said with obviously forced cheerfulness before turning and walking toward the trauma residents’ call rooms.
Her biting sarcasm, for some odd reason, made him smile.
He shook his head, his previous frustration draining away. Hannah was a feisty one, no doubt about it. And until this moment he’d never considered feistiness to be an admirable trait in a woman.
Allie had pretty much agreed with whatever he’d said, twisting her personality into whatever she thought he wanted. And now he could admit he’d found her ready agreement very annoying.
Truthfully, there was far too much to admire about Hannah. Her strength, her intelligence, her willingness to learn, her obvious empathy toward her patients and the way she stood up for herself.
The crux of his problem was that he liked her as a person. Respected her as a surgical resident. Desired her as a woman.
Where in the hell would he find the strength to stay away from her?
* * *
Hannah fell asleep the moment she got home and ended up sleeping far too long, well into the evening, which only served to screw up her entire sleep schedule as she was then wide-awake for over half the night.
Thinking of Jake. Reliving the passionate night they’d spent together at his condo. And every interaction they’d had since then.
Her butt was seriously dragging the next morning and as far as she was concerned, it was all Jake’s fault.
It was ironic to realize that by the time she managed to get her sleep cycle back on track, it would be her turn to be on first call again.
She’d known going into the program that all residents took call every fourth night. But she hadn’t fully appreciated how the first-year residents ended up fielding most of the phone calls to the point that the more senior residents got far more sleep.
At least she had something to look forward to after her first year as a resident was over. Just three-hundred and fifty-eight days to go.
Since that thought was totally depressing, she quickly shoved it aside. There was no point in wishing away her life.
She’d take each day for the learning experience it offered.
Jake was once again the attending physician on duty for her Saturday-night call. She was proud of how she’d managed to keep him at a distance over the past few days since their disastrous kiss in her call room. Every interaction with him had been cool and impersonal.
But during rounds it was just the two of them, creating an intimacy she found hard to ignore. Thankfully, their trauma pagers went off the moment they finished, so they ran down to the ED together. Their patient was a guy in his early thirties, with the size and stature of a football player, who’d fallen down a flight of stairs. He was already intubated and unconscious as she began her trauma assessment.
Without warning, he suddenly woke up, extremities flailing wildly. He smacked Hannah in the back of her head with his arm. Caught off guard, she ended up sprawled on top of him. When she lifted her head, trying to get her feet under her, she gasped when his other fist came flying straight at her face.
“Look out!” Jake shouted, and miraculously he caught the guy’s fist inches before it could connect. “Are you all right?” he asked harshly, as she stumbled out of harm’s way.
Numbly, she nodded, even though the back of her head still throbbed painfully. For a moment their gazes locked and she thought she saw a flash of concern in Jake’s green eyes before he turned his attention to the patient.
“Get locking restraints on this guy now!” he ordered. “And give him ten milligrams of Versed to calm him down.”
Within five minutes the muscle-bound patient was once again lying peacefully on the gurney, almost as if nothing had happened. It would have been comical if her head didn’t hurt.
“Are you really all right?” Jake asked in an undertone, after the patient had been to the CT scanner and back.
“I’m fine. Thanks for saving me from a broken nose.”
Her lighthearted attempt at humor fell flat and for a moment it looked as if he wanted to say something more, but they were interrupted by the neurosurgeon coming into the trauma bay.
Leaving Jake to discuss the muscleman’s head bleed, which they’d found on a CT scan, she retreated to the cafeteria to review her notes. No way did she want to make another careless mistake, the way she had with the dose of Mr. Turkow’s antibiotics.
But images of Jake’s concern kept flashing in her mind. After a quick meal she went to find ibuprofen for her headache.
The calls were sporadic, nothing serious. Until she was called up to the general floor because a patient needed IV antibiotics and the nurse wasn’t able to get one in place.
Hannah went to the patient’s bedside and introduced herself again. Mrs. Eva Carmichael was an elderly patient who’d had her gallbladder removed earlier that day by Dr. Holt, and just one glance at the woman’s bruised arms convinced Hannah her veins were pretty much nonexistent.
“She’s probably going to need a jugular or subclavian central line,” Josie, the nurse, informed her in a low voice.
Hannah sighed. Jake had left pretty clear instructions during rounds about this particular patient. Any issues whatsoever were to go directly to him. Apparently Mrs. Carmichael
was a friend of Gregory Matthews’s mother.
Nothing like having connections to the chief of surgery.
When Jake answered her page, she explained the situation.
“I’ll be right up.”
She hung up the phone and went back to Mrs. Carmichael’s bedside. “Dr. Holt is going to come up to explain your options,” she informed her.
“Thank you, dear,” the elderly woman said kindly, patting her hand as if the patient-doctor roles were reversed. “He’s such a nice young man, isn’t he?”
Hannah’s smile was strained. “Yes, he is. Very nice.”
“And so handsome, too!” Mrs. Carmichael’s eyes held a mischievous glint. “Don’t you agree?”
“Yes, he’s very handsome,” she agreed again, trying to think of a way to change the subject.
“Hello,” Jake greeted them both as he walked into the room. Hannah feared her expression gave her away when he shot a curious glance in her direction before going over to take the patient’s hand. “How are you feeling, Mrs. C.?”
“A little achy, that’s all,” she responded. “We were just talking about you, Dr. Holt.”
“Really? Good or bad?” he asked jokingly.
“Good, of course,” Mrs. Carmichael said with a weak laugh that turned into a moan as she put her hand over the dressing covering her fresh surgical incision. “Hannah and I both think you’re nice and handsome.”
Hannah hoped he didn’t notice her flush of embarrassment as she tried to get the conversation back on track. “Mrs. Carmichael’s peripheral IV infiltrated just before her next dose of antibiotics was due. Rather than keep poking at her, I thought we should consider a central line.”
“Hmm.” Jake did a quick examination of the woman’s arms and then nodded reluctantly. “Mrs. C., you understand that we need you to get a full course of antibiotics, as your gall bladder was infected. I think Dr. Stewart’s assessment is right on. We really need to put a catheter into one of your large veins, either along your neck or beneath your clavicle.” He indicated the areas he meant on her skin. “And what that means is that we’ll have to do a minor surgical procedure.”
