by Laura Iding
“Are you going to put me to sleep?” she asked.
“No, ma’am,” Hannah piped up. “But Dr. Holt is going to give you numbing medicine so it shouldn’t hurt much. We will have to move you to the ICU for the procedure, but you’ll come back here to your regular room when it’s over. Shouldn’t take more than an hour.”
A loud beeping echoed in the room as their pagers went off. Hannah read the trauma alert—two motor-vehicle-crash victims from a head-on collision were on their way in.
“Actually, Dr. Stewart is going to put this catheter in for you,” Jake corrected as he put his pager back in its holder. “But she’s a great doctor, Mrs. C., so I’m leaving you in good hands.”
Hannah’s stomach clenched with dread, but she knew better than to say anything in front of the patient. Especially a VIP. “I’ll make the arrangements,” she said, and then quickly followed Jake out of the room.
“Meet me down in the trauma room when you’re finished,” he said as he headed for the stairwell.
“Wait a minute,” she said, reaching out to grab his arm. “You can’t seriously expect me to do this alone?”
“You’ve placed central lines before—in fact, we just did one the other day, didn’t we?” he asked. But then he frowned, a flash of uncertainty in his gaze. “Unless your head hurts too much?”
As an excuse it would have been the easy way out, but, while tempted, she just couldn’t do it. “No, my head is fine. But, Jake, she’s a VIP!” Hannah couldn’t believe he meant her to do the procedure all alone. What if something bad happened?
“Look, Hannah, I have two seriously injured patients on the way in, and Mrs. Carmichael’s antibiotics are already overdue,” Jake pointed out in a reasonable tone. “You’re capable of putting the catheter in yourself. Get the medical student to assist, as Richard will be with me.”
“But—”
“Don’t forget to come down to the trauma bay as soon as you’re finished,” he said again, before heading down the stairs.
Helplessly, she watched him leave, wishing she dared put off the procedure until Jake could be there.
But what if they had a busy night? More trauma patients could arrive. If Mrs. Carmichael didn’t get her antibiotics, she could go into septic shock. Besides, Hannah didn’t want to have to explain to the chief why she hadn’t got the line in.
She took a deep breath and let it out slowly. She could do this. She was a surgeon. And as Jake had said, she’d just put a central line in another patient two days ago.
This procedure would be no different.
Except that Mrs. Carmichael happened to be the mother of a friend of the chief’s.
Don’t think about it, she warned herself as she strode back to the nurses’ station. She made the arrangements with Josie to have Mrs. Carmichael transported to the ICU and then she paged the medical student, Renee Anderson, to assist.
The ICU was extremely busy, so there wasn’t anyone available to help out. The nurse dashed into the room long enough to put the patient on the heart monitor and to place the call light on the floor. “Step on this if you run into trouble,” she advised, before dashing out again.
Hannah glanced curiously at Renee, who shrugged. “It works,” the medical student said wryly. “Hey, it’s easy enough to step on it while maintaining a sterile field.”
Okay, then. Hannah explained the steps of the procedure to Mrs. Carmichael while Renee opened the sterile tray. Hannah donned her sterile garb, and then began to prep the site. Poor Mrs. Carmichael flinched a bit when she injected the Lidocaine. “I’m sorry, this is going to burn a little,” Hannah apologized.
“I’m okay,” the elderly lady said, her voice muffled beneath the sterile drapes.
Mrs. C. was a real trouper. If she was frightened in any way, she certainly didn’t show it.
For some reason, the patient’s confidence in her abilities helped Hannah relax.
She picked up the large-bore needle and then gestured for Renee to bring over the ultrasound machine. “I need you to help me find the subclavian vein,” she instructed. “Draw the probe slowly across the skin.”
Renee was also dressed in sterile garb and she took out a clean ultrasound probe and gently moved it over the area Hannah indicated, right beneath the clavicle bone.
“Stop. You have it right there,” Hannah said when the vein lit up on the screen. She double-checked her landmarks with her thumb and middle finger. “Okay, Mrs. Carmichael, I’m going to insert the needle. Let me know if you feel any pain.”
She slid the needle through the skin, grateful that the area was well numbed as the patient didn’t move. She advanced the needle and then stopped the moment she hit a blood return. Holding the needle steady, she picked up the guide wire and threaded it through the end of the needle, slipping it farther into the blood vessel. Once the wire was in, the rest of the procedure went much easier.
“Are you okay under there?” Hannah asked, as she threaded the catheter over the guide wire.
“Yes, dear,” Mrs. Carmichael responded faintly.
Suddenly the cardiac-monitor alarm began to beep, in a triple beep pattern that signaled the most urgent alarm.
“What’s wrong?” Renee asked.
“V-tach,” Hannah murmured in a grim voice, her heart lodging in her throat when she stared at the monitor. She knew there was always a risk of central venous catheters going in too far, tickling the heart muscle and causing arrhythmias, but the phenomenon had never happened to her.
“What should we do?” Renee asked, her voice rising in panic. “Step on the call light? Ask the nurse to call a code?”
“No, just give me a minute.” Hannah hoped and prayed she was making the right decision as she fixed her gaze on the heart monitor and slowly pulled back on the guide wire.
CHAPTER SIX
“WHAT’S going on in here?” the nurse who’d put the call light on the floor demanded as she came running into the room.
“Everything is fine,” Hannah said, sending the nurse a pointed glare. Didn’t she realize the patient could hear every word they were saying? Even if there was a reason to panic, they didn’t need to add to the patient’s distress. But the emergency was short-lived. The cardiac monitor stopped beeping as Mrs. Carmichael’s heart returned to a normal rhythm. The tension in the room evaporated.
“Are you okay, Mrs. Carmichael?” Hannah asked, feeling as if her own heart was in V-tach the way her pulse jumped erratically in her chest.
“I’m fine,” the elderly woman murmured.
“I’m glad to hear that. The wire tickled your heart a little, causing the monitor to alarm, but everything is fine now. The catheter is in place—we just need to place a couple of stitches to keep it there.”
“Whatever you say, dear,” Mrs. Carmichael said, remaining amazingly calm.
Hannah took a deep breath, trying to control her jagged nerves. Thank heavens Mrs. Carmichael’s condition had stabilized. She couldn’t imagine how Jake would have reacted if she’d caused his VIP patient to code.
And she really didn’t want to explain that to the chief of trauma surgery.
Good thing Mrs. Carmichael was so nice or this entire event could have been made out to look much worse.
Hannah finished stitching Mrs. Carmichael’s catheter in place and then covered the area with a sterile, transparent dressing. She ordered a portable chest X-ray to verify proper placement and to rule out any potential complications, like a pneumothorax. After she confirmed everything was fine on the X-ray, she made arrangements for the elderly woman to return to her room, feeling strangely exhilarated.
She’d handled the potentially emergent situation pretty well all things considered. And she wanted someone to share the good news with.
Jake. She found herself wishing she could talk to Jake.
The knowledge was disturbing. Jake wasn’t her friend or her confidant. And certainly not her lover.
He was her boss and, as such, he’d expect her to handle
any emergency situation. Especially one that might have potentially been her fault. It could be that Mrs. Carmichael’s potassium levels were out of whack or she’d put the guide wire in too far. Or both, she silently acknowledged.
After a brief discussion with the pharmacist about getting Mrs. Carmichael’s antibiotics back on schedule, she headed down to the trauma room.
Halfway down the stairs, her cell phone chirped from the depths of her lab-coat pocket. She pulled it out and glanced at the text message, wondering who on earth would be contacting her. Her mother was usually the only one who called and her mother didn’t have a clue how to text.
Hey, sis, out on parole. Call me.
She stopped abruptly, grabbing the rail so her momentum didn’t cause her to fall flat on her face.
Dear God. Her brother Tristan was out of jail.
Hannah stared at the text message for a full minute, assailed by a wave of hope, almost overwhelmed by despair.
After a brief internal debate she thrust her phone back in her pocket without calling or responding to his text message. There wasn’t time to get into a long conversation with her brother. Jake was waiting for her down in the trauma bay and the two motor-vehicle-crash patients deserved to take priority at the moment.
Besides, it wasn’t likely her brother was calling to share good news. If she knew Tristan, he probably needed money. After all, being in debt was how he’d gotten in trouble in the first place.
And that was a situation she just couldn’t deal with right now.
* * *
Jake glanced up, sensing the moment Hannah walked into the trauma bay, and frowned when he noted the strained expression on her face. Had he been wrong to trust her with Mrs. C.’s line placement? For a moment he feared the worst. “Problems with the procedure?”
“The guide wire tickled her heart, causing a few arrhythmias, but she’s fine. The line is in good position and her antibiotics are infusing now.”
For a moment he searched her gaze, realizing that, despite the complication, she was proud of her accomplishment. “She does have a small frame, so you likely went in a little too far.”
“Agreed. Luckily she bounced back quickly, tolerating the procedure really well.”
He nodded, reluctantly impressed by the way she took responsibility for what had happened, rather than blaming something else. And a little V-tach during a line placement was fairly common. But if the procedure went well, what was bothering her? Did she still have a headache after getting whacked by their head-injured patient?
And why did he care if she had a headache or not? Wild, rambunctious patients were not uncommon on Trauma. She was lucky she hadn’t suffered anything worse than a headache. One of his colleagues back in Minneapolis had suffered a broken jaw after being slugged by a patient.
Those moments when Hannah had been lying half-stunned over their patient, her face in the line of fire from the guy’s fist, kept replaying over and over in his mind. Forcing him to acknowledge how he was failing miserably in his goal of keeping their relationship from becoming personal.
Granted, he would have reacted the same way if anyone else on his team had been in danger. But he doubted he’d continue dwelling on the event hours later.
He shouldn’t be feeling so protective of her.
She walked over to the most recent trauma patient, as if intending to get caught up on the events that had transpired in her absence. Once again, she seemed determined to learn everything possible.
He couldn’t remember any other first-year resident being this intense. And he couldn’t help being curious as to why she’d chosen to be a surgeon in the first place. Other areas of medicine were far easier to manage.
But he sensed Hannah didn’t take the easy way out, ever.
For the tenth time he found himself wishing Hannah had been in some other residency program, rather than here at Chicago Care. Because he’d never experienced a physical connection this strong with anyone else.
Certainly not with Allie. At least, he’d thought he had with Allie, only to discover the feelings had been all on his side, not hers.
“Did you see his labs?” Hannah asked, dragging his attention to the present.
The lab screen was directly in front of him, so he quickly scanned the results. “His lactic-acid level is high, likely due to necrotic bowel.” Exactly as he’d suspected. “Call the O.R. and let them know we’re coming up.”
“Will do.” He was surprised she didn’t immediately ask if she could scrub in on the case.
Then again, none of his interactions with Hannah went the way he expected.
And why was that fact so intriguing?
As they headed to the O.R., Hannah’s cell phone rang from the depths of her lab coat. He watched her punch a button, sending the call to voice mail.
Strange, as the time was well after midnight. Who on earth would be calling her?
A flash of jealousy caught him off guard, before he quickly reined it in. Hannah’s personal life wasn’t any of his business. They were nothing more than colleagues, and the sooner his brain figured that out, the better off he’d be.
Yet as they scrubbed in at the sinks in the core of the O.R., he could tell she was still upset, seemingly completely lost in her thoughts.
“You’re not supposed to scrub so hard you draw blood,” he murmured dryly.
She glanced up at him in surprise, and then dropped her gaze back down to her reddened hands.
“Sorry,” she muttered, tossing aside the brush and then doing the final rinse.
He finished his rinse, as well. “You need to make sure your mind is focused when you enter the O.R.,” he advised, trying to pretend he wasn’t dying to know what was bothering her. “So put whatever issues you have aside until later, understand?”
“Got it,” she said with a curt nod.
He wanted to say more, but heading into a surgical case wasn’t the time or the place. As they began the procedure, he couldn’t complain about the way she handled herself in the O.R. She seemed completely engrossed in the case at hand. He ended up taking a little extra time, allowing her to do a good portion of the procedure herself.
Not that he was giving her any special treatment or anything. He’d do the same for any of his residents.
A wide smile blossomed on her face when they’d stripped off their gloves and their masks when the case was finished, forcing him to acknowledge once again how different she was from any other resident. “That was awesome!” she exclaimed. “Thanks for letting me do so much.”
“You’re welcome,” he muttered, knowing he was sinking deeper under her spell every minute they spent together. Man, he needed to get a grip. He turned away, intending to put distance between them. “See you later. I need to head up to the ICU to check on the second trauma patient Richard is caring for.”
“I’ll come with you,” she volunteered, catching up with him.
He stifled a low groan and tried not to look at her as they rode the elevator up to the third floor, but it wasn’t easy. When her cell phone chirped again, he glanced at her, letting a hint of his exasperation show. “Do you want to talk about it?”
“What? The bowel resection?”
He wasn’t fooled by her wide-eyed, innocent expression. She knew very well what he’d meant. “About whatever is bothering you. Every time that phone of yours goes off, you practically jump out of your skin.”
“It’s nothing,” she said quickly. “Just some personal family stuff.”
He shouldn’t have been relieved by her answer, but he was. At least the persistent caller wasn’t some former boyfriend or something. Still, her reluctance to talk inexplicably bothered him. When they reached the ICU, he paused outside the doors. “Take a break, Hannah. Deal with your family issues and then get your head back into patient care.”
“My head is fully engaged with patient care,” she replied stubbornly. “The personal stuff can wait.”
It was on the tip of his tongue to argue, b
ut in the end he let it go.
Reminding himself that whatever Hannah’s problems were, they certainly weren’t any of his business.
* * *
Hannah did her best to focus on the conversation between Richard and Jake regarding their female trauma patient, Isabella Cronin, who’d suffered multiple pelvic fractures after crashing into a tree.
Yet her mind kept drifting back to Jake’s unexpected offer to talk about her personal problems.
Surprisingly, she’d been sorely tempted to unload her messed-up family situation on him, even though she knew that was the worst thing she could do. The shame of growing up in the Chicago projects was something she couldn’t shed like a second skin.
Especially considering her mother, disabled by severe rheumatoid arthritis, still lived in the low-income, city-subsidized housing. Just five years ago, her mother’s condition had gotten so bad she hadn’t been able to continue her job as a waitress in a diner, so Hannah had started supporting her financially.
And now she’d probably end up supporting her brother, too.
If Jake knew anything about her background, or the truth about some of the things she’d done, he’d look at her differently, and the last thing she wanted was for him to begin judging her performance on something other than her abilities as a surgeon.
The very thought of being treated differently nearly made her break out into a cold sweat. She’d kept her past, and the mistakes she’d made, well hidden for too long to let the secret out now.
“Make sure she remains NPO for possible surgery tomorrow morning,” Jake advised.
She dragged her attention to the patient before them. “Shouldn’t we start her on heparin, as she’ll be lying in bed for an extended period of time?”
Richard gave an exasperated sigh and she immediately realized she’d missed something important.
“We can’t give any anticoagulation to patients with a head injury,” Jake said mildly. “And her CT scan showed a questionable area that could be a small subdural hematoma.”
