* * *
Frustration gnawed Kate's stomach. Perched at the desk in her dim, air-conditioned cubicle, she pressed two fingers under her breastbone, as if she could rub the burn away. Common sense and medical training told her to eat. Instead, she sipped at her third—or was it fourth?—cup of coffee, studying the file spread out before her, trying to drown her nagging dissatisfaction in hard work and caffeine. Nothing new there.
Kate took pride in her analytic intelligence. Amy got the beauty, their mother always said, and heart and charm, and Kate got the brains. Her mind dug and worried at problems with the tenacity of a trailer-park dog going after a possum.
Four-year-old Jack MacNeill was a problem.
Kate leafed back through the thick folder labeled MACNEILL, JACK, trying to reconcile the clinic notes with her observations from that morning and her memories from four years ago. At the time of the accident that maimed baby Jack, Kate had been gearing up for Auburn, to be groomed for an eventual return to Jefferson's burn unit. But even in her stressed-out and sleep-deprived final days, the MacNeills had made an impression. It seemed everyone connected with the burn unit had been touched in some way by that particular patient. Iron Man, the nurses had dubbed the baby who refused to die.
The title could just as well apply to his father. Kate recalled Patrick MacNeill's stoic response four years ago to his family's devastation, his steady presence in his son's hospital room. Whatever rage or grief the father had felt, he'd been a formidable advocate, insisting that he be informed and involved in every step of baby Jack's treatment.
So maybe she had two problems.
She had a sudden vision of the man's vital hands, arrogant chin and measuring blue eyes and expelled her breath sharply. Sexual attraction was another problem she didn't need. Thumbing another antacid off the roll in her pocket, Kate popped it in her mouth, sucking furiously as she read. The chalky cherry flavor warred with the bitter taste of coffee. She crunched the tablet down anyway.
Methodically, she went through the surgery notes, progress reports and exam charts, page after page of Dr. Gerald Swaim's spiky, black writing. The burn unit's director was certainly conscientious, despite an old-boy attitude that made Kate arch like her cat. He was well established and well regarded. If he said elective cosmetic surgery was called for in the MacNeill child's case, then of course he was right. Of course he was.
She just didn't happen to agree with him.
Her gut flared again. Kate covered her groan with a cough and another sip of coffee. The last thing she wanted to do at this point in her career was antagonize the director of her unit. Burn doctors were the elite of medicine. For outsider Kate, to attain that level of excellence, to make a difference on that scale, was the culmination of fourteen years' hard work. She fully expected Swaim to offer her an attending slot when her fellowship expired in June, but she needed his goodwill. Maybe she wasn't as politically savvy as some of her colleagues, maybe she didn't play golf, but she was darn sure that second-guessing the center's director wasn't the best way to get his support.
Patrick MacNeill's eyes, blue as flame and hard as steel, burned against the background of medical records, judging and finding her wanting.
Kate swallowed. Look, she argued against the demand in those eyes, there's nothing I can do. You didn't want your son to see me. You wouldn't let me examine him. You thought I was the nurse. Her fault, she thought. She should have introduced herself immediately. Still, she fanned the little spark of indignation produced by Patrick MacNeill's unthinking discrimination, hoping to fuel her resolve. How could she question a senior surgeon's call on the strength of his clinical notes and her fleeting observation?
She couldn't, Kate decided. For the child's sake, she would mention her concern about his hand. Swaim could determine whether to take that matter any further. But she wasn't going to say a word about the advisability of performing elective surgery on a preschooler. She didn't want the program director thinking she was questioning his expertise.
Patrick MacNeill was not her problem. Jack MacNeill was not her patient. She had no authority to interfere in his case.
Kate stared at the chart in front of her until the black lines wavered like ants marching on a picnic. In spite of the chalky sweet antacid, she had a sour taste in her mouth. No authority, sure. But didn't she have the responsibility?
* * *
"Sharon, there's been a mistake," Kate complained, stalking down the hall toward the nurses' station. "I can't possibly have another appointment with the MacNeill boy. He was in here two days ago."
Even to her own ears, she sounded too sharp. Three days of managing a double caseload were definitely taking their toll. The news that Swaim was expected back early next week didn't do a thing to chase away the worries spinning ratlike in her head and gnawing holes in her stomach lining. Kate knew she was considered more reasonable than some of her colleagues, but that didn't mean she was liked. The awareness twinged without bleeding, like an old scar. Serious Kate had never been liked.
The burn nurse looked up from stacking sterile instruments to peer at Kate's clipboard. "Your two o'clock?"
"Yes."
Sharon sniffed and resumed loading the cart. "No mistake. The father called and said he wanted to see you again."
Kate pressed her lips together. "Not me. Swaim."
"Not Swaim. He specifically asked for you."
"Oh." Oh, shoot. She couldn't afford to alienate the nursing staff. In spite of the natural antagonism that sometimes existed between surgeons and nurses, Sharon Williams was one of Kate's few allies in the unit. "Did he, um, mention why?"
Sharon raised her eyebrows, thrusting her chin in the direction of the patient waiting room. "No. Why don't you try asking him?"
Before she could help herself, before she could stop and prepare, Kate glanced through the wired glass to the tidy rows of upholstered chairs. Patrick MacNeill paced between them, too big to be contained, too energetic to stand still. He raked his dark hair with his fingers and then jammed his big hands in his pockets, straining his flight jacket across his broad shoulders.
It was unprofessional, it was irrational, it was embarrassing, but when Kate looked at him her jaw went slack and her knees sagged.
She closed her mouth and stiffened her spine. She would not let him get to her. At least, she wouldn't let it show. She'd spent too many years being patronized by aggressive male colleagues, too much of her life being intimidated by assured and handsome men, to pant and sigh over some virile specimen now.
"All right, I will. Thank you, Sharon."
Ignoring the nurse's amused, speculative look, Kate approached the carpeted waiting room, a professional smile pasted to her face. Young Jack MacNeill slumped in his chair, swinging oversize feet. Despite his early childhood trauma, he was going to grow up tall, Kate thought. Like his father.
Something in the child's patient, dejected posture touched her heart. Without thinking, she spoke. "Hey, Jack. So you guys just couldn't wait to see me again, is that it?"
She regretted the stupidly flirtatious words the instant they left her mouth. But the boy brightened, smiling up at her from under the bill of his cap.
His father stopped pacing. "Dr. Sinclair. Thanks for seeing us again on such short notice."
She shook hands, noting the strength and warmth of his grip, proud of her composure. "You're quite welcome. Won't you come this way?"
In spite of the polite distance he maintained, she was too conscious of him as he followed her through the double doors and down the hall, his size, his tread, his … maleness, she supposed. And wasn't that bomber jacket a bit of an affectation? It made him look like some World War II pinup boy. When they took their seats, Jack up on the table, Patrick MacNeill in the chair by the door, she propped against the examining room's tiny sink instead of perching on her customary stool. She needed every inch of advantage she could get.
"So." She hugged her clipboard to her chest. "What's new?"
&nb
sp; Jack turned wide eyes on his father.
Patrick smiled reassuringly at the boy before turning to Kate. "The other day you said—you mentioned you'd like a look at Jack's hand. I didn't think much of it at the time." His fierce blue eyes met hers without apology. "But that night I watched him. And yesterday. He can't—he doesn't seem to be using his thumb like he used to. I want you to take a look at it now."
Satisfaction flared in Kate. She liked being right. She'd like nothing better than to help Jack MacNeill and prove her worth as a consultant to Gerald Swaim. On the other hand, she didn't want the exalted director to think she was questioning his judgment or encroaching on his case.
She stepped to the exam table, carefully keeping her voice neutral and light. "Of course. Let's see what we've got here."
Jack's ears shrunk to his shoulders. "Is it gonna hurt?"
By the door, Patrick MacNeill's big body stirred protectively and then stilled. Kate thought of what the boy had endured, what they'd both endured, so far, and drew on her pediatrics training for a technique she sometimes found helpful with small patients. Swaim disdained her soft approach, she knew, and the boy was Swaim's case. But she was the one examining him, darn it.
"I'm going to bend your fingers. It might get a little uncomfortable. Do you want to sit on your dad's lap?"
"Can I?"
"If it's all right with your dad. You're a pretty big boy."
"All the MacNeills are big and tough. But I can take him," Patrick growled. He rose from his chair and swooped the child into the air, making him giggle with delight.
"Rough and tough and good enough!" the boy shouted gleefully. "That's what Uncle Sean says."
Good enough for what? Kate wondered dryly, fascinated by this glimpse into the masculine MacNeill clan. But Patrick MacNeill mounted the long, narrow table and held, his son comfortably on his lap, waiting for her to examine him.
Goodness, Kate thought. This technique sure felt different when she used it with her patients' moms. Clearing her throat, she stepped between the tall man's knees and took Jack's hand, stabilizing it in both of hers.
"I'm going to do some exercises with you. I bet you already know a lot of them, but I don't want you to help me, all right? You can tell me if it feels uncomfortable."
Jack nodded gravely. One after the other, at different angles and degrees, Kate flexed, separated and curled his fingers, thumb, palm and wrist. The familiar exercises drew her concentration, blunting her awareness of the big man looming over them both.
Several times, in response to her touch, Jack stiffened. Once he cried out and pulled away. Kate stifled her own totally useless empathetic response as Patrick MacNeill cuddled the boy, his deep baritone soothing. Jack sighed and leaned back against that broad chest, turning his face into his father's arm.
Patrick nodded at her over the child's head. "Okay. Go on."
Appreciation welled in Kate for his support. Appreciation, and just a tingle of envy for the love that flowed from father to son. What on earth had gotten into her today? Methodically, Kate returned to testing the full range of motion in Jack's hand. The results were clear. Too clear. This time, a correct diagnosis brought her little satisfaction.
She patted Jack's hand and released it. "That's great. We're all done now."
"You did good, buddy." Patrick praised his son.
Jack squirmed. "Can I get down now?"
"You bet." Patrick's voice as he spoke to his son was cheerfully casual, in contrast to his watchful, wary eyes.
Reluctantly, Kate met the question in his gaze. "Maybe we could speak alone? Jack could go with Nurse Williams. There's a playroom attached to the—"
He held up one large palm, forestalling her. "We know the playroom. Go ahead, buddy. I'll be along in a minute."
Yes, Kate thought, they would know the playroom. She'd reviewed Jack's chart. She knew how many surgeries the boy had been through, how many hospital stays, how many days and weeks of therapy and recuperation in the first two years following the accident. She saw the cost in the quick hug the child required from his dad before trotting off, hand in hand, with Sharon Williams. She saw the burden in his father's tense shoulders, the profound weariness etched in the corners of his eyes, the doubt that all his masculine assurance could not disguise or allay.
It made what she had to say to him now doubly hard.
* * *
Chapter 2
«^»
Dr. Sinclair steered him to her office, a gray, featureless cubicle with towering files and ruthlessly organized shelves. Patrick stiffened with dislike. He couldn't imagine a less welcoming or less feminine environment. No pictures, no photographs, no nonsense. A philodendron dropped yellowing leaves in one corner.
A bad sign. He hoped the lady doctor took better care of her patients than her plants.
She leaned forward earnestly across the neat stacks on her desk. "In the majority of cases, this kind of operation is done as soon as possible and not again unless we see compromised function. Jack is very young. I wouldn't even suggest we operate except that this is Jack's dominant hand."
"Why not?"
"Frankly, preschoolers don't cooperate very well in their own physical therapy. Without a great deal of parental support—"
Patrick straightened in his ridiculous little chair. He didn't need another doctor preaching to him about the role of loved ones in the healing process. "He's got parental support. What do you need to do to fix the hand?"
She sat back, as if his response wasn't quite what she expected. "Well, we… Surgery is the first step."
He'd figured that. He was already planning how to break the news to Jack and calculating the time he'd need to take off work. If he called his mom, Patrick knew, Bridget MacNeill would hop the next available flight from Boston to be with her son and grandson. But both his parents had put their lives on hold for him after the accident. A potent combination of love and pride prevented him from asking for their help again.
He and Jack would make it on their own.
Dr. Sinclair cleared her throat. "We can replace the skin of the affected joints. But after the reconstructive procedure, you will need to exercise Jack's hand through a passive range of motion many times a—"
He appreciated her meticulous attempt to explain, but it wasn't necessary. "Who's the best person to do the surgery?" he interrupted.
"I could do it." She capped and uncapped her pen several times. The unconscious nervous gesture was oddly appealing. "But Dr.
Swaim should be back soon, and your son is Dr. Swaim's patient. I think it would be best if we schedule the procedure for his return."
She hadn't really answered his question, Patrick noted, his brows drawing together in concern. But what she said made sense.
"Replace the skin, you said. You mean grafts?"
Holding his gaze, she nodded, her brown eyes wide and compassionate.
Hell. As clearly as if it were yesterday, he could hear the screams of his infant son as grafts were peeled from his uninjured back and stomach to replace the charred skin on head and arms and hands. Twelve days of slow and painstaking torture to combat the destruction of one drunk driver's moment of carelessness.
He retreated from her unspoken pity, sitting to military attention in his tiny chair. "How many?" he rapped. "Where?"
"It's a relatively small area," she assured him. "We'll replace little diamond-shaped pieces in the crease of these three fingers and the palm." She held out her own hand to illustrate. "And here, at the thumb. Dr. Swaim should be able to harvest what he needs in one procedure."
He forced himself to ask, for Jack's sake. "Where would he take it from?"
"The graft? He can probably get all he needs in one long strip from the groin."
Patrick winced with a grown man's reflex action and a father's sympathy.
"I know," the doctor said kindly. "But it's really a very shallow, thin piece. One skin thickness. Jack will have no visible scarring. He won't even need a dressing th
ere."
"How long will he be in the hospital?"
"Overnight," she answered promptly. "Home the next day."
"Fine. Let's do it."
A hint of exasperation appeared on her face. "Mr. MacNeill, do you— You do understand the implications of what I've been saying."
He understood them, sure. She was telling him his son needed to undergo another complex, painful procedure to ready him for a protracted and even more painful course of physical therapy. Swell. Leaning back in his chair, Patrick crossed one ankle over the opposite knee. "Yes."
"There is no point to this surgery without extensive follow-up at home."
Irritation at her prodding clamped his jaw. Any time the brass wanted a job done, they sent in the Marines. If Marine pilot Patrick MacNeill said he'd do something, then it was as good as done. Enough already.
On the other hand, Patrick reminded himself, the doctor also had a job to do. And actually, he appreciated her honesty. In his experience—and it was broader and harder than he once could ever have imagined—not all doctors troubled to make sure their patients' parents were truly informed.
"Yeah, you made that clear."
"I just want you to understand—"
"Doctor," he interrupted, moderating his tone so as not to give offense to the well-meaning lady doctor, "I may not have a medical degree, but if you speak slowly and use little words, I can follow you fine. Jack is losing the use of his hand. He needs an operation and he needs physical therapy. Okay."
Her rounded chin lifted. "We're not talking about fifteen minutes twice a day. In adult patients, we tell them to go through the full range of motion every hour on the hour that they're awake. A child won't do that. You will have to do everything for him. His exercises will become the center of your relationship with your son."
The prospect appalled Patrick, but he spoke firmly. "Whatever it takes. Whatever he needs."
The doctor's face softened. She was pretty when the tight lines bracketing her mouth relaxed. He didn't want to notice that, or respond to the sympathy in her eyes.
THE PASSION OF PARICK MACNEILL Page 2
