by Gina Wilkins
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Following Doctor’s Orders
Caro Carson
Chapter One
She heard his voice before she saw him.
Through the constant hum of voices that formed the background noise of the emergency department at West Central Texas Hospital, his deep bass carried. Although he was a fireman by profession, his voice always made her think of cowboys. With its mild Texas drawl and the hint of a wink in the tone, his voice brought to mind a cowboy who’d come to town looking for beer and girls and a good time. He wasn’t a serious man.
She was a serious woman. Dr. Brooke Brown, emergency physician, could hardly be anything else. The buck stopped here—right here, at the pen in her hand. When she wrote a medical order, it was followed, and the results sat squarely on her shoulders. Whether the patient lived or died was her responsibility—medically, legally, morally.
It stood to reason, then, that she was the one female employee in the emergency department that didn’t get giggly-excited when the radio announced that the firefighters from Engine Thirty-Seven were bringing in another patient. Brooke had weightier things to think on than which team of Austin’s firefighters and paramedics had the most bachelors—or which had the bachelor with the sexiest voice.
But Engine Thirty-Seven did.
Brooke would never acknowledge such a thing out loud, but the two women standing at the nurses’ station weren’t so reserved.
“It’s gonna be a great shift,” one woman said. “The studs of Thirty-Seven are here to kick it off right.”
“It’s Eye Candy Wednesday.”
“Yesterday, you said it was Eye Candy Tuesday.”
“Every day that Thirty-Seven comes here is an eye candy day.”
Ignoring their light banter, Brooke continued to listen to the distinctive rumbling bass of one member of the Eye Candy Engine. Firefighter Zach Bishop was rattling off the patient’s basic information to the triage nurse, his voice coming from just behind Brooke and to her right—room three, she was sure—compound fracture of the tibia spoken in the same tone of voice as Mary Ellen, don’t break my heart and tell me that diamond means you’re engaged, darlin’.
Zach Bishop always conveyed the impression there was nothing to worry about. Nothing was unfixable or alarming. The patient could have confidence his injury was treatable. The nurse could flirt safely as she showed off her new engagement ring, knowing the firefighter with the movie-star looks didn’t truly expect her to betray her fiancé.
Dr. Brown, however, knew there was always something to worry about. Specifically, Brooke worried about the people of Austin who came to the emergency room of West Central with their complaints, big and small. She had confidence that she could handle the medical complaints—a professional confidence. Zach’s kind of confidence was personal—and masculine—and a distraction to the smooth operation of her department.
Was it any wonder that they’d spent nearly a year as something close to adversaries?
Adversaries wasn’t the right word. They worked together smoothly. He was a good paramedic, and his shameless appreciation of the female attention that was showered upon him always came second after the patient’s care. But as the handsome Mr. Bishop returned all the smiles that came his way, Brooke frowned in annoyance.
She couldn’t accuse him of trying to get attention. He’d just walk in, casually pushing a gurney, and the contrast between his sun-streaked short hair and his black uniform caught the eye. Whether he wore the black T-shirt of the fire department or the black button-down shirt of the ambulance corps he moonlighted with, the short sleeves of both uniforms revealed the defined muscles of his arms—biceps, triceps, carpi ulnaris.
After his first few visits, it had become obvious to Brooke that while the man didn’t seek feminine attention, he certainly didn’t discourage it. He wasn’t required to stop and chat with every woman who wanted to stop and chat with him, but he did.
Early in September, Brooke had leveled a look of disapproval his way as he was leaving the ER. He usually only raised a brow in an amused response to her glare, but that time, he’d leaned in just a bit too close to deliver the most ridiculous line she’d ever heard: If I had a nickel every time a woman as beautiful as you frowned at me, I’d have...five cents. Then he’d simply walked away, out through the sliding glass doors that led to the ambulances parked outside.
The next time he’d brought in a patient while Brooke was on duty, every woman in his vicinity had slowed her pace just enough to smile and be smiled at once more. Brooke must have frowned again, because he’d leaned in and quietly said, “Ten cents.”
She’d been ready that time. “I find it hard to believe you’ve only been frowned at twice in your life.”
“It’s not the frowns that are scarce. It’s that I never see women as beautiful as you are.” He’d had the audacity to wink as he’d left her standing alone at the nurses’ station.
And so it went. On the days she was working and Engine Thirty-Seven happened to bring a patient in, Zach would deliver a ridiculously corny line for her ears only. I finally placed your accent.
I don’t have an accent.
You must be from Tennessee, because you’re the only ten I see.
She’d either scowl or roll her eyes, because she was brunette and brainy and not the type that boys flirted with. Then they’d part company for hours or days or a week, however long it was before Engine Thirty-Seven again transported a patient to West Central during a shift that she and Bishop both happened to be working.
It was amazing, really, that they’d been carrying on this routine for the better part of a year, exchanging frowns for one-liners out of earshot of their coworkers. It was harder and harder not to smile each time; Brooke had a grudging respect for his unending supply of silly lines. Still, she didn’t like the way Engine Thirty-Seven’s arrival disrupted the concentration of her otherwise disciplined staff.
Case in point: the nurses in front of Brooke began debating whose turn it was to take this afternoon’s patient with the broken tibia. “It’s my turn to work with the hot fireman. You got the medevac guys last night.”
“Yeah, but their patient was critical. It wasn’t like they had time to stop and flirt.”
Brooke let their silliness slide past her as she finished dashing off her discharge orders for the patient she’d just seen. Like all doctors, she wrote quickly out of necessity, but she prided herself on slowing just enough when it came to numbers so that no pharmacist or nurse would misread the dose. Mistakes were unacceptable. Scribbling was irresponsible.
“But that man is delectable.” Both nurses sighed.
Yes, Zach was, in a strictly eye-candy kind of way, but Brooke had more important things to think about, and so did these nurses.
She handed the orders to one nurse. “Please discharge room two.” The nurse, blonde and single, wrinkled her nose in defeat as she left the nurses’ station.
Brooke nodded curtly at the other nurse. “Come to room three with me.”
Brooke had assigned the older, married nurse to work room three with her for reasons that had nothing
to do with the firefighter. On a straightforward case like this fracture would probably be, an experienced nurse like Loretta could handle most of the care. Brooke would only have to see the patient twice—once to do the initial assessment and once to ensure whatever treatment she ordered had been completed. This freed Brooke for the cases where only an MD could perform the work. It was efficient.
“Radiology will be about twenty minutes,” Loretta said.
Brooke almost smiled. The nurse must have overheard Zach say the injury was a fracture, just as Brooke had, and she’d contacted radiology without being asked. Experience and efficiency were invaluable.
The nurse had known Brooke wouldn’t touch the injury without seeing an X-ray first. No doctor would. The X-ray was necessary to verify that no debris existed that might be driven deeper into the soft tissues of the injured leg while it was being set. A compound fracture, one with the bone protruding from the skin, could only be set temporarily, at any rate. The injury would undoubtedly require surgery within a few hours. That was a job for a different type of doctor, in a different part of West Central.
“Tetanus?” Nurse Loretta asked. “Whichever antibiotic is handy today?”
“Yes on both. Whatever cephalosporin is in the machine, if there are no allergies.”
Loretta had suggested exactly what Brooke would have ordered.
See? My decision was rational. It has nothing to do with keeping away from Zach Bishop a woman who is younger and single and more likely to appeal to him.
Brooke was not the type to be possessive when it came to a handsome face, a hard body or a deep cowboy voice. She tended to date men who were more bookish. Intellectually stimulating. Men she could engage in conversation without first needing to brace herself against the distraction of purely physical perfection.
Brooke paused outside room three and braced herself.
It did no good. As she walked in, her attention was caught by the most commanding presence in the room: his. It was human nature, she supposed, to notice who was dominant in every situation, and the tall man in the black firefighter’s T-shirt was definitely the most physically dominant man in the room.
Distraction over. Get to work.
Brooke was in charge once she entered a treatment room, so she focused on the elderly man on the gurney.
“Good afternoon. I’m Dr. Brown. You’re Harold Allman, is that correct?”
The man looked frail despite being heavyset. His white face and the stiff way he was holding himself meant he was in pain, but he still chuckled and looked up at Zach.
“Boy, times have changed,” he said conversationally, ignoring Brooke’s question. “Not only do we have lady doctors, but good-looking ones, too. This one’s a real looker.”
“That she is,” Zach said.
Brooke neither frowned nor smiled. She was accustomed to hearing this kind of tedious “lady doctor” comment from men of a certain generation. Beyond the patient’s bed, Loretta rolled her eyes and shook her head. Obviously, she was tired of the same old comments herself.
“Harold, how did you break your leg?” Brooke stepped forward to start the hands-on part of her exam, but Zach didn’t move out of her way as he normally would. At this point, with responsibility for the patient turned over from the paramedic to the hospital staff, he’d usually tell the patient goodbye and leave. But Harold, she realized, was clinging to Zach’s gloved hand with a white-knuckled grip at odds with his chuckle.
As Brooke pulled on her own latex gloves, she walked to the far side of the bed. Far be it from her to deny the old man comfort. If hanging on to a strong man like Zach gave Harold a little courage, that was fine with her.
Harold spoke with a noticeable hitch in his breath. “I’d like to tell you I did something that would impress you, young lady. I could’ve broken my leg sky diving. That would’ve been something, wouldn’t it? But the truth is, I just fell down my own porch stairs.”
“Were you dizzy before you fell?” Brooke asked.
“No, I’m just—I’m just turning into a clumsy old man.” He sounded sad.
“Nah, anyone can trip,” Zach said, and Brooke saw him give the old man’s hand a quick squeeze. “Happens to the best of us.”
“I’m going to look for other injuries. If anything is tender, let me know.” She checked Harold’s scalp, turned his head from side to side, pressed on his ribs and palpated his arm from shoulder to wrist. Judging by how tightly he gripped Zach’s hand, Harold’s other arm wasn’t injured, so Brooke decided to forgo that part of the exam.
She lifted one edge of the paper tent that was hiding the patient’s broken leg from his own view. The bone was protruding from the skin. Just seeing this type of injury could send patients into shock, so she kept the paper in place.
Pain also contributed to shock. Harold was being brave in his benignly chauvinistic way, but he was clearly suffering.
Brooke addressed Zach. “What have you given for pain, Mr. Bishop?”
“Morphine, two milligrams.”
She raised a brow at him. That dose was low. “Only once?”
Zach shrugged a bit. “Didn’t want to mask any chest pain.” His tone said it was no big deal, nothing to worry about.
“I see,” Brooke said, and she did. Zach suspected severe heart disease in this patient. A more potent dose of morphine could have meant the man would have a heart attack without feeling it. The attack would have to reach great severity before symptoms would be noticeable in a morphine-drugged, pain-free man.
The patient was already anxious and his body was under significant stress. Brooke knew Zach’s shrug and easy tone of voice were meant to keep the patient’s anxiety levels from skyrocketing. She envied Zach’s bedside manner.
“Nitroglycerin at the scene, Mr. Bishop?” Brooke could never match Zach’s life is good approach, but she did her part to keep the patient calm by continuing her methodical exam, palpating his undamaged leg as if she weren’t discussing a potentially life-threatening event with Zach.
Anticipating Brooke’s next order, Loretta opened a drawer and pulled out a pack of ECG leads, ready to place the little sticky circles on Harold’s chest so they could monitor his heart, although that wasn’t a typical part of treating a fracture. As if they’d choreographed it, Brooke moved to the foot of the bed as Loretta took her place.
While Loretta unbuttoned Harold’s shirt and attached the leads, Brooke pressed her fingertips to the ankle of Harold’s broken leg. She took his pulse without jostling the injury, needing to confirm that blood was still circulating past the fracture to reach his extremities.
The patient looked up at Zach and scolded him. “Now, don’t go embarrassing me in front of these pretty ladies. That chest pain comes and goes, I told you. I just take one of those tiny white pills, and I’m fine. Fit as a fiddle, except for my leg.” But his chuckle was forced and he rubbed at the center of his chest with his free hand.
No sooner had the nurse turned on the television-like monitor over the bed than Harold’s worried rubbing motion changed. He clutched at the open edge of his shirt. “Maybe...one of my pills?” he gasped.
Brooke read the jagged line of his ECG in a glance. A myocardial infarction—a heart attack—was underway. “I’m going to take good care of your heart, Harold. Let’s do something about that pain, too.”
From that moment, time slowed down and sped by simultaneously. It was always that way for Brooke while she led her team through an emergency. When she had to function at a high level of complex decision-making, everything seemed paradoxically simple.
At her word, the crash cart was called. Extra personnel filled the room. Decisions had to be made, one after the other, in a logical order. As a nurse tied a yellow disposable gown over Brooke’s white coat, Brooke called for the right drugs at the right doses. Once morphine had eased the panicked
and pained patient into unconsciousness, she quickly dressed the broken leg as a stopgap measure before the cardiac cath team arrived to rush the patient to their artery-opening, lifesaving theater.
After the patient and his bed had been rolled away to the cardiology floor, there was a moment of silence, of inactivity. As if the bed were still there, no one walked through the empty center of the room as they snapped off their gloves and discarded protective gear.
Brooke was the first to use the sink as she scrubbed her hands for the millionth time that day, the smell of the soap and the sound of the water bringing her back from that intense state of mind. She thanked her team for their work, making eye contact and nodding at each person, the equivalent of a handshake in an environment where hygiene procedures made real handshakes problematic.
Zach was not in the room. Brooke had been so very alert through it all. How had she missed his exit?
The image of Harold clinging to Zach’s hand was vivid in Brooke’s mind. When Harold had lost consciousness, his hand had slipped from Zach’s. Brooke could remember thinking, Now Zach can administer the oxygen. Brooke had ordered him to do just that, and he had, of course.
When had he left the room? It was curious, how moments that were crystal-clear became hazy. As more and more of her regular team had entered the room, Zach must have stepped out, no longer needed and making room for those who were. He was a good paramedic that way.
He was a good paramedic in every way. Sharp and smart in matters of medicine. Comforting in his cocky way. Patients loved him. Her staff loved him. And Brooke—well, she needed to at least thank him as she had the others.
He was probably out by the nurses’ station, filling out his own paperwork. Brooke would go out there to dictate this patient’s chart. She’d ignore Zach, he’d ignore her and just before he left, he’d lean in, ready to murmur some outrageous line in her ear. But this time, she would speak first.
