“You’re right; he wouldn’t. Which is why I resigned. He didn’t accept it, though. Instead he gave me an official leave of absence.” That had been Stewart’s doing, and although he appreciated his friend’s gesture, Ethan knew it was a waste of paperwork. He didn’t plan to go back. Not at the end of a year. Not ever.
“So you’re bumming around the country for a while?”
He wasn’t inclined to tell her that his “bumming around” was a permanent, not a temporary condition. “Yeah, I am. Ever since the middle of December. So I guess it’s officially been about seven months.”
Her gaze grew intent. “Any particular reason why you decided to take time off?”
“I wasn’t fired, if that’s what you’re afraid of.”
“I’m not,” she admitted. “I’m only curious why you felt the need to exchange your stethoscope for a hobo hat.”
He was beginning to regret he’d volunteered any information at all. That was what happened when he let down his guard—he said things that encouraged people to ask questions he didn’t want to answer. Unfortunately he couldn’t recall his words, like a manufacturer recalled a faulty product. On the other hand, if he treated the subject lightly, instead of allowing her to see how painful it was, she’d be satisfied.
“I needed a change and decided to take an extended and long overdue trip,” he said simply. “I also plan to continue my life of leisure once my three weeks with you are up,” he added, in case she entertained notions of turning their temporary arrangement into a more permanent one.
She smiled. “Why do I get the feeling you think I’m going to twist your arm so you’ll sign on for the long haul?”
“Because I think you will,” he said.
“Would it work? Twisting your arm, that is?”
“No.”
“Then I won’t waste my time,” she said, although she sounded too innocent for Ethan to believe her. “Be warned, though, that I intend to get every ounce of work out of you that I possibly can in the meantime.”
“Considering what happened tonight, I’m expecting as much.”
“A regular slave-driver,” she said cheerfully. “That’s me.”
The same waitress appeared, and refilled his mug while Ivy held a hand over hers. “No more, thanks, Janine,” she said. “If I load up on decaf, I won’t be able to sleep, either.”
“OK.” Janine addressed Ethan. “Can I get you anything else?” When he shook his head, she tore a ticket off her pad and placed it face-down on the table.
A mere moment after she’d cleared away the dishes, a familiar-looking young couple walked up. “Hello, Ivy,” the woman said. “It’s good to see you.”
Ivy beamed at their guests, before introducing them to Ethan as the owners of the small grocery store. “Fran, Marty—you’re eating late tonight, too, I see.”
“We just stopped in for a piece of peanut butter pie,” Marty announced. “Since we saw you, we thought we’d ask if there’s anything we can do for the Ellerbes or the Weatherses.”
“Barbara has the twins, so she might need a break every now and again,” Ivy remarked. “If I hear of anything in particular I’ll let you know.”
“Do that,” Fran said. She turned to Ethan. “You’re the new doctor in town, aren’t you?”
“For a few weeks, yes.” It seemed important to establish his short-term commitment, just so no one would build any false expectations.
“We’ve seen you in the grocery store,” Marty mentioned. “Bottled water, sandwich fixings and root beer.”
“Yeah,” he admitted. “I’m surprised you remember.”
“We know all of our customers’ preferences.” Marty preened a bit. “It’s how we know what to stock and what new products to try. In a place as small as ours we can’t afford to fill the shelves with items that don’t sell.”
“Now, Marty,” Fran said, “Dr. Locke isn’t interested in our business habits.” She turned to Ethan, her eyes shining with sincerity. “It’s wonderful having you here to help Ivy. We’d hate to wear her out within the first few months she’s here. In the meantime, if there’s anything we can do to make you feel at home, just let us know.”
“Thanks,” he said.
As soon as the two moved away, he lowered his voice. “Word travels fast, doesn’t it?”
“It’s a small town. We don’t have a newspaper, and there isn’t a lot to do besides pay attention to what everyone else is doing.” She smiled knowingly. “You’ll get used to it.”
He was accustomed to living in a city, where no one recognized him. Being the current hot topic of conversation was somewhat disconcerting. “I’m not so sure,” he admitted, before he sipped his refill.
“Trust me, you will,” she said. “Whatever you do, though, purchase your condoms out of town.”
He nearly spewed his coffee across the table. “What?”
Her eyes sparkled as her smile spread from ear to ear. “Trust me. If you don’t heed my advice, speculation will run rampant.”
“I assume the same rule applies for over-the-counter pregnancy kits?”
“Absolutely.”
“Thanks for the warning.”
“My pleasure.” She stifled a yawn. “I hate to eat and run, but my second wind just disappeared.”
“I can give you a lift if you’re too tired to drive.”
“I’ll manage, but thanks for the offer.”
In spite of the dark circles under her eyes and the tired droop in her shoulders, her smile stirred something in his chest—something he hadn’t felt for a long time. “I’ll walk you outside,” he said, suddenly wishing their time together wasn’t ending.
“Afraid I’ll get mugged in the parking lot?” she teased as she slid out of the booth.
He did the same, stopping long enough to toss down enough bills to cover their meals and a generous tip.
“My dinner’s on the house,” she said, apparently noticing the amount he’d left.
“Then the waitress just earned herself a nice tip,” he said as he ushered her past a booth of giggly teenagers to the door.
“That’s sweet of you, because Janine can really use the money.” She waved a hand in farewell to her father, and Ethan felt obliged to do the same.
Outside, before she got into her ten-year-old car, she grabbed his hand. “Thanks again. I’ll see you tomorrow, bright and early.”
The sensation of her soft hand in his short-circuited his brain. “Bright and early,” he echoed. But before he could tell her goodnight Janine came running out of the diner.
“Dr. Ivy,” she yelled. “Dr. Ivy.”
Ethan raised his hand. “She’s over here,”
“Thank goodness,” Janine said breathlessly. “You two have to come. One of our customers—a teenager—David Grayson—just passed out.”
CHAPTER FOUR
IVY brushed past Ethan and hurried toward the entrance, her exhaustion vanishing. “Is he choking?”
“Not that I could tell. Your dad sent me out here to find you.”
“A patient of yours?” Ethan asked Ivy.
Ivy shook her head. “No. I know the family by sight, but that’s all. His mom was ahead of me in high school by a few years.”
Inside, Ivy found a crowd of people surrounding the boy on the floor. Her father and Millie, his other evening waitress, were crouched beside him, while his young friends hovered nearby. Two girls were wringing their hands and crying. Another watched wide-eyed and clutched the arm of her boyfriend.
Someone—her father?—had pulled tables back to allow for more room.
“Let us through,” Ivy demanded, and the group parted to reveal a white-faced, drowsy fourteen-year-old, lying in a fetal position. “Everyone move back, so he can have some air.”
The group collectively took three steps back.
“I’m glad you two are here,” Don said, giving up his place to Ethan. “I don’t know what’s wrong with him. At first I thought he’d choked on food, but he wasn
’t eating. Then I thought he was having a seizure, but he doesn’t act like he’s convulsing, either.”
Ethan pulled out a chain around the boy’s neck from underneath his clothing. Ivy watched as he revealed a shiny new Medic-Alert pendant.
“He’s someone’s patient,” Ethan remarked.
She wrapped her fingers around the boy’s wrist to take his radial pulse. “I’d say so, but that doesn’t help us.” As soon as she finished counting, she addressed his friends. “Do any of you know if he has a medical condition?”
“No,” they echoed.
“Has he been ill? Or complained of being ill or feeling sick?” she asked.
Heads shook. “He mentioned he was tired and had a little bit of an upset stomach, but that’s all,” one of the teens mentioned. “In fact, we had to talk him into coming out with us tonight.”
Ivy watched Ethan bend down over David’s face, then straighten. His expression was grim.
“Call an ambulance,” he ordered, as he lifted one of David’s eyelids and checked his pupils.
Her father jumped up. “Right away.”
“Diabetic?” Ivy guessed.
Ethan nodded. “I think so. His breath is fruity-smelling. He’s probably in ketoacidosis. David? Can you hear me?”
David mumbled.
“David, are you a diabetic?”
Again, the teen mumbled.
Ivy eyed David’s friends. “What was he eating?”
A long-haired brunette answered. “Same thing the rest of us were. A burger, fries, soda.”
“Don’t forget the pie,” the other boy added. “Cherry. But he only took a few bites.”
Ivy exchanged a glance with Ethan. “Glucose overload, I’d guess.”
“Undoubtedly,” he agreed.
“I wonder if he didn’t take a large enough dose of insulin before dinner.”
“Or none at all,” Ethan said grimly.
While it would be nice to know, for future reference, if the boy had simply miscalculated or if he’d purposely omitted his insulin, their main concern right now was to stabilize his condition.
Immediately she looked for and found Janine. “I have a bag on my backseat. Bring it, will you?” While the waitress disappeared, she caught Ethan’s questioning gaze. “I carry a glucose meter in my medical kit. It pays to be prepared.”
“A regular Girl Scout.”
“That’s me.”
Her father hurried through the maze of tables to rejoin them. “Ambulance is on its way,” he huffed. “I also called David’s parents. His mom said he was diagnosed as a diabetic about three months ago.”
“Bingo,” Ethan said, clearly satisfied to have their diagnosis confirmed. “Check his pockets. He may carry insulin.”
Ivy began patting down the side pockets of David’s jeans, while Ethan turned to David’s friends. “Did he have a jacket?”
“Yeah.” His buddy pointed to the booth. “It’s over there.”
“Check his pockets,” Ethan repeated.
The teen scrambled into the seat and followed Ethan’s instructions. “What am I looking for?”
“A vial of medicine, a syringe, glucose tablets. Anything.”
The boy frantically turned the fabric inside out. “Nothing. There’s nothing.”
Ethan turned to Ivy. “What about you?”
She shook her head. “Same here.”
Janine flew back in, breathless. “I’ve got it.”
Ivy didn’t waste time. She flung a blood pressure cuff at Ethan, knowing he would monitor the vitals while she did her part. A minute later she stabbed David’s finger with a stylet, caught the large red drop of blood on a glucose strip and inserted it into her meter. Thirty seconds ticked by.
“Well?” Ethan demanded, clearly impatient.
The display lit up. “Three hundred,” she said. Normal glucose was under one hundred twenty, so David had definitely exceeded the limits.
“I don’t suppose you have IV supplies in your bag?” he mentioned.
Today Ivy wished that she did, although if she carried everything she might need she’d be driving a county emergency vehicle instead of her trusty old car. “Sorry. First aid stuff, mostly.”
One of the girls began to wail. “He’s breathing funny. Is he going to die?”
Ivy had noted David’s respirations were both deep and increased. Kussmaul’s respirations was the textbook term, and they were one more sign associated with diabetic ketoacidosis.
“We’re doing everything we can,” she told the girl. “But he needs to be in the hospital, where we can monitor him closely.” The main thing was to bring down his circulating glucose level and reverse the dehydration and cellular glucose depletion before he went into an irreversible coma. A major complication was electrolyte imbalance, especially a decreased potassium level which, if severe enough, could lead to heart dysrhythmias and death.
“Ambulance is here,” her father interrupted.
“OK,” she ordered. “Everybody needs to get out of the way so the paramedics have room to maneuver.”
The adults in the room drifted toward their tables and the teens moved about six feet away.
Two paramedics hauled in a gurney loaded down with supplies, while a local policeman stood nearby, ready to assist with crowd control.
“Ketoacidosis,” Ethan told Ben Kovacs as the emergency worker crouched beside him. “His vitals are abnormal and his respirations are increased. His fingerstick glucose is three hundred. As soon as you start a normal saline IV, transport him to the E.R.”
Ben nodded, and began ripping open intravenous fluid kits. “Will do.”
With Ben and Ethan taking control of the situation, Ivy rose and turned to David’s friends. “Why don’t you all go home?” she suggested kindly. “You can check with David’s parents in the morning to find out how he’s doing.”
“Can’t we go to the hospital, too?” the calmest girl of the three asked. “You see, we feel sort of responsible, because we insisted on eating out tonight.”
“I understand, but really, it will take hours before he’ll be able to have visitors. I doubt if your parents will want you staying up all night.”
“It isn’t like we have school tomorrow,” the boy beside her pointed out.
“Even so, this is a decision between you and your parents,” Ivy said firmly.
“If we go home, will we be able to see him tomorrow?” the girl asked.
“Maybe for a few minutes. I’m sure he’ll appreciate knowing how concerned you all were. In fact, I’ll tell him the first chance I get.”
Out of the corner of her eye, Ivy saw the three men move the gurney next to David’s prone figure, and immediately took a position to assist. On the count of three, David was settled on the thin mattress and on his way to the waiting ambulance.
“Why don’t you go home?” Ethan suggested as Ben’s partner slammed the doors closed and hopped behind the wheel.
“I’m on call,” she reminded him.
“That can be changed,” he said. “You’re dead on your feet.”
Although she knew she was, especially after existing on a couple of hours of sleep every night for the last two weeks, she hated to admit her weakness—especially to her new colleague. “I’m fine.” She’d no sooner said that when she stumbled on the gravel.
He grabbed her arm. “Really?” He didn’t sound convinced.
“Yes, really. Anyone can trip over a rock,” she said waspishly. “It doesn’t mean I’m too tired to do my job. Besides, it’s late. I’m sure you’re tired, too.”
“I’ve been taking life easy, remember? My three-week clock is ticking, so you might as well take advantage of it.”
Ivy was tempted. Really tempted. But she hadn’t given him the most basic of orientations yet! It wasn’t that she didn’t trust his abilities, or his intelligence to figure things out on his own, but leaving him to muddle through alone seemed so unprofessional.
“You’ve already done enough
today,” she insisted. “I can’t ask you to—”
“You aren’t asking. I’m volunteering. Which isn’t a common occurrence. Now, what would you rather do? Argue about this or let me treat the patient?”
“We’ll both go,” she decided.
“Afraid I won’t handle his case properly?” His tone was mocking, but underneath she sensed his hurt. Obviously he regretted telling his story, or at least the edited and highly condensed version.
“Your skills aren’t in question. I just don’t understand why you’re willing to get involved to the degree you have when a few hours ago you didn’t care if I worked twenty-four-seven.”
“Let’s just say I have a special interest in kids like young David.”
“Because of your brother?”
He hesitated as his gaze unflinchingly met hers. “Yes…”
His comment triggered something he’d said earlier. “Did he die under similar circumstances?” she asked, her heart going out to him.
“More or less.”
She’d seen too many families split by the death of a child, and suspected that this single event had completely changed Ethan’s life. “Then—”
“Let it go, Ivy,” he snapped. “Now isn’t the time to hash out my history. We should get to the hospital before David celebrates his next birthday.”
She knew they couldn’t do much for their patient over the next hour. The first step in treatment was to replace fluid and correct any electrolyte imbalances, especially abnormal potassium levels. With the IV set at a rate of one liter per hour, they still had a good portion of those sixty minutes left before they could administer insulin. The amount would be dependent upon his lab values, but they needed to be at the hospital to order the appropriate tests which would take time to perform.
“All right,” she said. “Want to ride with me, or take your own vehicle?”
“I’ll drive myself,” he said as they passed his car and he veered off toward the driver’s side.
“Then I’ll see you there.”
As she followed Ethan’s red taillights the five blocks to the hospital, she realized that Ethan Locke might pretend to be a rough, tough and gruff man, who didn’t care about anyone but himself, but underneath the obvious was a man who happened to be the exact opposite.
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