Ethan strode into David Grayson’s trauma room, pleased to see Nancy and two of her colleagues hooking the poor boy up to the usual host of monitors and gadgets. At least he wouldn’t have to introduce himself or explain his presence to these staff members. “Is it always this busy around here?” he asked, curious to hear their response.
Nancy glanced at him before she turned her attention back to David’s IV. “It runs in spells. Tonight, though, we’re definitely earning our salaries.”
“In that case I want a stat blood glucose level, electrolytes, both serum and urine ketones, BUN and Creatinine, and arterial blood gases.”
The nurse simply nodded, as if she’d expected those orders. “To save time, I already drew the venous blood samples and called out the lab tech. She should be here in a few minutes.”
Ivy rushed in. “How’s he doing?”
“About the same. All we can do now is wait until the lab gives us some numbers to work with.”
“OK.”
Ethan eyed the dark circles under her eyes and bit back a strongly worded suggestion to go home. If she wanted to stay, who was he to naysay her? After all, she was the one in charge and he was only the “hired help.” In charge or not, though, she had to know her limitations, so why couldn’t she just give in and let him do his job? She certainly didn’t act as if she didn’t trust him. She probably had some overdeveloped sense of responsibility that said she’d be deserting her patients if she stepped aside.
The problem was, if he had any sense he’d go home and leave David Grayson in her capable hands, as she seemed to want it that way, but she wasn’t in any shape to think clearly, either for herself or her patient. She was simply functioning on auto-pilot. Interns and residents did it all the time, but they had the luxury of knowing someone else was there to catch any mistakes they might make. Right now he was her safety net, which as far as he was concerned wasn’t a good thing.
She wasn’t in any shape to think clearly. As that thought rattled around his brain he came to a surprising realization. For the first time in a long time he was able to focus beyond his own problems to see someone else’s. It was nothing short of amazing, in fact, downright miraculous, and the reason for it was blatantly obvious.
Ivy.
Ivy had barged into his presence and had given him an hour of freedom. An hour when he’d felt…like his old self. No engulfing sadness, no sense of failure had plagued him for those sixty minutes. In fact, being with her had made him feel as if the last year hadn’t existed—that he was a man with huge dreams and endless possibilities in his future.
Because of her gift—a gift she hadn’t even known she’d given—he felt compelled to return the favor. But if she didn’t cooperate his so-called favor only meant that both of them would be exhausted tomorrow. The main point in his favor was that he wasn’t running on empty like she was, which meant he could orchestrate a few maneuvers of his own.
“Nothing we can do now but watch the clock,” he said. “How about a cup of coffee?”
She rubbed her face tiredly. “Sure. Why not?”
He ushered Ivy out of the room as the brunette lab tech rushed in, the tails of her white coat fluttering behind her as she hastened to button it over a pair of capri pants and a tank top. A male E.M.T. stood behind the nurses’ station, talking on the phone, but he hung up as Ethan and Ivy approached.
Ethan stopped at the desk. “Let me know when David’s parents arrive.”
“They’re already here,” said Robert, according to his name tag. “I put them in the family room.”
“OK.” He turned to Ivy. “Are you up to talking to them, or—”
“Go ahead,” she said. “I’m going to find some coffee.”
“Fair enough.”
David’s parents were in their late thirties, and Ethan saw a distinct family resemblance between father and son. After introducing himself, and explaining his diagnosis, Ethan admitted, “I wish I could tell you more right now, but we’re waiting for the lab results. Your son is receiving an IV now, to restore his electrolytes, and as soon as he’s gotten enough fluids we’ll be giving him insulin to bring his glucose down.”
Mrs. Grayson shook her head. “I don’t understand how this happened. He’s been taking his insulin shots.”
Ethan knew he had to tread carefully. “Have you seen him administer his injections lately?”
“No,” she admitted. “He does it in the bathroom.”
“Can he calculate the proper dosage? Does he check his blood-sugar levels regularly?”
“I’m sure he does,” Mr. Grayson said. “He’s been through all the instructions with Dr. Walt, his nurse practitioner and a dietician. He’s fourteen, and old enough to know how important it is to take his medication and watch his diet. There has to be some other reason why he’s in this ketoacidosis state you mention.”
“There are a lot of possible causes,” Ethan said. “Has he been ill in the past few days, or over-exerted himself with a new sport?”
Both parents shook their heads.
“Don’t worry,” Ethan said kindly. “We’ll straighten him out and get to the bottom of this so he can prevent it from happening again.”
“Can we see him now?”
“For a few minutes,” he said. “He’s pretty groggy, and will probably sleep most of the night.”
“When can he go home?”
“At this point I can’t say,” he said honestly. “It all depends on how serious his condition is and how quickly he responds to treatment.”
He escorted the Graysons to their son’s side, where Nancy told him that David had received the liter of fluids and she had received a verbal report of his lab results.
David’s potassium level was abnormally high, as he’d expected, and his blood glucose was at two-ninety—less than when they’d tested it in the restaurant, but only by a negligible amount. His blood pH was seven point two, which was lower than normal, and meant that he was definitely acidotic.
He immediately calculated a low dose of insulin therapy in order to bring down the glucose slowly, to lower the risk of causing cerebral edema, which was a rare but serious complication in children and adolescents. Because his potassium level was high, and the insulin would cause it to fall, he didn’t need to supplement David’s IV with the electrolyte now—although they’d have to monitor it closely to keep it within the normal limits.
Once again he marveled at how easily he’d made the transition to treating a patient David’s size. On the other hand it wasn’t too surprising, because he’d vacillated between specializing in adolescent medicine and neonatology before the latter had won out. How ironic to think he’d come full circle.
“Give him a bolus of regular insulin,” he told the nurse, stating the exact amount. “We’ll recheck in an hour, and if his glucose hasn’t dropped by fifty to seventy mg/dl, then we’ll modify the dose.”
“What about additional potassium?” she asked.
“The level is high right now and will fall, but we want it steady between three point three and five point five, so we’ll forgo it for the moment. We’ll repeat the test in two hours, and if the number falls within that range, we’ll supplement then.”
“Do you want to correct his pH with bicarbonate?”
“No, because his pH isn’t that low, and it will correct itself as we get insulin into him.”
With nothing left to do but wait for the next few hours, he went looking for Ivy and found her in the tiny staff lounge just off the E.R. She was sitting on a lumpy-looking sofa, her scuffed trainer-clad feet resting on the coffee table in front of her, sipping from a hospital mug.
“How’s the coffee?” he asked as he poured himself a cup, then leaned back against the counter to drink it.
“Awful, but at this time of night what can you expect?”
He grimaced at the taste. “A European or Italian roast would be nice.”
She scoffed. “Sorry, but you won’t get that on a good day. I doubt i
f anyone would even know what you’re asking for.”
“Pity.”
She sipped her brew again. “Did your hospital provide gourmet coffee for its staff?”
“No. Several of us in—” He stopped himself from mentioning his department. “Several of us on my floor considered ourselves coffee aficionados. Because we each took turns buying grounds when we ran out, eventually everyone developed a taste for more than the run-of-the-mill store-bought brand. One of our ward clerks worked part-time at a coffee-shop, and she often experimented when she fixed a pot.” He smacked his lips, remembering. “Heavenly—that’s what it was.”
“Ours definitely isn’t heavenly, but it packs a punch,” she said, stifling a yawn. “Any lab results yet?”
He recited them for her.
“What’s your treatment plan?” she asked.
“He just finished his first liter of saline, and Nancy is administering his first dose of insulin. If his glucose drops below two-fifty mg/dl by the next time we check it, we’ll switch from saline to five percent dextrose.”
“So now we wait?”
He nodded. “If I were you, I’d consider a nap.”
Again she hesitated, but she looked less sure of her decision, especially after she yawned again. “Maybe you’re right,” she conceded. “An hour or two should be enough to rejuvenate a few brain cells.”
Although he disagreed, he pretended otherwise. “Sounds good.”
“And you’ll wake me when you have the next set of numbers, right?”
Ivy needed more than sixty minutes of shut-eye; she needed about eighteen hours. But he wasn’t going to tell her that. It was going to be a long night of waiting for David’s condition to stabilize. It seemed pointless for both of them to stay awake.
“I will,” he promised, privately vowing not to try too hard. He drained the rest of his lukewarm coffee, noting that by the time he rinsed his mug, Ivy had curled into a fetal position and was fast asleep.
Like a true medical resident, he thought with a smile. They learned to instantly fall asleep because they often didn’t have the opportunity to grab more than a few winks at a time.
For several long minutes he watched her, taking in the way her eyelashes rested against her cheeks, the way her mouth had curled into the tiniest smile, the way she’d rested her face on her folded hands. She was definitely a remarkable woman, and she possessed a strong character to match. She clearly fought for what she believed, and didn’t include the word quit in her vocabulary.
Idly, he compared her to his former fiancée and realized that even from the short time he’d known Ivy the two women were worlds apart. While it was obvious that Ivy handled more problems on a daily basis than Tiffany did in a year, and faced each and every one head-on, Tiffany did not. The premature birth of their son and his resultant medical issues had been more than she could deal with. She’d looked to Ethan to make everything “normal”, and when he’d failed she’d blamed him.
Chances were, though, any other woman have responded in the same manner and held him responsible. After all, he was supposedly an expert at caring for neonates, and he took his failure personally. All the more reason to avoid a relationship, because he believed in total honesty. He refused to share his past and risk watching the light of trust die in someone’s eyes again.
Frankly, he couldn’t stand to see the light die in Ivy’s eyes. Like a prisoner waiting for his release, Ethan needed to focus on the end of his three weeks, and then he could go back to his quiet, solitary existence.
He tiptoed across the room and carefully closed the door behind him as Nancy approached. “I meant to ask you earlier, do you want me to call you or Dr. Ivy in a couple of hours?”
He guided her away from the lounge’s door, although he didn’t think a bomb could wake Ivy now. “Do not call Ivy under any circumstances,” he said. “She fell asleep on your sofa, and if at all possible I’d like her to stay that way until morning. Got that?”
She grinned. “Got it.” Her smile faded. “She won’t be happy if she knows what you’ve done.”
“So sue me. I’m doing this not only for her, but for the sake of the patients.”
Nancy nodded. “Do you have a phone number where I can reach you, or—”
It seemed counterproductive to drive home, especially since he lived seven miles out of town. “I thought I’d hang around here in case anything else happens—which, the way the night has gone, is entirely possible,” he said dryly. “I’d rather no one bothers her unless we’re completely out of our depth.”
She nodded, apparently agreeable with his plan. “Feel free to use the bed in Room One. Dr. Walt considers it the most comfy of all of them, and he should know. He’s spent many a night on it.”
“Don’t mind if I do.”
“You know, if I didn’t tell you before, Dr. Locke, welcome to Danton. I suspect you’re just what we need around here.”
Feeling long-term chains beginning to wrap around him, he tensed. “Yeah, well, I’m only here for three weeks, so don’t get any ideas about making my stay longer. Walt will be back by then, and I’ll be on my way.”
“If you say so,” she said dubiously.
“I do.” Of that much he was certain. He was only helping out because of a weak moment. Nothing more and nothing less. Once he did his stint, then perhaps he’d finally find the peace that had eluded him for the past few months.
CHAPTER FIVE
IVY woke to the sound of percolating coffee and its rich scent hanging in the air. For the briefest of moments she wondered if her dad had come over early and brewed a pot for her, but as the rough weave of the white cotton blanket in her grasp registered her eyes popped open and she found herself in the staff lounge instead of her bedroom.
Now she remembered her evening…For an instant she was impressed that a few hours’ sleep had so thoroughly rejuvenated her, but as soon as she saw the clock, she bolted upright.
7:00 a.m.
Where had the night gone?
Irritated because Ethan hadn’t woken her as promised, she flung off her blanket and strode through the E.R. “Where’s Dr. Locke?” she demanded of Nancy, who was going off-duty.
“He left about an hour ago,” the nurse said.
Ivy ran her hand through her hair, knowing that she wasn’t doing her tangled tresses any favors. “The Grayson boy?”
“His glucose was down to two-oh-five the last time we checked. His pH is up to seven point four, and his potassium is four point five. He’s getting IV insulin, potassium chloride and potassium phosphate, and five percent dextrose in his IV fluid. Dr. Locke admitted him because David is complaining of nausea.”
Everything Nancy told her fit what Ivy would have done—including keeping David for another day in the hospital. Discharging the teen before he could rehydrate on his own without an IV would only guarantee the boy would be back soon. “So where is Dr. Locke?”
Nancy shrugged. “Home, I guess. He said something about taking a shower before your office opened, so you’ll probably see him shortly.”
“He was supposed to wake me hours ago,” she groused.
“He tried,” the nurse said. “Honest. I watched him. You were dead to the world, though, so Dr. Locke gave up and said to let you sleep.”
Ivy ran a hand over her face. Dead to the world. “I find it hard to believe that he couldn’t wake me. I’m a very light sleeper.”
“You were terribly tired,” Nancy pointed out. “I thought you might wake up when he covered you with a blanket, but you slept through that, too.”
Normal house noises woke her up, so she doubted if she’d slept through everything Nancy claimed she had. Unfortunately it was too late to whine and complain about the situation now. In any case Nancy wasn’t responsible, but Ivy would definitely have words with the fellow who was.
“You realize, don’t you,” the nurse continued, “that this is the first night you’ve actually slept more than two hours in the last few weeks? If you
ask me, you ought to be kissing his feet for taking over instead of gearing up to explode. As a matter of fact—” she grinned “—maybe you should kiss something other than his feet. I certainly would.”
Ivy colored. She almost had when he’d agreed to help with the car-accident victims, but she’d learned from experience that having a relationship with a colleague was a prescription for heartache. Relationship or not, she was now indebted to him on three counts. One, for his three-week agreement; two, for treating Tommy Weathers, and three, for taking over the Grayson case so she could sleep. At this rate she’d never be able to even the score.
“If I were you,” the nurse added, “I’d turn myself into something less like what my cat sometimes drags home so Dr. Ethan doesn’t feel as if he wasted his magnanimous gesture.”
Ivy grinned. “I look that bad?”
“Let’s put it this way. If you want to impress someone, you won’t.”
“Then it’s a good thing I don’t. Want to impress someone, that is.”
“Ivy, Ivy, Ivy.” The forty-five-year-old nurse shook her head. “With an attitude like that you’ll end up never needing more than a two-cup coffee-maker in your house. I, for one, know that a certain eligible male loves his coffee.”
Ivy knew it, too. And if Ethan hung around anyone’s house for long, they’d be making it in industrial-sized urns. The thought of waking up to a full-bodied brew, or the man who’d inspired it in the first place, raised her core temperature another degree.
“All right, all right. I’ll go home and do what I can to make myself presentable. But I’m not doing it to impress anyone.”
The nurse smiled, as if she knew Ivy was only deluding herself. Because, strangely enough, Ivy wanted to impress Ethan—and not with her medical skills.
“If you say so. By the way, I’m on duty tonight, and I’d be perfectly happy if you kept things quiet so I could work on my niece’s baby’s afghan. She’s due in a month and I can only knit so fast.”
Ivy chuckled. “I’ll do my best.”
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