So when the call had come in about a teenage patient arriving in the E.R. with a sports injury, he’d practically sprinted through the halls as fast as a fellow about to miss his flight.
Unfortunately avoiding Ivy had come with a price. He’d been forced to hang out in the empty E.R., counting the ceiling and floor tiles to pass the time. Now, though, with films in hand, his good humor returned—along with Nancy, the nurse who’d disappeared to locate a newspaper for him to read.
“Thanks.” He pulled one of the films out of the manila envelope and held it over his head toward the fluorescent light in order to scrutinize the image. Seeing what he’d expected to see, he slid the film back inside its protective sleeve.
“I’ll need a sling and a clavicle wrap, or a four-inch elastic bandage,” he told her, before he strode back into Jason Sommerset’s cubicle.
“I have good news and bad news,” he told young Jason and his mother, Jane, as he immediately slid the films into the wall-mounted viewer and flicked on the light switch. “The bad news is that Jason has what I suspected from his symptoms. He has a broken collarbone—or clavicle, if you want the more technical term. You can see it quite plainly right here.” He pointed to the area. “The good news is that he has very limited displacement of the bone, so we plan to keep it that way so it can heal. As soon as Nancy brings in my supplies—” The door opened and the nurse appeared with his requested items in her hands. “Ah, here she is. I’m going to immobilize his shoulder. You’ll have to wear this, as well as a sling, for about four weeks.”
Jason’s hazel eyes sparkled. “Wow. No bath for a month!”
At Jane’s look of horror, Ethan chuckled. “No such luck, sport. The strap you’re getting will allow you to take it off and put it on yourself. Keep in mind that this doesn’t mean you can take it off whenever you feel like it. It belongs on you, not your dresser, your bed, or on the floor, buried under dirty clothes—especially if you want to have unlimited activities in a month.”
“OK. I can still play football, though, can’t I?” he asked.
“After four weeks, I don’t see why not,” Ethan said.
Disappointment covered Jason’s freckled face. “That’s an awfully long time.”
“Not really,” Ethan said. “Look at the bright side. You’ll still have plenty of summer left to do whatever you like. And by the time fall training begins you’ll be in tip-top condition.”
Jason’s expression of relief was almost comical, but Ethan didn’t laugh. Young teens were too self-conscious for him to do more than simply wink at Jason’s mother.
“OK, then, sport. The sooner we get your shoulder taken care of, the sooner you can enjoy the rest of your day.” Ethan began wrapping the figure-eight strap around Jason’s shoulders and under his arms as he explained the process and showed the youth how to adjust the Velcro closures and foam shoulder pads.
“It needs to be tight, but not uncomfortable,” he said, standing back to survey his handiwork. “How does that feel?”
Jason thought a minute, then nodded. “Fine.”
“Good. Here’s your sling.” He placed it into position, so Jason could rest his left arm at the proper height.
“I gotta wear this, too?” Jason was aghast.
“Absolutely,” Ethan said. “You don’t want your arm to heal improperly, do you? Because if it does we may need more drastic measures like surgery to correct it. Then your recovery will definitely last into the football season.”
Jason’s eyes widened, as if that was an option he hadn’t considered. Of course Ethan might have laid it on a bit thick, but sometimes the threat of worst-case scenario made the most recalcitrant patients compliant.
“I don’t want that,” Jason said fervently.
“Neither do I,” Ethan said, and he stepped back once more. “Any tingling in your arm?”
“No.”
Ethan checked Jason’s radial pulse and hand skin color one last time. Both were normal, which indicated good blood flow. “Perfect. Now, if your shoulder aches—which I imagine it does—you may take acetaminophen or ibuprofen. Don’t use aspirin, OK?”
Both Jason and Jane nodded.
“Go home and rest,” Ethan advised his young patient. “If you have any problems or questions, call me. Otherwise make an appointment to see me—er, Dr. Ivy, in four weeks.”
Ethan strode out of the cubicle and nearly mowed down Nancy. “Jason’s all set,” he informed her. “But if you would arrange for his follow-up appointment with Dr. Ivy’s office before they leave, I’d appreciate it.”
She nodded. “Your office just called. Dr. Ivy needs you asap.”
“Did they say why?”
“No. Only that if no one was bleeding, you were to get back right away.”
Once again he hustled back to the peds clinic, where he found Ivy pacing the hall with a chart in her hand. She stopped as soon as she saw him.
“It’s about time you got here,” she said tartly.
Whatever it was must be serious, because he’d never seen Ivy look so worried. “I came as soon as I could. What’s up?”
“I have a baby who—”
He held up both hands. “Wait a minute. I don’t do babies, remember?”
“I know you don’t, but I need a second opinion. You’re the only one who can give me one.”
Panic set in. “You don’t want my opinion. If your gut gave you a preliminary diagnosis, then go with your instinct.”
She grabbed his arm and tugged him inside the nearest room.
“I don’t care if you think you don’t know anything about babies, it doesn’t matter. You’re a doctor,” she ground out. “And I need you to listen to this kid’s chest and tell me what you hear. That’s all.”
He hesitated. Hearts and lungs worked the same, regardless of age and size. “How old is your patient?”
“Four months.”
“This wasn’t part of our arrangement,” he reminded her, mentally screaming this wasn’t supposed to happen!
She stiffened. “No, it wasn’t. But sometimes allowances have to be made. This is one of them.”
He hesitated and dug his suddenly sweaty hands inside his trouser pockets.
“Are you refusing to consult on a patient, Dr. Locke?” she asked crisply.
Although every fiber of his being demanded he refuse, he couldn’t. He’d never be able to face Ivy, much less look himself in the eye, if he did.
“No,” he said, surrendering unhappily. “I’ll see him.”
CHAPTER EIGHT
IVY didn’t understand why Ethan was so adamantly opposed to examining babies, but before the day ended she’d find out, she decided grimly. At the moment, though, she had to focus on her tiny patient.
She adjusted the chart that she’d tucked under one arm with a trembling hand. It would take a few minutes for relief to override the outrage still coursing through her veins, because she didn’t know what she would have said or done if he’d walked away from her. But she was certain of one thing—her reaction wouldn’t have been a pretty sight for anyone to behold.
“Good,” she said, although the victory felt hollow. “Slade Jantzen had a regular check-up several weeks ago at another facility. His mother says it was unremarkable. Today she brought him in because she thinks he has a bluish cast to his skin whenever he eats or cries, and at times he seems to have trouble breathing. She wanted me to check him out.”
“Pneumonia?”
“Not that I can tell,” she admitted. “His lungs sound clear. Nothing.”
“Did you order a chest X-ray?”
“Yes, but I haven’t got the films yet. Radiology’s processor is—”
“Having technical difficulties,” he finished. “Yes, I know. What about his oxygen saturation?”
“It’s low.”
His face appeared grim, as if he were steeling himself for the moments ahead. “All right. Let’s have a look at him.”
Ivy led the way, introducing Ethan to Slade
Jantzen’s mother, Ginny, who was in her early thirties and nicely dressed. “He’s going to examine Slade, too, because we want to be sure we don’t miss anything,” she told the other woman.
“Fine with me.” Ginny placed her son on the baby exam table and took off his small shirt while Ethan and Ivy stood nearby. Slade wrinkled up his nose, waved his arms and grunted if he were about to protest the indignity of being undressed, but as soon the neckline cleared his head he settled down to a mild fussiness as he lay on the paper-lined surface.
Ivy drew Ginny off to one side of the table, where they would remain out of Ethan’s way, yet she’d be close enough to observe Ethan’s body language and assist if necessary. “Have you noticed anything else that might help us understand what’s going on with your son?”
“Not really.” Ginny wrung her hands as a worried wrinkle formed between her eyebrows. “Nothing specific I can put my finger on. But he just doesn’t seem as active as my daughters were at this age. Slade seems content to watch what goes on rather than participate. He’s never been a good eater, but it seems to be getting worse. He also seems fussier than he did when we brought him home. That could just be a difference in children’s temperament, couldn’t it?” She sounded as if she suspected something were wrong, but wanted to be convinced her son was healthy.
“It could be,” Ivy said, unwilling to jump to conclusions, although the baby’s cyanotic bouts weren’t normal. “We may have to run a few more tests after Dr. Ethan is finished.”
Ivy watched Ethan touch the baby, tentatively at first, his features appearing as chiseled and as cold as a statue’s. She wondered with a sinking heart if she’d made a mistake when she’d pushed Ethan into his current position.
Suddenly, to her surprise, he drew a deep breath, glanced at her with an inscrutable gaze, paused for a millisecond, then handled the child like a pro. He listened to the little boy’s chest, tickled his neck under his chin to bring a smile, expertly looked in his eyes, ears and mouth, and down his throat, and felt his abdomen. His large hands gently probed as he spoke words of encouragement to the small boy. Efficiently, he rolled Slade onto his stomach and waited, as if testing the baby’s reaction to his new position.
Slade squirmed a bit, as if he didn’t enjoy being on his tummy, but didn’t make any large protest or attempt to voice his displeasure. Ivy knew a normal baby at his age would be trying to raise his head and chest, kicking and stretching and wriggling.
Ethan rolled Slade back onto his back, then placed him in a sitting position before he listened to his heart once again. Ivy watched carefully, hoping Ethan would hear what she had and confirm her suspicions. Yes, she could have immediately sent the baby to a specialist, but she was conscious of the expense, and she didn’t want to “cry wolf” if there was a simple explanation.
A minute later Ethan unhooked the stethoscope from his ears in an adept one-handed motion and wore it like a necklace so that Slade could play with the chestpiece dangling near him.
The baby obliged. He swatted the rubber tubing as if trying to grab it. Ethan smiled, looking far more at ease as he stroked down several spiked strands of Slade’s fine blond hair.
At that moment Ivy knew Ethan Locke was a fraud. Babies were his forte, because he handled this one as easily as a surgeon wielded a scalpel. The next question was, why did he deny his ability?
“Slade’s lungs sound great,” Ethan admitted as he rubbed the baby’s back a final time before picking him up and handing him to his mother. “I did pick up a heart murmur,” he said, sending a meaningful glance at Ivy.
Although relieved he’d confirmed her clinical observation, she was certain he saw the residual question in her eyes because he looked away.
“No one has ever told me that before,” Ginny exclaimed. “The last doctor said everything sounded fine.”
“A heart murmur is just an extra or an unusual noise,” he explained. “It could be harmless, or a sign of an abnormality. Considering his age, and the fact that no one’s discovered it before, and that he has episodes when he’s cyanotic or looks blue, we should run a few tests.”
“What tests?” Ginny paused from tugging Slade’s shirt over his head to ask.
“An ECG,” Ivy interjected. “An electrocardiogram. It’ll be quick and painless.”
“If Dr. Ivy hasn’t ordered lab work yet, we’ll run a blood count to get an idea of his hemoglobin and red blood cell numbers,” Ethan added. “The red cells carry hemoglobin, which carries the oxygen to his tissues. If he’s not getting enough oxygen because he’s anemic or for some other reason—”
“He turns blue,” Ginny finished. She hoisted Slade onto her shoulder and patted his back to ease his obvious fussiness.
Ethan nodded. “Exactly. After we get those results we’ll have a better idea of what is going on with your son.”
“I’ll make the arrangements,” Ivy told Ginny. “As soon as they’ve drawn Slade’s blood sample and done the EKG come back here. We should have a few answers in an hour or so, if you want to phone your husband.”
“Thanks. I’ll call him.”
By the time Ivy turned to leave the cubicle Ethan had gone. She was tempted to find him, but her questions could wait. Slade was her top priority, and if her instincts were correct Ethan wasn’t in a talkative frame of mind anyway.
As she’d predicted to Ginny, she had the lab reports, ECG tracing and chest films in her hands within the hour. Armed with information, and determined to shelve her curiosity for the moment, she found Ethan in the lounge, clutching his coffee mug with both hands and staring moodily into the cup.
“Here are Slade’s reports,” she said, placing them on the table.
“And?” He reached for the top one.
“His RBC and hemoglobin levels are above normal for a child his age. His lungs on the X-ray look OK, and I can’t say his heart looks grossly abnormal, but I’m not a radiologist,” she admitted.
He pulled out the chest films and held them up to the overhead light, one at a time. “His heart seems small and he has a right aortic arch. The main pulmonary artery segment almost appears concave. See how this area is curved inward slightly?” He pointed to the location. “But it’s hard to tell for certain from these particular films.”
For a man who refused to deal with babies, he seemed well versed in reading their X-rays, and she said so.
“Not now, Ivy,” he said tiredly.
“Then when?”
“I don’t know…later. What else do you have?”
She recognized his diversion tactic, but it was necessary. The patient should be her main concern at this moment, not Ethan’s past.
“His ECG is definitely abnormal.” She shifted pages to produce the tracing. “From the longer P waves, taller R and shorter S waves, he has something going on with his right ventricle.”
“And when you add in the systolic-ejection murmur, you have a child with a serious heart defect,” Ethan finished.
“That’s what I was afraid of,” Ivy said ruefully, “but I wanted a second opinion.”
“In fact, I’m guessing young Slade has Tet,” he said, using the shorthand for a condition known as Tetralogy of Fallot. This congenital defect involved four abnormalities of the heart and, given this baby’s problems, would require surgery to correct. “You can’t keep him here.”
As if she needed Ethan to point out the obvious. “I know. I’ll tell his parents.”
Heather burst into the room. “Someone needs to come asap. The Jantzen baby is turning blue.”
Ivy took off, aware of Ethan on her heels as she burst into the cubicle where young Slade was crying and struggling for air. His parents tried to soothe their son, but they weren’t succeeding. Instead, they looked at Ivy helplessly.
“We need oxygen,” she informed Heather, as Ethan grabbed the baby from his mother and placed him on his back on the exam table.
“What’s wrong?” Ginny cried, clutching her husband’s arm for support.
; “We believe he has a heart defect,” Ivy said, watching as Ethan pushed the baby’s knees to his little chest. A minute later Heather wheeled in a small tank of oxygen. While Ethan fitted a pediatric-sized mask over Slade’s face, Ivy heard his calm request for morphine.
In the back of her mind she wanted to believe his swift and focused actions were evidence of a phenomenal memory for his med-school pediatric training, but in her heart she knew the evidence she saw was indisputable. He’d done this procedure often enough for it to become second nature.
What else hadn’t he told her?
More importantly, why hadn’t he trusted her?
Anger and hurt suddenly flared, high enough to drown out her earlier curiosity.
“A heart defect?”
Slade’s father’s comment pulled her back to the conversation at hand, and she struggled to maintain an even tone. “I can’t say exactly, because he needs more sophisticated tests than we have available,” she said honestly, unwilling to share their diagnosis of Tet without all the supporting evidence. “But what’s happening is that the oxygen-poor blood coming into the heart is mixing with the oxygen-rich blood leaving the heart. Normally the heart’s system of valves doesn’t allow that to happen.”
“So what do we do?”
“I’ll call the air ambulance, as well as a pediatric cardiac surgeon,” she said decisively. “He’ll run more tests, especially a noninvasive echocardiogram, where sound waves will give him a picture of the heart’s structure. As soon as he determines what’s wrong he’ll take him to surgery and correct the problem.”
Ginny’s chin quivered and her eyes glistened as she sniffled. “Surgery?”
“They have remarkable success these days,” Ivy assured her. “It’s his only chance to have a normal life.”
Mr. Jantzen gripped his wife’s hand. “We understand.”
Ginny addressed Ethan. “Why are you holding his knees to his chest, and what did you give him?”
He met the woman’s gaze as he held Slade in position with one large but gently soothing hand. “Placing him in this position increases pressure in his aorta and the left side of his heart, and ultimately improves circulation to the lungs. We gave him morphine because it decreases the severity of his spells. These are only temporary solutions to keep him stable until he’s under a cardiac specialist’s care.”
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