by CJ Lyons
"I'm Dr. Hart." Cassie sat in the rolling stool and wheeled her way across the room, stopping as soon as little Antwan's shoulders hunched. "What brings you here this morning?"
"It's his ear," the mother replied. Cassie snuck a quick peak at the demographic sheet; so many mothers had different names than their children. Tammy Washington. "I don't know what's wrong, he took all the medicine the clinic gave him, but all weekend he's been complaining and last night it hurt so bad he was up all night crying."
"Do you remember what medicine he was on?"
"The pink stuff." Tammy shifted in her seat, rearranging Antwan's weight. Cassie took the opportunity to inch closer, watched as the toddler slit one eye open but didn't pull away.
"Amoxicillin?"
"Right. He took ten days, finished it last week. I tried to wait until the clinic opened, but he was crying so bad."
"It's all right, Ms. Washington. Hey, Antwan, I need you to give your mom a really big hug, all right?" Cassie warmed her stethoscope between her hands then slid it under Antwan's t-shirt. "Okay, big breaths now. Good job, that's perfect. How about if you turn around so I can listen to your heart?"
Still wary, Antwan obeyed, even smiling when Cassie pretended for a moment that she couldn't find his heartbeat. As she maneuvered through the exam she asked his mom more history but found nothing worrisome. Finally it was time. The big challenge in any toddler, but especially one whose ears were already painful: the ear check.
Cassie wrinkled her face in a mock expression of disbelief. "I think there's kitty cats in your ears, Antwan." His eyes grew wide and he shook his head, almost smiling but uncertain. "Let's take a look. We'll start with the one that doesn't hurt first. Okay, hold still and listen for the kitty cat." She gently positioned the otoscope. "Meow."
"Hey, momma, I got kitty cats!" No longer suspicious, he eagerly bounced forward on his mother's lap so that Cassie could check the other ear out.
"He's right," she pronounced after finding another kitty cat as well as a rip-roaring otitis media. "That ear is fire engine red and bulging with pus. I'm going to get him some pain medicine and the first dose of antibiotic before you leave. We're going to use a stronger medicine. It may give him diarrhea, so lots of yogurt, okay? Schedule an appointment with the clinic for an ear check, but if things aren't getting better in two days or if anything gets worse, he needs to be seen."
"Yes ma'am. Thank you."
"No problem. Hey, Antwan, you take all your medicine and don't you drive your momma crazy, okay?" Cassie fished out a Sponge Bob sticker and handed it to the little guy. He beamed with delight.
"What do you tell the nice doctor?" his mother prompted him.
"Thank you," he chimed out.
Cassie left the room still smiling. She loved it when kids weren't too sick. The radio on her belt squawked. "Dr. Hart to Trauma One, stat."
She limped down the hall, trying to restrain herself from running as the familiar rush of adrenalin humming through her veins. It felt good to be back.
Eight hours later, by the time her shift was over at four o'clock, Cassie was wishing for the cane once more. Not as a crutch, although her ankle now screamed with the ferocity of a toddler in the midst of a tantrum. If she'd brought the cane she could use it to fend off the awkward glances and whispers of her co-workers. Whispers that scurried underfoot like rats in the sewer, ambushing Cassie when she rounded a corner or entered a room.
With the cane Cassie could announce her presence, salvage some pride, instead of flushing as people became silent and adverted their eyes from her, uncertain how to label her now that she was back at work: resilient victim, tough as nails survivor, or flavor of the month gossip.
Finally, she'd retreated to the sanctuary of the dictation desk at the nurses' station and waited for her replacement. She eased her left leg out, stretching it gingerly.
"Someone help me!"
The woman's cries reverberated from the tile walls of the ER. Her high heels skidded on the white linoleum as she ran toward the nurses' station.
Cassie jumped up from her chair. Too fast, too fast, her leg shrieked. Her vision blurred with pain for one brutal moment. She grabbed the counter and steadied herself with a quick breath, then moved to intercept the frantic woman.
"What's the problem?"
"My baby, my baby." The woman's purple designer suede jacket flew open, and Cassie could see that beneath the empire-waist silk dress, she was pregnant. Very pregnant, at least seven months or so.
"Are you having contractions?" Cassie began to usher her down the hall, but she pulled away.
"You've got to help my baby!" The pregnant woman whirled, looking behind her. The ambulance bay doors slid open once more, and a security guard came running through, his arms filled with an ashen-colored toddler.
"Room one." Cassie hobbled ahead to hold the door open. The hysterical mother followed. "I need some help here," Cassie called over her shoulder into the nurses' station.
The guard almost tossed the baby onto the bed, immediately backing away, his own face flushed and sweating. Cassie began to undress the small boy, ripping apart snaps and buttons. The boy's arm was still jerking, and his eyes were deviated to the right; he was in the midst of a seizure. "What happened?"
"I don't know, he just started seizing–the monitor never went off–is he going to be all right?" the woman, his mother Cassie assumed, said.
Cassie stripped the boy to naked skin. A wide belt bristling with brightly colored wires encircled his chest. An apnea monitor designed to alert parents to breathing problems in their premature infants. But she'd never seen one used in a child as old as this boy who appeared to be at least fifteen months. Grabbing an oxygen mask, she stretched it over the boy's thick blonde curls, and listened to his chest. Breathing was fair, heart sounded good.
"When did the seizure begin?"
"About two-thirty, I had just put him down for his nap." The mother clasped her purse to her chest. She was taller than Cassie with blond hair styled in a neat bun and grey eyes framed by meticulous makeup.
"Why didn't you call 911?" She bent over to examine the child. Rachel Lloyd rushed in before the mother could answer.
"What do you need?" Then Rachel saw the boy on the table. "Charlie." She turned to the mother. "Virginia, what happened?"
"Rachel, he's had a seizure. I didn't know what to do, so I brought him here."
"Of course. We'll take care of him, everything will be all right."
"Help me get an IV," Cassie interrupted their reunion. If the boy had been seizing for over an hour, then Cassie was already out of time. If she didn't stop it soon, he could suffer permanent brain damage.
"Of course, Dr. Hart." Rachel moved to Charlie's side and began to search for a vein. "Dr. Hart, this is Virginia Ulrich. Charlie is her son." Rachel made the introductions while trying without success to start the IV.
"What kind of medical problems does Charlie have?" Cassie asked the mother, continuing her examination.
"Dr. Sterling follows him for apnea."
"Has he had seizures before?"
"After his pertussis shot."
"Damn," Rachel swore under her breath. Cassie looked up at that. She'd never heard Rachel swear before. "I can't get a line."
"I'll take a look." She searched for a likely vein, but the prolonged seizure had collapsed all of them. "Set up for an IO," she ordered after her own attempt failed.
The mother moved closer, rubbing her belly with slow, rhythmic movements as she watched Cassie work on her son. Rachel stopped what she was doing to stare at Cassie. "Don't you mean you want me to call Peds to come start an IV? That's what we usually do."
"We don't have time to wait for them. An IO is faster."
"But Dr. Sterling doesn't like us to–"
"Sterling's not here. Charlie's my patient. I'll do what is best for him."
Rachel glared at her, then turned to get the proper equipment. Cassie straightened and placed a hand on Virginia's f
orearm, drawing the mother's attention away from Charlie to her. "Mrs. Ulrich, Charlie is still seizing and he's in shock. We can't get an IV started, so I'd like to insert an intraosseus line. That is a special needle that will go into his lower leg bone, then we can give him the medicine he needs. We'll take it out as soon as we can. The main risks are damage to the bone and infection, but we do it under sterile conditions."
"That's fine, do it." The mother was amazingly composed for someone who had basically just been told that they had to drill into her child's leg bone.
"You might want to step outside. It's not a pleasant thing to watch."
"No, I'm fine. I want to stay."
Cassie didn't have time to argue. She turned back to Charlie, mentally visualizing the intraosseus procedure as she prepped his shin with Betadine.
"Our usual protocol when we can't get a line on a child is to call Peds." Rachel's tone was one of a schoolmarm instructing a recalcitrant student.
Cassie said nothing. Rachel was an excellent nurse, but if she had her way, every patient would be handled according to a cookbook of procedures, each accompanied by the necessary paperwork in triplicate.
Cassie reached for the sterile bone marrow needle. She placed the needle against the skin and bore down, leaning her weight on the thin dagger of metal until she felt it break through the bone. The resulting crack echoed throughout the room. She winced, she hated that noise, then looked up and saw Mrs. Ulrich at the head of the bed, watching closely.
"There's good flow," she told Rachel as she secured the needle into position. "Push a milligram of Ativan. Get me a blood sugar, chem panel, CBC and blood culture."
Cassie combed her fingers through Charlie's thick golden curls as she waited for the medication to take effect. Slowly, his limbs relaxed, the seizure activity faded. She bent over him, flicking her light into his eyes, then examined his mouth with a tongue depressor.
She frowned. That was strange. The inside of Charlie's upper lip was bruised, and there were tiny broken blood vessels on his face.
"Have you noticed these little red dots before?" she asked Mrs. Ulrich.
"The petechia?"
The mother surprised Cassie by knowing the medical term. "Yes."
"A few days. You can check his chart, we were here last week."
Charlie's color was finally improving, Cassie noted with satisfaction. "Who's on for Peds?"
"Dr. Sterling." Rachel replied.
"Thank God," Virginia gushed at the mention of the Chief of Pediatrics. "Dr. Sterling will know what to do. He always does."
In her two years as an attending physician at Three Rivers, Cassie had only spoken with Karl Sterling on the phone a handful of times and had yet to meet him in person. Since most of his time was spent in administrative duties, Sterling rarely took call and only cared for a small, select group of patients.
"Give him a call and tell the Peds ICU that we have a customer for them." She'd finally get the chance to see the renowned Dr. Sterling in action.
Mrs. Ulrich looked up at that. "You're going to admit him? Can't I take him home?"
Cassie swiveled her head to look at the mother in surprise. "I'm afraid Charlie is going to be here for a while. We need to find out what caused the prolonged seizure and those petechiae. The Pediatric ICU doctors will be down to talk to you more."
"No, I want Dr. Sterling involved. He's cared for Charlie all of his life. No one knows him better."
"Certainly. I'll call him myself," Cassie said. "But you'll still have to talk to the ICU doctors."
Virginia frowned. "All right. But I'm not going anywhere until Dr. Sterling says it's okay."
<><><>
"Any messages for me?" Cassie asked the desk clerk after she alerted Sterling that he had a patient. The clerk shook his head in time to the Godsmack playing over his headphones. Cassie tried to ignore the knot of disappointment that tensed her shoulders. She'd hoped Drake would call. He knew it was her first day back.
She wished she understood what was going on with him. He hadn't touched her since the shooting almost six weeks ago. Forty-one days ago to be exact. And Cassie was definitely counting the days.
Why was he acting like this, holding her at arm's length?
Was Drake merely biding his time, waiting for her to get back on her feet again, before he called it off? After all, she had saved his life–couldn't just dump her like a hot potato, could he?
Next time she saw him, she'd find out. She needed to know where she stood.
Thrusting aside all thoughts of Drake and her life outside the ER, Cassie gave the physician replacing her a quick sign out, then returned to the critical care room to check on Charlie Ulrich.
Rachel had found a rocking chair for Mrs. Ulrich and was helping her into it. By the time the Peds residents arrived, Charlie's color was improved, and there was no further seizure activity.
"Dr. Sterling is on his way," Cassie told Charlie's mother.
"Oh, thank goodness. He'll know what to do. He's a brilliant man. If it wasn't for Dr. Sterling, Charlie wouldn't be alive today."
"Do you want me to place a central line?" Cassie asked the pediatric residents.
"No, I think you've done quite enough, Dr. Hart," came a deep voice from behind her. Cassie turned, and Karl Sterling was there. A tall man with silver hair and pale blue eyes, the Pediatric Department Chairman resembled the stereotypical Norman Rockwell portrait of everything a physician should be. A full professor with tenure, he had an established reputation in SIDS research.
"Was an intraosseus absolutely necessary? If you can't get an IV in a child, I'd rather that you called us to come down and do it for you." Sterling's tone was mild, not condemning, and he tempered his words with a fatherly smile. "After all, that's what we're here for."
Cassie bristled at the pediatrician's indictment of her and her department's skills but tried not to let it show. She couldn't tell if Sterling was being sincere or patronizing. Besides, with the mother in the room, this was hardly the time to be arguing about procedures.
Sterling moved to take Virginia Ulrich's hand. "How are you holding up?" he asked, his voice gentle.
"I'm so glad you're here, Dr. Sterling. I don't know what happened, everything was going so well–"
"Don't worry, Virginia. We'll work it out. Let me just examine Charlie now." Sterling donned his stethoscope and bent over the little boy on the gurney.
Cassie left. The story was puzzling, but the pediatric residents and Karl Sterling could sort it all out.
She headed down the hall to the security office inside the ambulance bay. Video cameras were positioned in all of the critical care rooms, the tapes used for quality assurance and educational purposes.
At least one good thing had come from Charlie's resuscitation. Cassie was preparing a teaching video of emergency procedures. If the video from Charlie's IO looked good, she would include it.
"You mind making a dupe of the video from Trauma 1 for me?" she asked the security guard monitoring the surveillance. It was the same man who had brought Charlie in. "I only need the last hour or so."
"Sure thing, doc."
"Thanks. Just drop it by my office when it's ready."
"I sure am glad the kid's gonna be all right. The way that mother was shrieking, I thought he was dead already."
Not bad for her first day back, Cassie decided as she headed back to her office. Her ankle was hurting, but nothing she couldn't handle. And, despite the awkward encounters with her co-workers, it felt good to be back in the ER–like coming home.
Her office was behind the nurses' station, a windowless cement block cube that had been a broom closet in its previous incarnation. The narrow confines barely held her bookcases, desk and two chairs, but, since Cassie was junior faculty, she wasn't complaining.
She opened her office door to find Drake lounging in her desk chair, long legs stretched out before him. A beautiful bouquet of exotic flowers graced the desk, white orchids glowing against the green
florist paper. So, he hadn't forgotten after all.
His eyes were rimmed by tiny worry lines that hadn't been there six weeks ago. He climbed to his feet, still a little stiff. She knew he had no idea how lucky he was that he'd recovered so quickly. It didn't matter to Drake–all he wanted was to get back to work again.
"How was your first day back?" he asked.
Cassie shrugged. She was exhausted after her encounter with Sterling's patient, but that was the last thing he needed to hear about.
"These are beautiful." She dipped her face into the flowers and inhaled a deep lungful of the sweet fragrance. Drake wore a flannel shirt over jeans with no telltale bulge of a gun, so she guessed his day had been worse than hers. "What did the psychiatrist say?"
He winced, and she knew she'd been too direct. She couldn't help it–she just wasn't any good at this give and take stuff relationships were made of.
She pushed the door shut, noticed the way he tensed at the sudden bang. The small room overflowed with everything unspoken between them.
"Can you go back to duty?" she asked, her face tilting up to meet his gaze. She moved toward him, their bodies almost touching until he stepped out of reach. His avoidance of her flared her anger further. She couldn't stand this limbo any longer. She needed to know one way or the other how he felt.
"He wants a few more sessions, but he said I could return to desk duty tomorrow."
Enough small talk. Cassie took another step, forcing Drake back against the edge of the desk. Before he could say anything more, she reached up, her fingers fisting in his hair, dragging his face down to meet hers.
She enjoyed his startled gasp as she pressed her lips over his. He flinched, but she gave him no maneuvering room, and after a long moment, she felt his body respond. His hands moved to rest on her hips, she could feel their heat through the thin cotton of her scrubs.
Yes, she thought as his lips parted, allowing her to plunge deeper into the kiss. This is right; this is how it's supposed to be.
