The Doctor's Christmas Proposal

by Laura Iding

  “I have one here.” The respiratory therapist held up the device.

  Mitch took it from his fingers. “Dana, has Jessica used this bi-pap mask before?”

  “Yes.” Dana’s expression was tense as he removed the ambu bag and placed the bi-pap mask over the patient’s nose and mouth. With the respiratory therapist’s help, they connected the apparatus so that there was an additional push of pressure with every breath Jessica took.

  “I’d like to give her a touch of Versed to relax her. These bi-pap masks are difficult to tolerate.”

  “I know.” Dana frowned, trying to remember. “I believe we used Versed before with her, but in small amounts.”

  “Let’s start with one milligram.” Mitch kept his eye on the pulse oximeter reading, showing an oxygen saturation of 80 percent. Pretty low, even with PPH primary pulmonary hypertension. He’d rather see the number a little closer to ninety percent.

  “Sounds good,” Dana agreed, looking relieved.

  He nodded to the medication administration nurse standing on the other side of the bed. At his signal, she bent to inject the Versed into Jessica’s IV.

  The rest of the Code Blue team stood back to let Dana and Mitch take care of the situation. For a moment their gazes collided, and he was startled when a flash of awareness sprang between them. He tore his gaze away with an effort. He couldn’t deny he was glad elf Dana was here to help guide him, since he wasn’t nearly as familiar with the patient’s history as she was.

  “Pulse ox is up to 88 percent,” Dana announced with relief. “Much better.”

  “Yeah, but I’d still like to keep an eye on her in the ICU for at least twenty-four hours.” He couldn’t help raking his gaze over Dana’s green attire, only partially covered by the paper gown she’d donned when Jessica’s condition had deteriorated. As much as he appreciated a nice pair of legs, the green tights were a bit much. “Are you actually on duty in that get-up?”

  She blushed and self-consciously tugged the paper gown over her tunic. “Not yet. I start at three. I was on my way to visit Jessica when the code was called.”

  “If you don’t mind, maybe you could punch in early. I could use your help to get up to speed on Ms. Kinkade’s medical history.”

  She stared for a minute at his name printed across the upper left breast pocket of his lab coat. They’d never met but he figured she’d recognize his name as the new attending on duty. “Certainly, Dr. Reynolds.” For some reason her crisp response made him want to grin. “But first I need to let Chad and Wendy know what’s going on.”

  The patient’s children. His smile faded. “Of course.” He turned to the resident who was supposed to be in charge of the Code Blue who but hadn’t said a word while Dana had argued with the anesthesiologist. “Steve, I’m trusting you to get Ms. Kinkade safely transferred to the ICU. Once you get there, prepare to place an arterial line but wait for me before you start the procedure.”

  “Yes sir.” The resident nodded.

  “Do you have any questions?” Mitch had his doubts about the resident’s ability to handle the simple transfer. The guy hadn’t exactly stepped up to take a leadership role during the emergency situation.

  “No, sir.” The resident shook his head.

  “Good. I’ll meet you over there in a few minutes.”

  “I can talk to the kids myself,” Dana protested.

  “No.” As much as he wanted to avoid the task, avoid the children, his sense of duty wouldn’t let him. He rubbed a hand over his stomach as if to dislodge the heavy boulder of dread sitting there, forcing himself to stay when he really wanted nothing more than to follow the patient to the ICU. He gestured to the door. “We’ll both talk to them.”

  CHAPTER TWO

  DANA HAD HEARD about Dr. Mitch Reynolds through the unit gossip mill. Some of the nurses had already discovered Dr. Reynolds, the new critical care intensivist, was single but she hadn’t really believed he was as handsome as they’d claimed.

  She’d been wrong. With his dark chocolate-brown hair and square jaw, he was far more attractive than she’d ever imagined. One glance from his dark eyes had made her toes curl in the pointy-toed elf shoes.

  The nurses had also mentioned that he’d been recruited from Nebraska. Or was it Kansas? She couldn’t remember.

  Either way, she wished she could have met him for the first time under different circumstances but, then again, there were lots of things she’d wished for that had never come true. No point in thinking about the attractive intensivist on a personal level—her luck with men was abysmal. Turning her back on him, she turned and headed into the hall, determined to help ease the news for Jessica’s kids.

  Wendy ran toward her, tears streaming from her eyes. “Is Momma going to be all right?”

  “Yes, she’s doing much better.” Dana wrapped her arm around the girl, then glanced up at a very somber Chad. She included both of them in her explanation. “Her breathing is much easier now because we put a special mask on her face. The doctor wants to keep an eye on her in the ICU.”

  “No-o-o,” Wendy wailed, then buried her face against Dana’s thighs like she had earlier. “I don’t want her to go to the ICU.”

  “Wendy, the doctor knows what’s best for Mom,” Chad said in a weary tone.

  Mitch cleared his throat, drawing their attention. “I’m Dr. Mitch Reynolds. I’m the ICU specialist and I’ll be taking good care of your mother while she’s in the ICU.”

  In a very adult fashion, Chad stepped forward to shake his hand. “Thanks.” Then he tugged at Wendy, trying to peel her away from Dana. “Let’s go. We have to call Grandma to pick us up.”

  “Why don’t you wait a few minutes before calling?” Dana suggested, giving Chad’s shoulder a gentle squeeze. “As soon as your mom is settled in the ICU, you can come in and see how she’s doing for yourselves.”

  Mitch frowned, but didn’t say anything. Did he have a problem with the kids visiting their mother in the ICU? Surely not.

  “All right.” Ever the responsible one, Chad picked up the two stockings they’d gotten from the Christmas party then took his sister’s hand. “Do we have to go down to the waiting room?” He was obviously more than familiar with the ICU routine from previous visits.

  Dana hesitated. As a rule, children weren’t supposed to be in the ICU family center without adult supervision. She didn’t know why the kid’s grandmother had dropped them off and left them at the hospital with Jessica—possibly to get in some last-minute Christmas shopping. The family center was one floor below the ICU, but if she were in their shoes, she’d want to wait someplace close by. “Why don’t you come with me? There’s a patient lounge right outside the ICU, where you can sit and wait for a few minutes. Then we’ll call your grandmother to pick you up.”

  “Don’t you think they should wait downstairs?” Mitch whispered under his breath as she led the way down the hall towards the lounge. “Maybe their grandmother should be with them before they go in to visit.”

  She glanced over the kids’ heads at him in exasperation and slowed her pace. Keeping her voice low, she said, “I know the ICU is a scary place, but these kids are used to it. They’ll be with their grandmother the rest of the weekend. For now, let them spend time with their mother. Besides, there’s a huge Christmas tree in the lounge. A much better environment for them than the crowded waiting room.”

  “I’d better go help the resident with the procedure,” Mitch muttered, averting his gaze and disappearing through the ICU automatic doors without so much as a backward glance.

  Dana stared after him for a moment, puzzled by his strange behavior. Something was bothering the new critical care intensivist and despite the fact his problems weren’t any of her business, she was curious to know what was going on behind those dark eyes of his.

  In the staff locker room, Dana quickly changed into scrubs, then headed back out into the intensive care unit to begin her upcoming shift. Her name sprawled next to the charge nurse title for the
evening shift on the grease board made her sigh. Good thing she’d come in a few minutes early. When she was in charge, she appreciated having a few minutes to review the patients herself before everyone else crowded in.

  She was surprised to see Dr. Reynolds standing in the unit, apparently waiting for her as he stepped toward her when she walked in. There was no sign of his earlier reticence—in fact, he greeted her with a smile.

  “Hi, Dana.” His assessing gaze lingered over her proper attire, making her cheeks burn. She knew better than to think he cared one way or the other what she’d looked like beneath the baggy scrubs, but for some reason she couldn’t seem to brush off his dark gaze.

  “Welcome to Trinity Medical Center, Dr. Reynolds.” She decided this was their chance to start over on a more professional note. She smiled. “Is this your first week on the ICU rotation?”

  “Mitch.” He took her arm and steered her away from the central nurses’ station, where a couple of the day nurses were finishing up their charting, to a quiet corner off to the side.

  When he let go of her arm, she could swear she still felt the searing imprint of his fingers against her skin. Her blush deepened and she bemoaned her fair skin. “Uh, is something wrong?”

  “Fill me in on Jessica Kinkade’s past medical history, if you don’t mind.” His low voice was rich and smooth, like cream.

  For a moment she almost told him to go and read the chart for himself, but bit back the uncharitable comment before it could spring free. It wasn’t his fault she’d been assigned in charge. She rubbed a hand over her thigh because even though she’d taken off the green tights, her legs still itched. Thinking back, she tried to remember what she knew about Jessica’s case.

  “Jessica Kinkade was first diagnosed with pulmonary hypertension four years ago. I remember because Wendy was only three years old at the time. She wasn’t diagnosed right away, not until after the disease had progressed pretty far. She didn’t respond to calcium channel blockers, but was stable on intravenous Prostacyclin until last year, when she was switched to the new drug, Romadylin.”

  “Prior to showing symptoms of the disease, was she ever put on diet pills?” Mitch asked with a frown.

  “Not that I’m aware of.” All of her memories of Jessica were of a very thin woman but that had only been since she’d become ill.

  “If she has primary pulmonary hypertension, she’s a better candidate for a lung transplant.” He must have sensed her confusion. “There was a patient back in Kansas who ended up with symptoms after months of taking diet pills. She wasn’t my patient, but I covered her care for a week while her primary physician was on vacation.”

  “Oh, I see.” She nodded, understanding his apparent interest. “Jessica was put on the transplant list once they started the Romadylin.”

  “Because patients can’t be listed for a transplant until they fail Prostacyclin therapy,” Mitch added thoughtfully. “What about her social situation? I know she has two kids, but what about the kid’s father? Is he still in the picture?”

  “Sort of.” For a moment the fuzzy image of her own father, whom she hadn’t seen since her childhood, filled her mind. She’d gotten over the pain of being abandoned long ago. Only on rare occasions, like now, did he pop into her head. Stupid to dwell on things she couldn’t change. She tore her thoughts away from her personal life and concentrated on Jessica’s care. “They split up shortly after she was diagnosed, and I’ve only met him once or twice. I don’t know if he still sees the kids. And I don’t think she ever formally filed for divorce. Her mother is her main support system, although she has a sister, too.”

  “Thanks for going through her medical history with me.” Mitch turned away, then swung back. “You know, the way you stood up to the anesthesiologist at the Code Blue was very impressive. Your quick thinking probably saved her life.”

  “Ah…thanks.” Her cheeks grew warm again and she knew this time Mitch noticed because a smile tugged at the corner of his mouth. That same intangible awareness sizzled again between them. Wary of the strange reaction, she caught her breath then pulled her gaze away with an effort. A small group of nurses was gathered in front of the patient assignment board, waiting for her. “I’d better get to work. I’m in charge and they’re waiting for me to get a run-down on the patients in the unit.”

  “Do you mind if I listen in?” Mitch asked.

  Heck, yeah, she minded. But, of course, she couldn’t say that, so she lifted a negligent shoulder. “If you like.”

  She was keenly aware of Mitch standing behind her as she listened to the run-down on the patients in the ICU. She had been off for two days, but a few of the names were familiar. Especially Jessica Kinkade’s.

  “Thanks, Amy.” She turned from the day charge nurse to glance back at the rest of her co-workers. “Let me know which patients you want to take care of.”

  A few of the nurses piped up right away, as they wanted the same patients they’d had the previous day. Dana didn’t blame them at all, and accommodated their request. By the time the rest of the patients were assigned, she’d ended up with Jessica Kinkade as one of her patients. The other was a new admission from the previous night, a man with a subdural head bleed. He’d been reported as being a little on the agitated side, so she suspected he’d be a handful. As a rule, sedatives were never given to head-injury patients.

  She started to listen to the day shift nurse’s report on both of her patients, then remembered she’d left Wendy and Chad in the lounge outside the ICU. Glancing over, she realized Jessica’s arterial line had been placed without any issues.

  “Shoot. I have to get Jessica’s kids. Give me a few minutes, will you?”

  “Sure.” Amy pulled a chart toward her. “Take your time. I have plenty of documentation to finish.”

  The kids were waiting patiently. Wendy had taken the coloring book out of the gift stocking and was coloring in the pictures. “Look, Dana.” She held up her picture, beaming with pride. “Do you think Mommy will like this?”

  The brightly colored picture was of a very elaborate Christmas angel. The picture was something her mother would have loved. Dana smiled. “It’s beautiful, Wendy. I’m sure your mother will love it.” She held out a hand. “Are you ready to go and see her?”

  Wendy nodded.

  In subdued silence, the kids walked along on either side of her as they entered the unit. Wendy clutched her hand like a lifeline. Mitch was at the bedside, listening to Jessica’s lungs when they approached.

  He didn’t see them until he’d put his stethoscope away and stepped back. His spine stiffened and Dana would swear a curtain dropped over his dark eyes as he glanced at the kids. “She’s doing fine.” He gave a feeble attempt at a smile before turning away.

  Wendy and Chad didn’t seem to notice anything was wrong with him. Jessica was awake and when she saw her children, she reached a hand toward them.

  “Mommy!” Wendy dropped Dana’s hand to grab her mother’s. “Look, I made you a picture.” Wendy held it up in her mother’s line of vision.

  “Wonderful.” Jessica grasped her daughter’s hand and looked at her son. “Love…you…both.”

  Talking with the bi-pap mask wasn’t easy, Dana knew, so she stepped forward to explain to the kids. “Your mom needs this tight mask on her face to breathe, and talking will be hard for her. Don’t worry, though, she can hear you just fine.”

  Mitch disappeared from the room and Dana wondered why his demeanor had changed so dramatically. She thought it was odd that he didn’t try to communicate more with Wendy and Chad.

  Did Mitch have an issue with kids? Both times around them he’d changed, as if emotionally withdrawing from the situation. Strange, because he seemed so nice. Maybe he simply didn’t understand how to relate to them. He’d earned several brownie points in her book for insisting on telling the kids personally what had transpired after the Code Blue.

  Dana didn’t have time to ponder his odd reaction because as soon as she’d finis
hed getting report, she called Jessica’s mother to pick up Wendy and Chad then went over to examine her other patient, who was growing more rambunctious by the minute. She wished she could give him something to calm him down, but the neurosurgeons would never order any medication that might mask the patient’s symptoms in case the head injury grew worse.

  “Lyle. Mr. Tanner. You need this oxygen mask to help your breathing.” She replaced the mask over his face for the third time in less than a minute. Even with his wrists lightly restrained, he managed to wiggle the mask off by thrashing his head from side to side and using his shoulder to displace the mask. She straightened it yet again. “Lyle, please, try to relax. You’re in the hospital. Can you hear me? Wiggle your toes if you can hear me.”

  No response. She took a step back to look at the clipboard, hoping his neuro status hadn’t taken a turn for the worse.

  Without warning, he arched his back, then lashed out with his right leg in an amazing roundhouse kick. She reared back in the nick of time, the heel of his foot missing her face by less than an inch.

  “Dana.” Mitch was at her side in an instant, leaning over the patient and capturing Lyle’s ankles firmly in his grasp. “Get some leg restraints.”

  She didn’t need to be told twice, and fetched them from a drawer at the bedside. “Amy told me she had them handy, in case he got worse.”

  “Seems to me Amy should have put them on right away.” Mitch’s tone was sharp, and he scowled. “The guy almost kicked you in the face.”

  “I know. But the theory on restraints is to use the least amount possible. Amy wouldn’t put them on unless she had a reason to suspect he’d get worse.” She tied the restraint around one ankle, then threaded the end through a loop on the bed frame. “Hey, maybe he was only trying to wiggle his toes?”

  Her attempt at humor was lost on him. His dark brows pulled together in a frown. “I want these restraints on at all times.”

  “You’ll need to write an order.”

  “Don’t worry, I will.”