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Contents:
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The Pledge
Graduation Day
We, the undersigned, having barely survived four years of nursing school and preparing to go forth and find a job, do hereby vow to meet at Granetti's at least once a week, not do anything drastic to our hair without consulting each other first and never, ever—no matter how rich, how handsome, how funny, how smart—marry a doctor.
Katie Sheppard, R.N.
Dana Rowan, R.N.
Lee Murphy, R.N.
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Chapter One
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It was only two weeks into January and Katie Sheppard had already broken four of her five New Year's resolutions. She'd yet to clean a single closet. She hadn't registered for the yoga class that was supposed to reduce stress and expand her mind. And last night, while blubbering her way through her favorite movie, she'd blown her diet with an entire pint of Häagen-Dazs. Now, instead of cutting back on the hours she volunteered at a free women's clinic—resolution number four—she'd actually agreed to help expand its program. If the day didn't end soon, she had the feeling number five would also bite the dust. In a way, she supposed it already had.
When asked to take on more than I can comfortably handle, I will learn to say no, and mean it.
Right, she mentally muttered, pulling open the heavy stairwell door leading to her unit. If she'd sounded any more convincing talking to the clinic's director, whom she'd bumped into in the hospital's cafeteria, she would have wound up running the whole bloody program.
Her female friends were more generous, but her friend Mike was right—her backbone was made of mush.
"Dr. Brennan was looking for you a few minutes ago, Katie. Did you see him?"
Speak of the devil.
Deciding she'd have to finish beating herself up later, Katie did an about-face as she passed the telemetry unit's nurses' station with its long white counters and banks of cardiac monitors. A hot pink stethoscope hung around her neck, the bell and earpieces dangling against the top of her light blue scrubs. Wincing as she loosened a strand of frustratingly curly, wheat-colored hair caught under the neon-colored tubing, she sidestepped an orderly and headed for the middle-age model of efficiency seated behind the high counter.
Alice Ives, the unit's secretary and everyone's self-appointed mom, had barely glanced up when she'd spoken. The woman's attention was riveted to the photos one of the other cardiac nurses had brought in of her family's Christmas vacation in Hawaii. Katie had taken her turn drooling over them between patient assessments, morning rounds and a staff meeting.
"Did he say what he wanted?"
"Only that it could wait. He's doing a procedure in 307 if you want to catch him. By the way," she added, still flipping through photos, "he didn't seem too happy about whatever it was."
Confusion settled in Katie's dark brown eyes. If Mike said it could wait, then what he wanted probably had nothing to do with a case. Where his patients were concerned, he invariably wanted answers five minutes ago.
"I won't interrupt him," Katie said, wondering if something had gone wrong with his research study—the one he'd roped her into helping him with. "But if he finishes in the next few minutes, I'll be down with the new admit."
Reaching over the counter, she slid her clipboard from where she'd left it before she'd gone on the break she wished she hadn't taken, and paused long enough to see which picture had Alice so transfixed.
It was the one of a palm tree silhouetted against an orange and magenta sky. A lovers' sunset, she thought, feeling a little wistful herself. "Living vicariously is the pits, isn't it?"
The older woman sighed like a preteen with a crush on a rock star. "I'd kill to go to those islands," she admitted, touching the image of the palm tree. "With two kids in college and another starting next year, the only sand Larry and I will see for the next ten years will be on the beach at Lincoln City. And it won't stop raining there until July."
"The Oregon coast certainly isn't known for sun," Katie agreed, thinking of the beach an hour and a half drive through the mountains from Honeygrove. "But we do have all that gorgeous, rugged shoreline."
Alice peered over the top of the purple-rimmed half glasses that matched her grape-colored pantsuit. "You sound like you're describing a man. That's what you should be checking out, too, you know? Men. Not scenery. You're never going to get the family you want if you don't start looking a little harder."
A tolerant smile curved Katie's mouth. "How did we get from discussing your desire to go to Hawaii to my lack of a man?"
"It's that association thing. You know, the one where someone says something that reminds you of something else? But as long as we are talking about it, is there anything new and exciting you've been keeping from me?"
"I don't have time for 'new and exciting,'" Katie muttered, thinking she'd have even less time for herself now, thanks to her starchless spine.
Alice made a disapproving sound. "Time is all you will have if you don't get out there and circulate, girl. Maybe you should go somewhere exotic," she suggested, her confidential tone barely audible over the muffled clatter of lunch trays being collected and a page coming over the loudspeaker. Behind her, a technician continuously scanned the monitors, green lines spiking over gray screens. "You're thirty years old. Single. And your only dependent is a cat. If I were in your position," she confided, punching at a blinking light on the console as the phone continued to ring, "I'd be gone in the time it took me to pack a book and a bathing suit.
"Three-G, Alice speaking," she answered, arching her penciled eyebrow at Katie in subtle challenge.
"Hey, Katie." The tech at the monitors kept her focus on one of the screens. "The patient in 316 has had ten beats of V tach. You want to check it out?"
Alice's outspoken observations sounded suspiciously like those Katie heard more and more lately from her own mother. But thoughts of turning into an old maid vanished along with images of muscular males and mai tais. The telemetry unit of Honeygrove Memorial Hospital handled heart patients who weren't sick enough for the Cardiac Intensive Care Unit, but too sick for the medical floors. Three-sixteen was Eva Horton, a spry seventy-four-year-old who'd suffered a heart attack while out for her morning walk. Her indomitable spirit had survived open-heart surgery and enough drugs to drop an elephant. If her heart stayed in the arrhythmia of ventricular tachycardia, however, she wouldn't survive much longer.
Maneuvering around a tall, stainless steel meal cart, Katie aimed for the break between a stuffed laundry cart and a gurney coming down the crowded hall. When she had assessed Eva twenty minutes ago, the woman had been totally stable, her vitals good, her potassium level fine.
Rounding the corner into the room, still working to pinpoint what was going wrong, she deliberately slowed her stride. The young aide preparing to give Eva her bath walked out of the bathroom as Katie ran a practiced eye over the face of the thin, silver-haired woman propped up in the bed.
"How are you doing?" Katie asked, picking up the woman's wrinkled hand. Professional as she was, she had a definite soft spot for this widow who'd confided that she simply didn't have time to have a bad heart. She had grandchildren to spoil, a foursome in bridge she couldn't let down and a shower to grout. At the moment, however, the once-energetic woman's skin was pale and clammy, perspiration misted her upper lip, and the edges of her mouth had a distinct blue outline.
"I feel funny." Eva swallowed, pressing her hand to her chest when Katie released it. "A bit short of breath."
She had been off oxygen since yesterday. Reaching for it even as the woman spoke, Katie turned on the airflow, but she
didn't get the cannula in place. In the time it took to blink, the woman's eyes rolled back behind her gold-rimmed bifocals, and her head sagged forward like a rag doll's.
The thin clear oxygen line swung against the wall of outlets and ports like the pendulum of a clock as Katie snatched up the phone by the bed.
The nurses' aide, a statuesque brunette barely over twenty and new on the floor that week, stood clutching the washbasin she'd just filled. Her already pale skin suddenly looked as ashen as the patient's.
"Get her flat," Katie ordered, wondering what the girl was waiting for. With the phone cradled against her shoulder, Katie lowered the side rails. "And get a backboard under her." Her mind racing, she whipped the patient's glasses off and started ripping off the gown. "Code Blue. Three-G. Room 316," she said into the phone, and threw the pillow in the general direction of a chair.
The phone still rocked in its cradle when she grabbed the backboard the aide pulled from the foot of the bed and shoved it under the unconscious woman. From beyond the room, a bell-like chime sounded an instant before an amazingly tranquil voice came over the intercom. "Code blue. Three-G. Room 316. Code blue. Three-G. Room 316."
The code was repeated a third time, but Katie scarcely heard it. At that very second elsewhere in the hospital, she knew that nurses, technicians and doctors were bolting for the stairways. Any person available answered a code, no one taking the chance that others would take care of it. Within the minute, there could be twenty people in the room, each prepared to handle a part of what one person couldn't effectively do alone.
Except for the aide. She hadn't moved.
Katie tipped back her patient's head to get a straight airway. "Don't just stand there," she insisted, her own heart pounding. "Get a mask. You breathe. I'll compress. Come on!"
The young aide shook her hands as if ridding them of water, her eyes flashing fear and panic. "I've never done this for real before. Only in class."
"Then pretend it isn't for real if it helps! Just do it!"
Had a patient's life not hung in the balance, the empathy Katie could rarely suppress would have tempered her response. It was the aide's first code and she was freaking. Having slid into a dead faint the first time she'd witnessed surgery, Katie could hardly be critical. But she had no time to feel frustrated, and even less time to waste. The patient had no pulse.
"Where's that cart?" she called, a little frantic herself as she crossed her hands on the older woman's ominously still chest and began rapid compressions. "I need help here."
"You got it."
It vaguely occurred to Katie that Mike must have finished whatever he'd been working on. Six feet two inches of what her irascible buddy Dana called a black-haired, blue-eyed studmuffin barreled through the wide doorway with an open white lab coat over his dress shirt, slacks and tie. With one sweeping glance, he noted the brunette fumbling with a breathing mask, assessed the situation on the bed and slipped into action.
"I've got her, Katie. You breathe."
The deep timbre of Mike's voice had been described as everything from the low rumble of distant thunder to the slow burn of good brandy. Half of the female staff claimed his voice alone was enough to accelerate a woman's heart rate. Katie was more interested in his hands. The instant they slipped under hers to take over the compressions, reassurance registered through the adrenaline rush that got everyone through a code. She'd trust Mike with her own life. He'd already saved it a couple of times. He'd saved her rear anyway. But she'd only been a kid at the time.
"I'm on three, four…"
"Five," Mike said, taking over the count while Katie breathed air into the woman's lungs.
The code cart rolled through the door with two nurses, a tech and an electrical cord trailing behind it. As sometimes happened, someone had simply grabbed the cart and ran without unplugging the defibrillator first. The code cart was actually a big red toolbox on wheels, and Cindy, a redheaded RN with a million freckles, hit the charge switch on the defibrillator anchored to the top. A second later, the paddles were ready and she frantically tore away the plastic lock on the cart's base to open the drawers and trays of meds and supplies.
In those same seconds, a respiratory therapist began bagging the patient, relieving Katie of having to breathe for her, and Mike snatched the paddles. He had them a fraction of an inch from the patient's chest when Katie called for gel pads.
Mike froze, the tension in his body almost palpable as a package came sailing across the bed. Katie snatched it up, ripped it open and slapped on two hand-size orange conduction pads, one on the right ribs, the other near the bright red scar bisecting the chest. She knew Mike wouldn't like the delay, but the pads conducted the electricity better, and without them, the paddles left burns that hurt like the devil.
He had the paddles in place even as she pulled back.
"Clear."
His brisk command was followed by a heavy, hollow thwump as two hundred joules of electricity bucked the body on the bed. Eva landed as she'd been, and lay as limp as before.
From across the room, Katie heard something solid hit a wall and slide to the floor.
"Somebody check the bathroom," she called, quickly adding the three leads from the defibrillator monitor to the other leads already on the patient's chest so they could see what was going on. "I think the aide's in there."
Next to Katie, a nurse in blue scrubs like her own was hanging an IV, connecting it to the catheter in the patient's needle-bruised arm. Behind the redhead tossing out supplies from the code cart, someone in green scrubs was recording the beehive of activity on a clipboard. The doorway was jammed with personnel leaving because there were enough people working the code and others arriving to see if they were needed.
Katie had the third lead in place. Atop the cart, the monitor jumped to life, the white lines spiking over a black screen indicating a shuddering heart. "She's still in V tach."
"Go to three hundred," Mike called. Another sharp, "Clear," and the patient's body bucked once more.
The frenetic pattern of the deadly arrhythmia still looked like tremors on a seismograph. "Three sixty."
Mike applied the paddles again.
"That did it. She's in sinus," Cindy announced, watching the heartbeat on the cart's monitor.
Sinus rhythm was good. It was normal. It was exactly what they wanted.
Mike's glance met Katie's in a split second of mutually acknowledged relief even as Eva moaned and her eyes fluttered open. The respiratory therapist eased the bag from her mouth. Confusion, then panic, washed over the woman's suddenly flushed face.
Wanting to ease her fear, Katie murmured, "It's okay, Eva. We're right here."
"What's going on?" The tremor in Eva's voice was mirrored in her hand as she reached to clutch the sheet.
Katie pulled up to cover her exposed chest. "Why are all these people here? Wasn't I sitting up?" Without her glasses, identities were hard for the woman to establish. She blinked past the dozen people surrounding her bed to focus on the darkly attractive man towering over her. "Dr. Brennan? Where did you come from? Why are you here?"
Katie's hand rested on Eva's shoulder. Feeling the woman tremble, she automatically gave Eva a comforting squeeze, and glanced at Mike as he handed her a blood pressure cuff. The faint smile carving lines into his lean cheeks was intended to reassure his patient, but his blue eyes remained intent while he explained to Eva that her heart had jumped out of rhythm, and that they'd had to use electricity to get it back in sync again.
Fear and anxiety were a patient's inevitable responses to such an episode. So were tears. They gathered in the corners of the older woman's eyes, then slipped down her cheeks as the gravity of her situation sunk in. Katie, her thoughts divided between the various needs of her patient while she strapped on the cuff and took the woman's blood pressure, glanced toward the box of tissues on the far side of the bed.
Mike was already ahead of her. Handing the shaken woman a tissue, he told his patient to try breathi
ng deeply, then pushed his hands into the pockets of his slacks. With his focus on the monitor, he explained that she would be moved to CICU as soon as they could get her there.
"Just until we're sure you're stable," he assured.
Over the tearing sound of Velcro releasing its grip, Katie removed the cuff and passed on the reading. "I'll go with you and make sure you're settled."
"That would be a good idea," Mike replied, seeing how tightly his patient was holding her hand.
"Is this going to happen again?"
It wasn't often that the patient's surgeon was around when a patient crashed. But since he had been—and since it was Mike—Katie knew she wouldn't be left to interpret explanations or decode words that often left patients more frightened than they already were. Even as the activity continued around her with Katie administering the drugs Mike ordered and the respiratory therapist adjusting the oxygen cannula around her head and under her nose, Eva responded to the considerate way Mike answered her questions. Or maybe, Katie mused, thinking of the comments others had made, what the patient responded to was simply the deep, soothing timbre of his voice. It held authority, assurance, certainty. Strength. As Katie watched the agitated beats slow on the monitor, she wondered if maybe his voice couldn't calm a heart, as well as excite one.
Not that he excited hers. At least, not since she'd recovered from the crush she'd had on him when she was nine years old. He'd been thirteen at the time, and very much the big brother she'd never had. Now she thought of him only as a friend. One of her best. Over the years, she'd come to realize she simply couldn't let herself think of him any other way.
Except, like now, when she thought of him in professional terms. In the eight years she'd worked in cardiology, she'd encountered any number of surgeons whose arrogance was exceeded only by their lack of sensitivity. And cardiac surgeons—because the human heart was literally in their hands—could be the most arrogant of the lot. Neither she, nor any of the other nurses in the unit, considered Mike among them. He was exceptionally skilled. Brilliant was the word often bandied about by the surgical staff. And he demanded as much of those who worked with him as he did of himself. That was something that intimidated the daylights out of the newer, younger nurses. The rest, those who'd been around for a while, simply stood in awe of him. But Katie knew what many did not. Despite the self-confidence, the drive and the talent, he often found the work he did profoundly humbling.
FROM HOUSECALLS TO HUSBAND Page 1
