Critical Care: 1 (Mercy Hospital)

by Candace Calvert

  “Amen.” Erin’s eyes brimmed with tears despite her grin. “Good company, indeed.” She held her coffee aside and wrapped one arm around Claire in a tight hug. “Thank you for being here. It means more than you can know.”

  “Ditto,” Claire said as Erin leaned back in her chair again. “And I’m glad you’ll be close by in case I need your help in the clinic today.”

  “Count on it,” Erin said, suspecting once again that this former ER nurse was unsure of herself. “Just call me. I’ll need a break. Logan will be watching Keeley Roberts like a vulture over a wounded jackrabbit, and I may end up as referee. Thank goodness Sarah will be here. She probably has Logan’s coffee brewing already.”

  +++

  Sarah slammed the Jetta into reverse, remembering at the last second to glance over her shoulder. It was garbage day, and her neighbor had a habit of pushing her can into Sarah’s driveway. If she hit it, there would be precious seconds wasted getting out of the car to shove the can and disgusting mess aside. There was no time for any slipups. She hadn’t even had time to brush her teeth, for goodness’ sake.

  She fumbled on the console for a stick of gum as she pulled out into the street, then groaned as the thought came to her. Garbage day. Perfect name for a day spoiled by those sleeping pills, wine, and oversleeping. In an instant, guilt jabbed without mercy and her eyes blurred with tears. No. Not garbage day. Emily’s birthday. The best day of my life.

  She had only herself to blame for the mess of today. And for all the sad yesterdays leading up to it. Her fault. My sin. No one else’s. Now she had to do whatever she could to make up for it. To stop anything else bad from happening. Sarah glanced at the digital clock on the dash—7:04. Fortunately her fourplex was just minutes from the hospital. If she took the access road, she’d miss the stoplights. Then she’d hop onto the freeway for the last mile and cross the overpass. Sarah pressed the accelerator down hard and sped off.

  By the time she’d passed the second corner, she managed to reassure herself a little. Though it was only Keeley Roberts’s second shift, she was a skilled veteran and would be an acceptable backup in the fifteen minutes or so that Sarah would be gone. Erin was there, after all. Logan would still grumble undoubtedly, but Sarah could make him smile. He knew he could count on her. Sarah’s stomach churned. That’s a lie. She’d fouled it all up. Sent home yesterday, late again today. He’d never trust her again. Never, ever forgive me.

  Sarah whipped her head side to side as she approached the four-way stop, then pressed the Jetta forward without braking. The freeway on-ramp was just ahead. Almost there, almost there. Her mouth was dry, and her pulse vibrated inside her sleep-fuzzy head as if her heart had torn loose from her chest somehow and drifted upward like a helium balloon.

  Good, there it is. Sarah passed the freeway’s hospital sign, spotted the exit, and flattened the accelerator. Light traffic, thank goodness. Wait. Hold on. Why was that yellow van going so slowly? Crawling along, for heaven’s sake. A school van, with kids at the window, waving and laughing. Sarah’s breath caught. Oh no. It was stalled, stopped. No!

  She jammed her foot against the brake, but the distance kept closing like something out of a horrible dream; the faces of the kids getting clearer, their smiles fading, their mouths opening wide, screaming. Oh, please don’t let me hit them! She gripped the wheel, nearly standing up as she crushed the Jetta’s brake pedal to the floor and then made the only decision she could. Don’t hurt the kids. Don’t hurt the kids. . . . She cranked the wheel hard left, away from the van, using all her strength. Her shoulder strained in its socket as she struggled to prevent the wheel from straightening out.

  She felt the impact at the rear as she clipped the van, her seat belt biting viciously into her collarbone as the car tipped sideways and slid across the intersection toward the overpass guardrail.

  There was the acrid smell of smoking rubber, horrible sounds . . . honking, so much honking, shattering glass, ripping metal, and something hard slamming against her chest. Piercing and unbearable pain, her gargled scream . . . and finally merciful blackness.

  +++

  Logan glanced out his office window, thinking he could hear distant sirens. It didn’t matter; if they were headed here, there was nothing he could do about it.

  It was a completely different situation with the e-mail message on the computer in front of him. All he had to do with that was delete it without opening it. Right now. What point would there be in reading it? He’d already made his decision. He moved the computer mouse for the second time, letting the cursor hover over the line From: Rebeckah Caldwell. Subject: Re: wedding regrets.

  Regrets. Logan frowned, thinking how ridiculous it had been to use that wording in his brief note to Beckah. The invitation had been worded something like “please respond with acceptance or regrets regarding your attendance,” and he’d done it quickly without thinking. But now, seeing Beckah’s name alongside the word regrets . . . He’d delete the message and be done with it. He didn’t have regrets. Questions maybe. Once. But that was over now too. He was moving on. Tomorrow Beckah would walk down the aisle in Carmel and become someone else’s wife. Good. She deserved every bit of happiness that came her way. And his being at her wedding wouldn’t matter one way or the other.

  Besides, he had plans for tomorrow. He’d take Claire out somewhere nice, somewhere that didn’t involve hiking boots and fishing gear. He chuckled low in his throat. Or any risk of sitting on a chicken. Out to dinner maybe, at that great place on the Sacramento River next to where the Delta King paddle wheeler was docked. Rio City Café, the restaurant with all the windows and decks, the delta breezes, fresh-caught salmon, crab cakes, steaks, and those incredible St. Louis barbecued ribs. Claire might wear a dress, pull her hair up the way he liked it, showing off her beautiful, graceful neck. And she’d sit close to Logan, smelling so good and looking at him with those dove gray eyes. They’d talk and make plans.

  Logan glared at the computer. Why couldn’t he delete the e-mail and get it over with? He needed to go back to the ER. Get to work. The new nurse was pacing like a caged animal; Erin had had her nose out of joint about something ever since she walked in. He moved the computer mouse over the message again. What did he think it was going to say? That Beckah knew he was a coward all along and wouldn’t show up? That she was glad she’d found someone better than him? That she’d changed her mind and needed him to roar up on his motorcycle to rescue her? He clicked the mouse and opened the e-mail.

  Logan,

  I understand.

  Blessings,

  B.

  He hit the Delete button, battling an exasperating mix of disappointment and anger. She understood? What kind of cryptic garbage was that? Understood what? What on earth did Rebeckah Caldwell understand? That I don’t?

  No. Didn’t matter. It was done.

  Logan turned at a knock on his door. “Come in.”

  Erin stepped inside. “Sarah’s late. It’s only ten minutes by the clock, but you know how early she always gets here. She usually beats me by a few minutes. Technically that makes her forty minutes late. And I can’t get her on the phone.”

  “You tried her cell?”

  “No answer there, either.”

  “How’d you leave things with her yesterday when she went home sick? Did she say she’d be here today?”

  “I’m not sure I even asked. I only assumed.” She crossed her arms, staring at him. “You know as well as I do that Sarah has never voluntarily missed a day of work. I think I told her to take as much time as she needed, but I never figured she would. If she did, I’d expect her to call me. I’m worried.”

  Logan hesitated, then nodded toward the ER. “What’s going on out there?”

  “Keeley and I are handling it. Just those same three night shift patients waiting for lab results and two more signing in for triage—a forehead laceration and a case of pinkeye. Nothing big. I think we’re okay until urgent care opens, but . . .”

  “But
what?”

  Erin took a deep breath. “I keep thinking about Sarah. About how she’s been working too much. Everywhere. Not just ER. How she almost fainted the other day, how she was late for the first time ever last week and then fell asleep at work yesterday.”

  “Fell asleep?” Logan shook his head. “You said she was sick and had to go home.”

  “She didn’t want you to know. I found her in the lounge with her head down on the table. She said she had a cold and took an antihistamine.” Erin winced. “But I’m not sure now. What if it’s something serious?”

  “It’s ten minutes. Some people think that’s nothing—remember McMuffin?” He smiled, trying to reassure Erin, despite his own creeping doubts concerning how thin Sarah had become lately and those dark shadows under her eyes. That sadness when she talked about her family. “Some people think ten minutes late is on time.”

  “Not Sarah.” Erin twisted her ponytail, her expression thoughtful. “My personal judgment hasn’t been the best lately, and now I’m wondering if I missed something with her. Remember all those warnings Claire gave us about stress? And those symptoms that they mentioned at the debriefing. Do you think maybe—?”

  Ah, brother. Not this. “No, I don’t,” Logan said, cutting her off. Sarah was a warrior, tough as he was. That was that. He stood and grabbed his stethoscope. “Sarah’s running late. Period. We’ll give her five more minutes, and we’ll call her cell phone again. If she doesn’t show, I’ll get one of police units to drive by her place.”

  The ambulance radio squawked in the distance, fizzed into static, then started again as sirens began to wail from all directions.

  +++

  Claire walked out of the Human Resources office, frustrated. The director wasn’t in. Something about an unplanned early meeting, and then she’d be attending a systemwide training session. Claire nearly jumped when Merlene Hibbert called her name.

  The nursing director marched toward Claire, a no-nonsense look on her face. It was uncanny how the woman could sneak up so soundlessly; no wonder the nursing students toed the line. Claire squared her shoulders. If she’d had gum in her mouth, she would have spit it out. The woman was that intimidating. But when Merlene reached Claire, she smiled. For about two seconds.

  “Busy morning, too many people out sick,” she said in her singsong cadence. “I’ve a mind to make a few house calls, take some temperatures, see how legitimate these illnesses are, you know?” She eyed Claire’s scrubs. “Aren’t you in urgent care today?”

  “Yes, at ten,” Claire answered, wondering if Merlene were about to take her by the scruff of her neck back to her assigned building. Except that only two weeks ago this building was her proper workplace. And still my plan. “I was hoping to catch the HR director to confirm the agenda for the meeting on Monday.”

  Merlene nodded knowingly. “You mean the decision about the new clinical educator. You’re a bit anxious, are you?”

  “Yes,” Claire admitted. “I know there are only two applicants, but—”

  “Three. Now that Renee is back.”

  Claire’s stomach tensed at the mention of the nurse who’d held the position until three months ago. She wants her job back? “Renee Baxter? I thought she moved to Washington.”

  “Oregon. Except that she didn’t. Her husband decided not to take that job.” She shook her head. “Too rainy. And he didn’t know this before?” Her expression warmed. “But I believe that Renee is only interested in half-time hours. Between you and me, administration’s impressed with you. You’re the only one of the three applicants with CISM training, and then there’s your willingness to help out in the ER.”

  “The clinic,” Claire corrected, her voice sounding as breathless as she suddenly felt. She struggled against a queasy rush of dread. “Only urgent care. Not the ER. And today’s my last shift because they’ve found someone else.” She took a breath and let it out slowly, willing herself to stay calm and focused. Stick with the plan. Lord, you know my plan.

  “Nevertheless, you’ve made quite an impression,” Merlene said confidently. “In fact, I put in a special word for you.”

  Claire’s shoulders sagged with relief. “Oh, thank you. That means a lot.” She turned her head for a moment toward sounds in the distance—sirens?

  “Perhaps there would even be a possibility of a shared educator position. You could work part-time in education, part-time in the ER?”

  “But . . .” Claire’s stomach sank again. How on earth could this be happening? After all her hard work? all the planning and praying? She had to make Merlene understand. Stop her from suggesting this impossible—completely horrifying—idea to administration. Back to the ER?

  “No, that isn’t what I’d planned for. I don’t work ER anymore. I can’t—” Claire stopped and stared upward, certain she’d misunderstood the page. It repeated and her heart rose to her throat.

  “Claire Avery to the emergency department stat. Claire Avery report to ER.”

  By the time Claire had jogged across the campus to the outside doors of the emergency department, the overhead announcement of Code Triage had been made, meaning they were working a multicasualty disaster. What type she had no idea, but another ambulance, its siren screaming, was rounding the curve into the parking lot as she hustled up the ramp to the doors. Metal scoop stretchers leaned against the brick entryway, and red biohazard bags—overflowing with bloodstained gauze pads, IV packaging, and cardboard splints—littered the entrance. Trauma. What origin? How many victims? Why did they page me? Claire hurried through the doors and into chaos.

  Erin, holding an IV bag aloft, greeted her with a groan of relief. “I’ve never been so glad to see someone in my life.” She stepped out of the way as a medic dragging a scoop stretcher—its buckles clattering against the floor—charged by them and headed back outside. “Motor vehicle accident on the overpass,” she explained, raising her voice. “Sounds like four cars. A stalled school van with eight kids—minor injuries, thank heaven—and three other cars. So far a few fractures, a head injury who’s conscious but needs a CT scan.” She shook her head. “I guess the last car is still hanging over the guardrail. They’re trying to stabilize it. There’s supposed to be at least one victim pinned inside. No word on his condition.”

  Claire nodded, her hands clammy. She pushed down a wave of nausea, her mind whirling. “So, you need me to open urgent care early.”

  “No,” Erin said, nudging Claire to the side as a firefighter rushed past carrying a crying child. “I need you in the ER with me. I need everybody I can get. Sarah didn’t show, so it’s just Keeley and me. Logan’s shouting orders faster than an auctioneer.” She glanced past Claire toward the ambulance bay. “Argh, there’s the Channel 13 news van. C’mon, let’s get in there.”

  “Erin, I . . .” Claire choked. Please, God. How could she do this? How could she refuse? What if I panic? Claire looked into Erin’s eyes and nodded. “Just tell me what you need me to do.”

  Erin wedged the IV bag against her shoulder and reached out to squeeze Claire’s arm. “Great. You’re saving my life here. And I’m still praying that Sarah will show up any minute.”

  +++

  “How ’bout that brain scan?” Logan asked, catching Keeley’s gaze as she entered data into the computer.

  “They said they could take him in five minutes,” she answered, then amended it as she read Logan’s expression. “I could call radiology again, and—”

  “Do it.” Logan sighed as he scanned the trauma room and checked the clock. Despite the fact the new nurse was far too slow, thirty minutes after the arrival of the first victims they had things relatively under control. He studied Erin’s notes on the huge dry-erase board: fifty-year-old male with stable head injury and bruised ribs, thirty-four-year-old female with an uncomplicated leg fracture awaiting orthopedic consult, the teenager with multiple lacerations—he’d sew those later—and the kids, of course. Logan thought of the eight grade-schoolers Merlene was watching in urgen
t care. The only injury was a five-year-old with a possible wrist fracture. A miracle.

  His brows furrowed. No, not a miracle. The remaining victim, extricated from the car scant minutes ago and on her way in Code 3, had apparently swerved to avoid hitting that stalled school van. And ended up with her car dangling from a freeway overpass. A brave decision or a fatal one—he’d know which in a few minutes. So far, the woman’s vital signs were relatively stable. If things changed, she’d win a helicopter ride to Sacramento. Meanwhile, security was watching the doors, the public information officer was handling reporters, chaplain services were on hand for the panicky parents, and Merlene Hibbert was making balloons out of exam gloves over in urgent care.

  Logan glanced across the room to where Claire, wearing a plastic face shield, stood efficiently and quickly cleaning the teenager’s wounds. He frowned at Keeley’s careful and methodical pace. There was no comparison; Claire responded instantly to orders and worked with what appeared to be quiet confidence. Quiet, meaning she’d hardly said a word since she arrived. Except to answer his brief inquiry about Smokey—the cat was still missing, and he could see Claire was worried. Other than that, they’d barely talked. But that was okay; they were working. He only wished Keeley would do the wound cleaning and clinic-type tasks and Claire could be assigned to the more challenging patients. He’d need nurses with speed and efficiency when that Code 3 hit the door. Methodical, though safe, wasn’t going to cut it.

  But it wasn’t the time to second-guess Erin’s nursing assignments. She was more than a competent charge nurse. And right this minute he had no real complaints with the way things were going. If that changed, he’d—

  The ambulance radio squawked and Logan turned.

  “They’re pulling in,” Erin announced, striding away from the radio desk. “Our twenty-six-year-old female vehicle extrication. Semiconscious, facial wounds, bruised chest. BP 94 over 40, heart rate 100, respirations 28—here she is!” She signaled to the medics. “Put her in the code room, guys. Keeley, let’s go.”