by Anne Fraser
Fortunately for her, twenty-one-year-old Janice Myers arrived, complaining of abdominal pain.
Gina flipped through the latest lab and radiology reports. In spite of all the tests she’d run, she still couldn’t pinpoint the woman’s problem.
She wasn’t going to give up, though.
“Your beta HCG is negative, so we can rule out an ectopic pregnancy,” Gina informed Janice and her fiancé Kyle Burnham.
“I told you I wasn’t pregnant,” Janice said weakly as she lay on the gurney, clutching Kyle’s hand in a white-knuckled grip.
“I know, but I had to check as a precaution,” Gina told her kindly. “You’d be surprised how many women claim they aren’t expecting and the test turns up positive.”
“Then what’s wrong with her, Doctor?” Kyle demanded. Tall, lanky, and wearing a mechanic’s uniform, his worry was as obvious as the grease stains on his clothing. “She’s been like this since last night.”
“Abdominal pain, fever and your slightly elevated white blood count suggest appendicitis,” Gina admitted, “although those symptoms could be due to a number of other things as well.”
“Like what?”
She stuck to the more minor conditions on the list of possibilities. Suggesting Crohn’s disease or cancer at this stage was premature. “Pelvic inflammatory disease,” she said, thinking of how Janice only noted tenderness during her pelvic exam. “A hernia or diverticulitis, to name a few.”
“What about food poisoning?” Janice asked.
“Food-borne illnesses usually manifest themselves rather abruptly. You mentioned your pain actually started two days ago and gradually grew stronger, which doesn’t fit the picture.”
“So what do we do now?” Kyle asked, his gaze focused on Janice. “Wait and see if the pain goes away on its own?”
Gina tucked the metal chart under one arm. “Absolutely not. I’m going to ask for a surgical consult.”
“Surgery?”
Noting the horrified look the couple exchanged, Gina explained, “Your ultrasound didn’t show anything unusual, so he may decide it would be best to take a peek inside you with a laparoscope. But we’ll let him decide.” She patted Janice’s shoulder. “Try to relax. Dr Horton should be in shortly.”
She strode toward the nurses’ station and plunked the chart on the counter, conscious of Ruark and Lucy at the opposite end. “Call Horton for a stat consult,” she told Ruby. “Possible appendicitis in room three.”
“He won’t be happy,” Ruby warned, her kohl-lined eyes matching her short black-out-of-a-bottle hair. “He only left a little while ago.”
“I don’t care if he walked out the door and has to turn around and come back—it can’t be helped. My patient needs a surgery consult. If he won’t come, he should send someone else.”
“I’ll get right on it.”
“Please do.”
“When you’re free, Dr Sutton,” Ruark interrupted as Ruby picked up the phone, “I’d like a few minutes.”
She couldn’t refuse, although she wanted to. At times she’d been able to pretend the events of that morning had all been a bad dream. At others the throbbing in her cheek and the occasional whiff of his expensively masculine cologne as she stepped out of a patient’s cubicle reminded her otherwise. Now, with hope borne of desperation, she glanced at the whiteboard room grid.
To her regret, other than Janice’s name written in room three’s square, someone had wiped the board clean. “OK,” she said.
If he heard her reluctance, he didn’t comment. Instead, he politely followed her into his office.
She immediately noted the room’s appearance as she gingerly took the chair he offered. “You’ve been busy.”
He propped one hip on the edge of his desk. “It wasn’t as bad as it looked,” he admitted. “Most of the papers didn’t stray too far from their folders, so it was a matter of slipping them back inside. Until I figure out the filing system, I thought it best to enlist help and Ruby obliged. According to her, you might know where these belong.” He handed her a thin stack.
She quickly scanned them. “Contracts are kept in the accounting department. We certainly don’t deal with real estate down here.” She turned another page. “Selling equipment? We didn’t sell anything…” The list of items caught her attention.
“Why, that rotten…scoundrel,” she muttered under her breath.
“From your reaction, I assume you weren’t aware he was selling the department’s medical equipment?”
“Not at all.” She shook her head before one entry caught her eye and she pointed to it. “I recognize this ophthalmology scope. We had a patient with a scratched cornea and I couldn’t find it. Bill said he’d sent it out for repairs and we had to scrounge an ancient model out of storage.”
“No wonder he reacted so strongly when I wouldn’t give him time to clear out his desk,” he mused.
“He didn’t have time to hide the evidence,” she agreed, handing the papers back to Ruark. “Lucky for us he threw that coffee-cup.”
His gaze moved to her scratch and a muscle tensed in his jaw. “I don’t happen to agree. How’re you feeling?”
She gingerly touched the adhesive strip. “I’m fine. Other than an occasional throb, I hardly know it happened.”
Amusement flitted into his eyes, as if he knew she wasn’t being completely truthful, and she quickly changed the subject.
“Did you find anything else of interest in Bill’s files?”
He folded his arms across his chest, which only emphasized the broad shoulders she found so appealing. How odd for her to be attracted to him, of all people. He was a man who represented everything her father had given up, from his responsibilities to his extended family, so how could she possibly entertain any fantasies about him?
She should get out more, she decided. She should get involved in a cause more personal than treating patients day in and day out. As rewarding as she found her job, she clearly needed an activity that met her needs. With nothing more than a houseplant to call her own, her hormones were plainly running amuck.
Once again, she vacillated between wanting to hear the rest of his news immediately and wanting to postpone tonight’s meeting indefinitely.
“I did.” His deep voice yanked her attention back where it belonged—on her job. “Surprisingly enough, underneath the mess was an organized office. After meeting my predecessor, I would never have guessed.”
“First impressions can be deceiving,” she said lightly.
“I also find it hard to believe he was the driving force behind the department’s relatively smooth operation. But he wasn’t, was he?”
Because she didn’t know where he intended to go with this conversation, Gina’s smile faltered. “I couldn’t say,” she prevaricated.
“I’ve been talking to our personnel,” he began. “From the things they’ve told me of your accomplishments, I’d almost begun to wonder if you could walk on water.”
She chuckled. “Trust me, I can’t.”
“Your people are extremely loyal to you.”
The direction he was going now became clear—he was concerned about a power struggle. “Bill wasn’t the easiest man to get along with. If people had a problem that I could handle, I did. And if I couldn’t, I took it to him.” She reflected on the times he’d blustered and bellowed, fussed and fumed, until she’d persuaded him to consider other possibilities. She definitely wouldn’t miss her former boss at all. “Fortunately, I usually convinced him the situation wasn’t as bad as it first appeared, or I offered more sensible options.”
“Ever the diplomat.”
“I did what was necessary. Otherwise we wouldn’t have had a soul willing to work here longer than a week.” She met his gaze. “I assume things will be different now?”
“Without question,” he assured her. “I expect people to come directly to me, not hide behind you.”
His command was inevitable. Although she’d wished Bill had met his resp
onsibilities rather than leaving them for her to assume, facing the new reality was harder than she’d imagined. Whatever would she do with herself if she didn’t work eighty-hour weeks?
She hid her disappointment. “Of course.”
“I’m curious, though. Why didn’t you let Nevins sink or swim on his own?”
“Because I got tired of dealing with crises that shouldn’t have occurred, whether it was broken equipment, staffing issues, or proper procedures. I’d tried going over his head and was told to follow the proper chain of command. So, in order to treat patients, I chose to work with him instead of against him. I learned what made him tick.”
“Which was?”
“His ego. When he complained about a certain task, I volunteered to handle it on the grounds that his time was too important to spend on trivial matters.” She motioned to the papers Ruark had shown her, and smiled ruefully. “Apparently I gave him too much time.”
“Did you look through his files?”
“No!” She was aghast.
“Then you shouldn’t feel guilty,” he said. “In the meantime, I’ll alert Administration. They’ll probably decide to initiate punitive action.”
She nodded.
“You should also know this, Gina. I don’t plan to shirk my duties.”
“I’m glad to hear it.”
Ruby knocked on the door. “Excuse me, Dr Sutton? Dr Horton is here and—”
Gina heard his raised voice and mentally geared herself for the inevitable confrontation. “He’s not happy,” she finished as she stood. “I’m coming.” Without waiting for Ruark’s dismissal, she joined a blustering Frank Horton at the nurses’ station.
As soon as he saw her, he glared. “What is the meaning of this?” He slapped Janice Myers’s chart with his knuckles.
Gina fell into her ultra-calm mode, the same tone she used to deal with recalcitrant patients as well as staff. “I asked for a surgical consult. I suspect she has appendicitis.”
“I read her chart. From her symptoms, she could have any number of conditions. Check her for food poisoning.” He slid the chart across the counter where Gina caught it.
“Have you examined her yet?”
He frowned. “No. The woman doesn’t need surgery. Have you thought of PID?”
“Yes, I did, but she doesn’t have a history of pelvic inflammatory disease. And if PID is her problem, a laparoscopy would be helpful in the diagnosis.”
“Check for parasites.”
Gina held on to her temper. “I know my job,” she pointed out through gritted teeth. “The test isn’t necessary because her problem isn’t due to intestinal parasites. She hasn’t had any exposure and even if she had, the symptoms don’t match.”
“Surgery is already running behind schedule,” he pointed out. “If she isn’t better by tomorrow—”
“And if her appendix ruptures tonight?” she asked. “Or what if I’m wrong and she has a perforated peptic ulcer, acute gangrenous cholecystitis or some other surgical condition? Are you willing to risk the consequences of waiting another day? Because if you are, I hope you’ve paid your malpractice insurance premiums.”
Frank hesitated. “She doesn’t have appendicitis,” he insisted. “She doesn’t have rebound tenderness and her white count is hardly elevated.”
“Fine. Do a laparoscopy and prove me wrong. I’ll be happy to let you say ‘I told you so’. You can post it on the bulletin board in the cafeteria too, if you’d like.”
“I’m not taking her to surgery.”
“Suit yourself.” She moved behind the counter and grabbed the phone.
“What are you doing?” he asked.
“I’m transferring her to St Bridgit’s.”
“You can’t do that!” he blustered.
“Watch me.”
“But the paperwork! You can’t justify a transfer. There’ll be hell to pay,” he warned.
“Yes, but I won’t be the one paying. As for the paperwork? It won’t be any worse than the paperwork you’ll have if this woman dies.”
“Don’t be so melodramatic.” He sounded disgusted. “She’s not going to die.”
“You two.” Ruark’s voice interrupted. “Bring this into my office. Now.” He delivered his order in a tone that didn’t leave room for argument.
Once inside, with the door closed, he asked, “What’s the problem?”
Frank shot a triumphant look at Gina before he began. Even as he straightened to his full height, Ruark still stood several inches over him. “Gina wants me to perform unnecessary surgery. Because I won’t, she intends to transfer the patient to another hospital.”
“It’s not unnecessary,” she countered hotly.
Ruark raised his hands. “One at a time. Dr Horton?”
Fuming inside, Gina pressed her lips together and began counting to ten.
Apparently sensing the new ED chief would be an ally, Frank ran through Janice’s symptoms and test results to back his diagnosis.
“I see your dilemma,” Ruark said after Frank finished.
Gina gasped, and he continued as if she hadn’t made a sound. “However, it’s been my experience that possible appendicitis is nothing to ignore. If Dr Sutton believes the woman needs a laparoscopy, you should honor her request.”
Frank’s expression changed to disbelief. “But…but—” he blustered.
“Furthermore,” Ruark added, “if you can’t convince Surgery to hold a suite open, perhaps your boss can arrange for one. Dr Ahmadi is the chief of surgical services, isn’t he?”
“Yes, but…” Frank’s face turned red.
“On second thoughts,” Ruark mused, “you don’t appear as if you’re in the right frame of mind to operate. I’ll call upstairs and locate a more co-operative and open-minded surgeon. After I talk to Dr Ahmadi.”
Frank frowned as he squared his shoulders. “I’m a professional,” he said stiffly. “I’ll handle it.”
“I thought you would,” Ruark said smoothly. “Remember this, Dr Horton. Question Dr Sutton’s judgement with such hostility again, and it will be the last time you set foot in this department.”
Ruark’s quiet warning took a few seconds to sink in, but eventually Frank understood. His Adam’s apple bobbed as he swallowed before nodding. An instant later, he grabbed the chart out of Gina’s hand and stormed away.
Gina was speechless. She’d been prepared to defend herself on behalf of Ms Myers, and now that it was completely unnecessary, she felt cheated. She should have been thrilled by the outcome, and yet…she wasn’t. Ruark had defused the situation so handily, she was left with anger simmering in her veins.
“I would never demand a patient undergo unnecessary surgery,” she protested.
“I know.”
“I checked the woman thoroughly. She doesn’t present with the classic symptoms, but my gut says—”
“Gina, I trust your instincts. Frank Horton won’t give you any more trouble.”
He sounded far too pleased with himself, which only added to her ire. “Apparently not,” she replied stiffly.
He frowned. “I thought you’d be pleased.”
“I can fight my own battles, Dr Thomas,” she ground out.
“I’m sure you can, but you weren’t winning this one.”
She advanced. “Do you realize what you’ve done?”
“Saved a patient?”
“How will my colleagues ever respect my opinion if you threaten them should we ever disagree?”
“What did you want me to do? Let him yell at you as if you were a green first-year medical student?”
“No, but—”
“I stand behind my staff, and you, Gina, are mine. I don’t tolerate rudeness and the sooner everyone in this hospital realizes it, the better.”
It took a few seconds for his words to sink in, and when they did, she felt foolish. “I apologize for overreacting.”
“Accepted. We are a team,” he stressed. “Problems that arise aren’t yours or mine. Th
ey’re ours. We are in this together. Remember that.”
His intent gaze and the promise in his voice sent a shiver down her spine. We are in this together. You, Gina, are mine. She might not be an expert at reading between the lines, but she sensed undertones that he had a more proprietorial relationship in mind—a relationship that went beyond a professional employer-employee one.
In that instant, her life seemed to change before her eyes. Whether she wanted it or not, agreed to it or not, he was going to sweep her into something larger than her small world. For a woman who’d managed her life on her own, without anyone’s help or interference, the idea scared her to death.
Desperate to escape until she could regain her equilibrium, she said, “I’ve got to go.”
“Gina.”
She stopped at the door. “Yes?”
“My driver will pick you up at seven.”
“I’d rather drive myself.”
“Not an option. Unless you’d rather we meet at your house?”
Did she want him in her home, filling it with his presence? She didn’t think so. “What if I can’t leave work on time?”
“Then I’ll send the car here for you.”
That option was worse because of the questions it would raise if anyone saw her or realized she’d left her vehicle in the parking lot. The ER staff was a sharp-eyed bunch.
Hating to give in, she had no choice. He’d won this round. “Fine,” she said curtly. “I’ll be ready at seven.”
CHAPTER FOUR
“YOU have a lovely home,” Gina remarked politely after Hugh had delivered her into Ruark’s company later that evening.
“Thank you,” he said. “May I take your jacket?”
She shrugged off the cardigan that complemented her yellow sleeveless knee-length sheath. It had taken her an hour to decide what to wear before she’d settled on this simple outfit, but after seeing Ruark, she wished she’d opted for something more elegant. He appeared informal with the sleeves of his white silk shirt rolled to his forearms and his collar and top button unfastened, but wearing his clothes in such casual abandon didn’t hide the fabric’s quality or the tailored fit.
