A Doctor's Dilemma

by Laura Scott

  Kate rattled off Lifeline’s main number, then left. She threaded her way through Trinity Medical Center’s radiology department until she was outside. The sky overhead was a dark pewter gray, but the clouds didn’t look bad enough to ground them. At least, she hoped not. But as she strode to her car, the winds were high, blowing strands of hair across her face. She peeled them away from her eyes, grateful for the warmth inside her car as she shut the door behind her.

  Lifeline was located right across the street from Trinity, so she was early for her half of Shelly’s shift. Kate figured Jared wouldn’t mind if she did more paperwork, she’d only gotten through the first week of the schedule.

  Inside, she found the Lifeline crew sprawled in the lounge. Ethan caught her gaze, and she entered the room. “Morning, Kate. You are early, aren’t you?”

  Shocked at the way he’d initiated a conversation, she simply nodded. “MRI didn’t take as long as I thought.”

  Ethan’s brow puckered. “Did you get the results?”

  “Not yet.”

  Dirk, the pilot, nodded at her. “Hear you’re the one who let loose with the Silly String.”

  With an inward groan, she nodded. “Yeah? So?”

  Dirk raised his hand as if to ward off the retaliation. “So nothing. I heard it was a disaster and wish I could’ve seen the damage.”

  She rolled her eyes. “I didn’t cause damage. We cleaned up the mess without ruining a thing. Right, Ethan?”

  Ethan raised a brow. Then cleared his throat. “To be honest, I, uh, had trouble getting the stuff out of Carly’s hair.”

  “Really?” She suppressed a flash of guilt, worrying her lower lip with her teeth. “The pink stuff brushed right out of my hair.”

  “I gave Carly a bath first, which made the spongy stuff sticky. Didn’t work as well.”

  “Ugh.” Kate ran her fingers through her straight hair, imagining the mess. Poor Carly. “I guess I should have warned you about that.”

  He shrugged. “I’ll try to get the rest of it out later.”

  Kate wasn’t sure what to make of Ethan’s uncharacteristically laid-back attitude. Where was the tense, overly serious guy from yesterday? Was it possible he was already starting to mellow out? “I can help, if you like.”

  His eyes brightened. “Really? Carly would like that.”

  Shocked speechless again, she simply stared at him. She’d made the offer more out of guilt than believing he’d actually take her up on it. She did her best to hide her reaction. “Great.” Time to change the subject. “Tell me, did you guys fly today?”

  “First thing this morning, we did a hospital-to-hospital transfer,” Ethan informed her. “Our patient was a liver transplant candidate being sent from Brownsville Hospital to Trinity Medical. No problems in flight, the patient was unstable, but we managed to arrive without an issue.”

  “Good.” She should be glad Ethan seemed to be in a much better mood, but she found herself intensely curious about this new, loquacious side of him. If she didn’t know any better, she’d think he’d already gotten the full blast of her humor therapy treatment and had changed for the better. But that was hardly the case as she hadn’t even begun to roll out her plan.

  What had happened since yesterday? Why was he suddenly being so nice to her? Friendly?

  Because he wanted something more from her? Maybe on a personal level? A shiver of awareness clenched her stomach.

  “Jared called, he won’t be in again today. He asked if you would keep working on the schedule until he gets back,” Ethan added.

  Kate nodded her agreement, ignoring the wayward direction of her thoughts. Her job was to show Ethan how to laugh, nothing more. “Did he mention how Shelly was doing?”

  “He said Shelly is doing fine. Just that he needed to stay home to finalize some arrangements.” Ethan shrugged. “I didn’t ask specifics.”

  Understandable, since it really wasn’t any of their business. Yet the Lifeline family was a small one, especially the regular, full-time employees. Residents, like Ethan, came and went, but she and Jared and Shelly had worked together for a while now.

  The phone rang. Dirk picked it up as he was closest, then handed the receiver to her. “It’s Dr. Brooks, looking for you. I’ll be the pilot’s room if a call comes in.”

  “Okay, thanks.” She took the receiver as Dirk ambled out of the lounge. She was aware of Ethan’s penetrating gaze as she spoke. “Hi, Dr. Brooks, thanks for getting back to me so quickly.”

  “I figured you’d want to know your results. You’ll be happy to know there isn’t a rotator cuff tear in your shoulder after all. I’ll send a copy of this report to the orthopedic surgeon. It’s Dr. Hart, right?”

  “Yes, that’s correct.”

  “Good. Just go ahead and follow up with him. I’m sure there is physical therapy of some sort to help with the pain.”

  Relief washed over her. No surgery! Zippity do-dah! “Great. I’ll make a follow-up appointment with them soon. Thanks for letting me know.”

  “No problem.”

  Kate hung up the phone and instantly did a little happy dance. “Woo-hoo! No surgery!”

  Ethan frowned, reverting back to his serious self. “Still, you shouldn’t lift until you’re cleared by the orthopod.”

  “I’ll be careful.” Kate deftly unhooked the shoulder sling and tossed it aside, savoring the freedom of movement despite the flash of pain. “Although, you know very well what they’re going to say. Take it easy but use the shoulder normally and exercise the muscles regularly.”

  “There are specific shoulder strengthening exercises that a physical therapist can teach you to do,” Ethan corrected swiftly. “I did a surgical rotation on ortho, so I know what can happen if you injure it again. I mean it. Stay away from lifting, Kate.”

  “Really? You were in the general surgery residency program?” She pondered this bit of surprising news. ”What made you switch to emergency medicine?”

  Ethan’s expression became guarded, and he stood, shoving his hands deep into the pockets of his flight suit. “Oh, I don’t know, I just didn’t want to spend the next four years of my life in general surgery, then another two to three specializing before going into a private practice someplace.”

  “Really.” She suspected there was more to the story that he wasn’t telling her. “When did you switch? A year ago? After your wife died?”

  His gaze narrowed, and his jaw clenched. “Yes, if you must know, the surgical residency program takes a lot of time. Too much time I can’t afford to spend away from my family. Carly needs me.”

  “Ethan.” Kate took a few steps and placed a comforting hand on his arm. “I understand, and I admire you for what you’ve done for Carly. Didn’t I already mention I think she’s a great kid?”

  For a long moment, he remained stiff and unyielding, then the muscles of his forearm relaxed beneath her fingertips. Reluctantly, she let her hand drop from his arm.

  “Yeah, you did. She likes you, too. In fact, she talked about you last night before going to bed.”

  “She did?” How sweet.

  “Yeah, she wants you to be her friend.” His voice dropped low and husky as if he were asking her out on a date rather than discussing his daughter’s welfare. “She has friends in her classroom at school, but you made such an impression she wants you to be her best friend.”

  “Of course, I’ll be her friend.” Kate was touched by Carly’s response to their Silly String fight from the day before. The little girl’s carefree laughter had sounded wonderful. Could it be that Ethan’s daughter didn’t get enough fun at home? The idea troubled her. “You know, Ethan, laughing is good for the soul. There is actually scientific evidence proving the positive benefits of laughter on the body. I know you and Carly have gone through some very difficult times, but a little bit of laughter in both of your lives will go a long way.”

  She mentally braced for an argument, but he simply stared at her. “You could be right about Carly. I have to
tell you, last night was the first night in months she didn’t wake up in the middle of the night, crying from a nightmare.”

  “Oh, Ethan.” Kate’s heart squeezed in sympathy. “Nightmares are awful.”

  “So how about it?” His gaze held hers questioningly.

  “How about what?”

  “How about getting together on our next mutual day off? To find something fun to do with Carly?”

  Her heart leapt with anticipation. Yet, she knew he hadn’t intended to ask her out on a date. This was for Carly, his daughter. Quickly she recovered from her momentary flash of disappointment.

  “That’s a great idea. We can take Tyler, Jared and Shelly’s son, with us. With Shelly on bed rest, I’m sure she’d appreciate a break. Now, where should we go?” She thought for a moment, then snapped her fingers. “I know, we’ll take the kids to the indoor waterpark at Wisconsin Dells. They’ll have a great time. You will, too,” she added.

  Bemused, Ethan shook his head. “I don’t care about me, I just want Carly to have fun. I’ll leave you in charge.”

  Ha! Little did he know, this was exactly what she’d hoped for. An entire day to show Ethan the value of fun. Obviously, they both cared about Carly, but Kate knew his daughter wasn’t the only one she cared about. Ethan needed to lighten up, too. By the time she was finished with Ethan, he’d be a new man.

  A smiling, laughing, happy one.

  Chapter Six

  Kate didn’t have a chance to pin Ethan down on an actual date for their indoor waterpark adventure because their pagers went off. “Cedar Bluff Hospital is requesting an ICU transfer, a thirty-six-year-old woman with stroke symptoms,” Ethan said.

  “A stroke at thirty-six?” Kate quickly followed Ethan out to the hangar with Dirk right behind them. “That can’t be right. She’s too young.”

  Ethan’s expression was grim as they climbed aboard the chopper and donned their helmets. Kate did a quick survey of the interior supplies, including the flight bag, grateful to see every item was exactly where it belonged. She then pulled out her Lifeline clipboard and began to make preliminary notations as to the details of the flight.

  Slanting Ethan a curious look, she found him staring pensively out the window as if she weren’t there. Puzzled by his troubled expression, she waited until Dirk had them airborne, then flipped on her microphone.

  “Ethan? Are you all right?”

  “Fine.” His tone was curt, and he didn’t smile. His gaze slid from hers, and he didn’t elaborate further. She suspected he wasn’t fine at all, but this wasn’t the time to press the issue.

  Kate pushed another button on her microphone, connecting them to the paramedic base. “Base, this is Lifeline. We’re going to need the transferring physician at Cedar Bluff to call us with report on this patient’s condition.”

  “Ten-four, we’ll get back to you.”

  Kate left the connection open and glanced at her watch. The flight to Cedar Bluff Hospital wasn’t too long, but she would feel better knowing a little more about what was going on with their patient. There had to be more to the story, some sort of significant past medical history or medications the patient was taking to have caused stroke symptoms at such a young age.

  Her mind slid from concern for her patient to Ethan. His reaction nagged at her. Had his wife suffered from something similar? All Kate really knew was that his wife had died of cancer. Cancer wasn’t the same as a stroke, although there were certain types of cancer, leukemia for example, that made a person more vulnerable to blood clots. And blood clots could cause a stroke.

  Or maybe his wife had been about the same age of thirty-six when she had died. Either way, she suspected this flight wasn’t going to be easy for him. She glanced over to where he was seated so stoically across from her, wishing she dared to ask.

  “Lifeline, this is paramedic base. We have the transferring physician on the line. She’ll give you report on the patient you’re picking up. Go ahead, Dr. Gaines.”

  Ethan grabbed the second clipboard. They both listened and took notes as the physician began to provide the patient’s recent history and brief hospital course.

  “Charlene Perkins is a thirty-six-year-old female, recently diagnosed with leukemia. She stopped taking her enoxaparin at home and developed a deep vein thrombosis. After she arrived at the hospital, she showed signs of neurological changes. Suspecting a stroke, we immediately started her on tPA and called for transport to Trinity Medical Center.”

  “What other medications was she on?” Ethan asked.

  Dr. Gaines rattled off several medications Kate recognized as chemotherapy drugs, although cancer was not her specialty. Ethan asked a few more questions, then disconnected the call.

  They were quiet for several long moments until Dirk cued the intercom. “ETA approximately five minutes.”

  Kate set her clipboard aside, then gently took Ethan’s from his hands. He didn’t seem to notice. Within moments, they began their descent onto the helipad.

  There was no more time to talk as they quickly disembarked from the chopper. Before she could get over to help him, he’d pulled the gurney out himself, leveraging it to its full upright position.

  Kate slung the flight bag over her non-injured shoulder, but Ethan quickly took the bag from her and placed it on the gurney. Since Dirk kept the chopper engines running, they couldn’t communicate until they pulled off their helmets and headed inside the hospital where it was much quieter.

  They took the elevator down to the emergency department. When they entered, they could easily pick out their patient because she was the only one with a half dozen hospital personnel huddled around her bed.

  Ethan took charge, his pensive thoughts during the flight pushed aside to focus on the here and now. “Dr. Gaines? Any change in Charlene’s condition?”

  Katie busied herself with switching over the IV fluids to their own helicopter appropriate portable equipment, listening to the conversation as she did.

  “Not really. The bolus dose of tPA has already infused. We just started the continuous infusion.”

  “Hmmm.” Ethan didn’t say anything more as they quickly transferred the patient from the ED bed to their gurney. Once that was done, he pulled out his penlight and checked Charlene’s pupils as Kate finished reconnecting the monitoring equipment. “Her left pupil is still larger than the right, although they both react.”

  “Yes,” Dr. Gaines agreed. “Before we started the tPA, her left pupil didn’t react at all.”

  Ethan took the paperwork from Dr. Gaines, flipping through the information to find the lab values.

  “What about her family?” Kate asked as she finished with the equipment setup.

  “She has a husband and a young son. They’re already on their way to Milwaukee,” the ED nurse answered.

  If not for the way the paperwork in Ethan’s hands abruptly trembled, she wouldn’t have noticed his startled reaction. But he quickly pulled himself together.

  “All set?” He tucked the discharge paperwork beneath the gurney mattress.

  “Yes, we’re ready to roll,” Kate said.

  “Good.” He nodded at Dr. Gaines, then pulled the foot of the gurney as Kate pushed from the head of the bed. Her shoulder protested the movement, but she ignored the pain. Clearly, her minor injury was nothing compared to what this patient was suffering.

  She didn’t think she winced at all, but Ethan suddenly pulled on the gurney hard enough that she didn’t have to do anything more than steer as they rolled out to where Dirk waited in the helicopter. When he saw them coming, Dirk jumped out and met them at the rear of the chopper.

  Kate tried to motion him back, but he didn’t pay any attention, quickly helping Ethan lift the patient into the back hatch before nimbly jumping back into the pilot seat. Kate wasn’t required to do anything more than shut the hatch behind Ethan and their patient with her good arm, then climb in the side door.

  Within moments, Dirk informed them they were ready to lift off. Kat
e carefully put the headphones over Charlene’s ears, then rested a comforting hand on her arm as she spoke.

  “Charlene, we have you safely tucked inside the Lifeline helicopter. You’re on your way to Trinity Medical Center. I don’t want you to worry about a thing. I promise you are in good hands. We’ll only be in the air for about thirty minutes, maybe less.” Kate took Charlene’s left hand in hers. “If you can hear me, Charlene, squeeze my hand.”

  To her surprise, the small hand tightened around hers.

  “Great! I’m so glad you can hear me. Now, if you’re having any pain, squeeze my hand.”

  The hand in hers didn’t move.

  “Okay, then. You’re going to be just fine. Rest now and let us take care of you.”

  Ethan frowned at her, then proceeded to perform another neurological exam. Kate wondered why he was upset with her. Had she done something wrong? For the life of her, she couldn’t think of what.

  Between them, they kept a sharp eye on Charlene’s neuro status. Halfway to Trinity, she began to have respiratory problems.

  “Her pulse ox is dropping.” Kate double-checked the portable vent settings. “I wish we could listen to her lungs.”

  “Try hyperventilating her.”

  Kate followed Ethan’s direction. “Think she threw a blood clot to her lungs?”

  His troubled gaze met hers. “Maybe. From the look of her labs, she could be on the verge of DIC. Maybe she’s septic as well.”

  “She’s not running a fever, but that doesn’t preclude the possibility,” Kate agreed. “Should I give her another bolus of tPA?”

  “Not yet.” Ethan cued his mic. “Dirk, how soon will we arrive at Trinity?”

  “ETA ten minutes,” Dirk responded.

  Ethan hesitated. “If her pulse ox doesn’t improve with hyperventilation, we’ll bolus her again.”

  Kate nodded, grabbing the Ambu bag. “I hope this works.”

  She disconnected Charlene from the portable vent and began giving her manual breaths with the Ambu bag. She and Ethan both watched the pulse oximeter readings. After ten breaths, the pulse ox hadn’t budged one bit. Their patient still had dangerously low oxygen levels in her blood.