Amy claps her hands together while fighting back tears, and for a moment she can’t speak. She feels Ellis quietly rub her elbow from beside her.
Jeffrey’s dad explains how his son spent a month in neuro intensive care in London, then moved to a rehabilitation center. It’s only in the last week, he says, that Jeffrey began to walk and talk again. It won’t be a complete recovery, he says, “but it’ll be close enough. And the best part is that he’s home now, with us.”
Amy hugs Jeffrey before he climbs back into his wheelchair, lets his parents hug her again too. “Thank you for coming in,” she says.
“Thank you,” Jeffrey’s mom says.
After they’ve gone, Kate shakes her head at Ellis and Amy, but she’s grinning. “Ellis, don’t ever let Amy deny that saving that kid was the best work she’s ever done. I mean, freakin’ brain surgery! Ames, you’re a bloody rock star, and don’t you forget it.”
“Yes, mom.” Rock star? Nope. But yeah, she’s a pretty damned good surgeon, and she’s going to remember this boy for the rest of her life.
“I want,” Ellis whispers pointedly, “to hear a lot more about this.”
Chapter Twenty-Six
Ellis opens the oven to check the chicken-spaghetti casserole for about the sixth time in the last twenty minutes. It still has awhile to go, but she needs something to do with her nervous energy. Amy will be here any minute. She knows instinctively tonight will be a watershed moment for them, because they’re going to talk—about everything. She has no idea how Amy’s going to react. She doesn’t even know what she’s going to say to Amy any more, because everything has changed. It was seeing that little boy and his parents. Ellis can’t explain why the current of her thoughts has shifted so drastically.
She’s always understood that severe changes to the services a hospital offers result not only in inconveniences to patients, but sometimes death or at least less desirable outcomes. It’s a tough reality of such decisions. Removing or cutting back on emergency department hours almost certainly leads to patient deaths—that one’s a no-brainer. But the less headline-grabbing changes, like removing obstetrics or certain surgical procedures, can lead to an exodus of doctors and nurses who no longer want to work in that environment, prompting patients to lose confidence in the hospital too. It’s a vicious circle.
Ellis opens a bottle of red wine to let it breathe. She can’t get that little boy Jeffrey out of her mind—his sweetness, his gratitude. And to see him push himself out of that wheelchair and walk a few steps was nothing short of amazing. She didn’t miss the emotion in Amy’s voice and in her eyes either. Without Amy, without the hospital’s ER and its staff, without well-trained surgical staff too, that boy would surely be dead, and Ellis can’t pry that thought from her mind. Jeffrey is not a statistic, he’s a little boy with his entire future in front of him, and Ellis isn’t cold enough to offer up cuts to the board that will decimate the hospital and kill a kid like him. She doesn’t want blood on her hands. But if she doesn’t offer up something, the county hospital board is going to start arbitrarily chopping things because there is no other choice. The hospital has a deficit and the government has made it clear that it will not throw more money at hospitals. Which isn’t fair, because fixed costs like heating and electricity and salaries all go up. Find a way to make do with what you’ve got is the common mantra.
Ideas have begun germinating in Ellis’s mind, but she has days, maybe weeks of research, before she can hammer and chisel them into something worth putting down on paper. It’s a long shot, what she has in mind, but it’s her duty to look at everything, to put as many options on the table as possible. For the first time since she began this review, she feels like solutions are at her fingertips—real solutions that everyone can live with.
The doorbell rings and her stomach does a pleasant little flip. She smiles as instinctively as taking a breath because it’s Amy at the door. “Hi, Amy. Thanks for coming,” she says, because if she doesn’t say something, she’s going to rush into Amy’s arms and kiss her.
“Hi.” Amy’s eyes rake over her, leaving Ellis light-headed. “You look great, Ellis.”
“Thanks. You’re a sight for sore eyes yourself. Come in.”
Amy hands her a bottle of red wine. “Wow, something smells delicious. I guess you probably have figured out by now that I don’t have a lot of time to cook.”
Ellis laughs. “In other words, you’d like anything I cook for you?”
Amy’s eyes do that top-to-bottom sweep of her body again, and it’s all Ellis can do not to throw herself at her. “My mouth is watering, if that’s any indication.”
Watering for what, Ellis wants to say but doesn’t, in case Amy doesn’t want to take the flirtation further. She can’t decide from hour to hour these days whether Amy wants to rip her clothes off and jump her bones or throw her on a raft and cast her out to sea. “Glass of wine?”
“Love one.”
They stand around the kitchen island as Ellis pours them each a glass. She has never fallen for someone before who is so closely aligned with the work she does, and she’s doing a shitty job of handling it. She knows she should demand that she and Amy put their relationship above anything that might happen at the hospital, that they separate the two things. But rarely do ultimatums work. It’s obvious that neither of them is going to give in, is going to volunteer to put their work second, but she’s hopeful they can find a way because of Amy’s words the other day—that she misses her and cares for her. It’s something to build on, and dammit, she’s going to grab onto it with both hands.
Ellis fusses with the garlic bread while they make small talk about Mia, about Amy’s parents, about Kate and Erin, until it’s time to plate up. Amy tucks into the casserole like she hasn’t eaten in a week.
“You like?” Ellis asks.
“I love. I’m a huge pasta freak.”
“Good. So am I. Hey, that boy, Jeffrey. The brain injury kid? I can’t get him out of my mind. Would you tell me what happened?”
Amy walks Ellis through that day, admits her lack of confidence almost paralyzed her until she decided that Jeffrey had nothing to lose and everything to gain, that she would be letting him down if she didn’t try. “It’s like this. If I didn’t go for the home run swing, the game would have for sure been lost. It actually made the decision simple.”
“And did you expect him to recover so well?”
“No. I figured his best outcome would probably be non-verbal with the cognitive abilities of a three-year-old. And I certainly never expected him to walk again.”
“Seeing him and his parents, how grateful they were, boy, it’s humbling. How does it make you feel, knowing you not only saved his life, but saved who he is? And that you saved his family from the worst kind of heartbreak?”
Amy twitches, clearly uncomfortable talking about herself this way. “I don’t know. Thrilled, of course. Surprised but thrilled. And…happy that it worked out.”
“Amy…” Ellis shakes her head. And here she thought surgeons were supposed to be a bunch of arrogant prima donnas. “If you hadn’t been there—”
“I did my job. And I happened to do it well that day, with lots of help. But mostly it’s because the hospital was there. Because we have an ER and surgeons and surgical staff and nurses and—”
“I know, Amy.”
“Then why can’t this be easy? Why can’t we find a way to keep the things we do well here?”
Ellis swallows her doubts and states boldly, “I think we can.”
“What do you mean?” Amy can’t possibly have heard correctly, because until now, Ellis has made it clear that drastic changes to the hospital are needed. Which, in Amy’s experience, is always code for major service cuts.
“Come on, let’s go sit in the living room.”
The anticipation is killing her, but Amy follows Ellis into the living room, sits on the sofa while careful to leave space between them. She places her glass of wine on the coffee table and waits for Ellis to
continue.
“I think I’ve been going about this all wrong.”
What? Is she talking about us or the hospital? And that’s the problem in a nutshell right there, Amy decides. She never knows where the lines are with Ellis, because sometimes they’re drawn in sand that quickly shifts or washes away and sometimes they’re as thick as the Great Wall of China.
“In my line of work,” Ellis continues, “it’s almost always about cutting services, because let’s face it, funding has been static now for a few years while costs keep going up. I mean, of course we can nickel-and-dime things, like adding more self-check-in kiosks or increasing parking fees, charging a patient a dollar or two every time an ER doc has to write them a prescription. But we both know that’s not going to be enough here. It’s poking a hole where we need to dig a trench.”
“You’re scaring the hell out of me.”
“Sorry, I know. And you had a right to be scared.”
“Had? Past tense?”
“Hopefully.”
“You want to tell me what’s going on in that big, sexy brain of yours?”
“It’s actually quite simple. I’d been so fixated on the expenditure column that I ignored the revenue column. I mean, that’s oversimplifying things, but I know what the revenue column looks like, and it’s pretty flat with very little flexibility. We have government funding, and then we have things like parking fees the hospital can charge, community fundraising for equipment, a few small nickels and dimes here and there, but that’s it.”
“Okay. So what are we missing?”
“That’s exactly what I’m talking about. I was missing a key part of the solution. Or what could be the solution to this whole problem. And it requires an entirely new approach.”
Amy takes a sip of wine for something to occupy her hands. She’s going to go crazy if Ellis doesn’t spit it out.
“What I was missing was this: Your hospital could keep everything it has if only it can bring in enough revenue to help offset its costs.”
“We don’t allow for-profit care. That’s—”
“I know. I’m talking about adding instead of subtracting.”
“You’ve lost me. You already said that things like parking fees aren’t enough.” Amy’s hopes for a solution are perilously close to crashing again.
“Sorry. I’m talking about adding programs that will bring in government revenue. I’ve got about a million ideas, none of which I’ve worked out all the nuts and bolts for yet, but here’s a few. The way the hospital pairs with training family physicians such as Erin Kirkland could be the tip of the iceberg. More medical schools, nursing schools, pharmacy schools, social work programs, and so forth could pair up with the hospital, providing not only bodies, but much needed money in return for teaching their students. Even paramedic programs. Become a teaching center, because those are tremendous streams of revenue. And there’s more. Did you know there’s more than three thousand square feet of unused space in the hospital? Why not rent that out to a physiotherapy provider or even a dentistry business? The hospital would get monthly rent and it would bring hundreds more people into the facility each week, with all those people having to pay for parking.” Ellis is practically vibrating, and she’s talking with such conviction that Amy has no choice but to be swept along with her. “Then there are programs, a whole host of publicly funded programs the hospital could apply for. Again, it would bring in money that would help pay for staff, help pay for the electricity that keeps the lights on.”
Amy keeps her voice neutral. She’s afraid to get too excited. “What kind of programs?”
“There’s a two-year pilot project on offer right now for hospitals that want to take on a cardiac rehab program. Patients recovering from heart attacks come in a couple of times a week for a checkup, plus an exercise program, they learn about nutrition, talk to a social worker and so on. Staff are usually contracted out for this part—nutritionists, physiotherapists, social workers—but my research shows that the nutritionist you already have on staff could easily absorb this into her workload. Same with the physio assistants. Social workers could be students doing a co-op placement here. This would all be extra money in the hospital’s pocket, and the cardiac rehab program pays $250,000 a year.”
Amy whistles. “That’s enough to pay the annual salaries of three nurses.”
“Exactly. There are other possibilities too. What’s to say this hospital can’t become a regional center for colonoscopies? Right now, four hours a week of OR time is devoted to colonoscopies. Suppose all the hospitals under this regional umbrella could be convinced to hand over their colonoscopies to Erie Shores, increasing the OR hours from four a week to, say, twenty. Bingo, you’ve brought in enough revenue to hire another surgeon and probably another OR nurse.”
“Holy crap, Ellis, you’re right. Our operating rooms are idle thirty-six percent of the time. If we could keep them going five or even six days a week, twelve hours a day…”
Ellis’s grin is the most beautiful thing Amy has ever seen. “Wait, I’m not done yet. There are a dozen extra beds in the hospital that haven’t been used in years, since a previous round of cutbacks. The county badly needs more palliative care beds. Voila. Turning four of those beds into palliative care beds would bring in another half a million dollars a year in funding.”
Amy’s nodding, unable to contain her enthusiasm. “So you’re saying maximize our space, maximize our staff to bring on board programs that the government is happy to shell out money for, turn this hospital into a money generator instead of a money loser.”
“Absolutely. I’m also thinking of suggesting an IT consultant be hired to introduce new software programs that could scale down the workload in administration, meaning downsizing a body or two in that department. For instance, the average proportion of costs devoted to administration in Canadian hospitals is 12.4 per cent. At this hospital, it’s 13.5, so we need to get that figure down.”
Amy’s stunned into silence.
“I think we could do these changes quite easily here,” Ellis says. “It’s going to take a few more weeks of research for me to get everything down on paper, but I know there’s money out there for hospitals. It’s a matter of doing the right things, doing the things the government of the day decides is a priority, and then being flexible enough to adapt. We can’t keep doing things the way they’ve always been done and expect the money to keep rolling in. It’s about—”
Amy leaps across the space between them and kisses Ellis on the mouth. “You’re brilliant, do you know that?”
“Well, I don’t know about brilliant. But will you give me genius?”
Amy laughs and kisses Ellis again. “I love you, Ellis Hall.”
Ellis’s eyes widen almost comically, but so be it. Amy’s said the three magic words and she’s not going to take them back no matter what Ellis says next, because you know what? If Ellis feels differently, well, it does nothing to change how Amy feels. It’s done, she’s put her heart on a silver platter for Ellis. And she will survive it.
Chapter Twenty-Seven
“Amy, are you sure?”
They’re still sitting on the sofa, but closer so that the lengths of their bodies are touching.
“Sure of what?”
“That you…love me?” The urge to touch Amy is irresistible, and Ellis raises a hand to her cheek, cups it lightly, hopes it conveys the tenderness she feels toward this woman.
“I am. And I do.”
“Oh, sweetheart.” Ellis chokes on the sob rising in her throat. “I love you too. I’ve been in love with you ever since those Thursday afternoons at the hotel.”
Amy holds her tightly; they’re both choking back tears.
“I didn’t dare to hope that…you would be able to love someone again,” Ellis says. She hadn’t expected the declaration, not yet. “It’s…thank you for being so brave.”
Amy pulls back to look Ellis in the eyes. “It’s not bravery. It’s being smart for a change. And it’
s about growing up and getting over myself. People get hurt all the time in relationships. Mine didn’t work out. And yeah, the things Lisa and I went through sucked, especially for her, but when I see a kid like Jeffrey and his parents pushing on, moving forward, having hope, how can I not do the same thing in my own life? I’d be stupid to let you go. And I’d regret it for the rest of my life.”
Ellis places both hands on Amy’s face, pulls her into her, and kisses her again. Tenderly. She’s so in love with this fabulous woman, it shocks her. Shocks her because she’s never felt this way about anyone before, never thought she was capable of it, never thought she’d find someone worthy of her love. The stuff in movies and romance books? She always swore it was a bunch of drivel fabricated by the entertainment industry, a fantasy completely unattainable for all but the very lucky. It was never truly something she thought would be in her future, because she wasn’t a sucker like everyone else. Well, she thinks with satisfaction, who’s the sucker now?
Amy looks at her funny. “What are you chuckling at?”
“Myself. I never thought I’d be a mere mortal who actually fell in love.”
“And now?”
Ellis grows serious. “Now I think falling for you is the best thing I’ve ever done in my life.”
Amy kisses Ellis again, slowly, then trails her mouth along her jawline, planting soft kisses with a touch that’s featherlight. Ellis tingles everywhere, so exquisite is Amy’s touch. “I want you so much it hurts.”
Ellis has to work at finding her voice. “There’s…so much we still need to talk about.”
“Not now. Oh, so not now.”
Ellis laughs, takes her cue, and jumps up from the sofa. She holds out her hand to Amy. She wants to worship her lover’s body, and damn, it’s been far too long. The rule they made about not sleeping together until her report’s finished…well, she can’t not make love to Amy after all this. She’s throbbing and wet and her voice is a low rumble when she says, “The bedroom’s this way.”
Thursday Afternoons Page 22
