Critical Care (27 page)

"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 urgent 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."

The ambulance crew swept past Claire and into the code room, two
paramedics hustling the stretcher and a big firefighter in yellow
turnouts trotting alongside, holding the IV bag shoulder-high.

The patient's face was covered in blood, her fair hair matted
with it. A significant scalp wound likely. A stiff orange foam collar
protected her neck, and much of her face was obscured by an oxygen mask attached to a high-flow bag. Her clothing cut away, she'd
been partially covered by a silver foil survival blanket. A cardiac
monitor lay wedged alongside her on the gurney. The woman's
skin, beneath the dried blood, was pale-sickly pale. And her small
hands motionless.

Claire's pulse quickened. She watched from the doorway
as Logan talked with paramedics before starting his exam. Erin
attached the ER's monitoring electrodes and switched the oxygen
tubing from the portable tank to the wall source. Keeley took the IV
bag from the firefighter and hooked it carefully onto a pole. Claire
turned her attention back to the woman on the gurney, feeling irresistibly drawn and horrified at the same time. Her mouth went dry
and leg muscles tensed as her heart rate accelerated-adrenaline,
effective as an injection straight into her bloodstream.

Claire focused, seeing nothing but the trauma victim who
remained completely still, without response to Erin's touch as she
adjusted the oxygen mask. Claire leaned forward slightly, staring
at the patient's chest to be sure it was still moving. It was, thank
goodness. If her chest hadn't been moving, this poor, waxy-pale
woman would look like she was already dead.

Claire grabbed the doorframe against a sudden and crippling
wave of dizziness. No, don't. Don't. I don't know this patient. It's not
Kevin. It's a stranger.

"Logan!" Erin cried out. "This is Sarah!"

"Sarah?"

Someone called her name, but Sarah didn't dare lose her concentration. The bicycle was wobbling and the pedals so hard to
reach. She needed to sit up tall, hold on tighter, steer with everything she had or she'd crash again. And the pain was too awful to
let that happen. If only she wasn't alone. Are you there, Daddy? Are
you holding on to me?

"Open your eyes, Sarah." That voice again, deep, strong. And
a touch, warm and gentle against her face.

Daddy?

"That's my girl. I need to check your eyes now-hang in here
with me."

Sarah squinted into the pinpoint light, struggling to focus. So
bright. Too bright. It hurt her head and made her eyes water. She
blinked and tried to see beyond. Blurry faces, people gathering
around. More lights, glowing like ...

A sob rose in Sarah's chest, setting off a spasm of pain, but she
smiled anyway. The joy was far stronger than the pain. She shut her
eyes, warm tears sliding down her face. Lights. Of course. The glow
from a hundred brilliant candles. Emily's birthday party.

You didn't forget us, Daddy.

Erin watched as Logan left the code room. It had been forty minutes since Sarah arrived. It seemed like forty years. And it was killing her not to be at that bedside, but she'd had to delegate Sarah's
nursing care to Keeley Roberts. They were still on disaster status,
and Erin was in charge. She was required to be free to oversee the
department. As for Claire, Erin wasn't sure what was going on with
her. Except that she'd turned white as a ghost when the Code 3
ambulance arrived and then kept her distance from the resuscitation room like it was full of rattlesnakes.

Erin looked up as Logan approached the desk. "Well? How's
Sarah doing?" she asked. Logan's immediate frown nearly stopped
her heart. "What? Has something changed?"

"No, Sarah's fairly stable. I don't like her heart rate yet, and
those rib fractures could be a problem, but the brain CT report is
back-it's normal." Logan shook his head. "The concussion made
her so blasted squirrelly. She asked me if her little girl was okay. I
was thinking, her little girl? She doesn't have a child. It really threw
me until I realized she was probably asking about the five-year-old
from the school van. The kid we treated for the wrist fracture. Sarah
must've heard the medics talking about her." He was quiet for a
moment, a muscle bunching along his jaw. "She nearly killed herself to avoid hitting that van. You know how Sarah is about kids."

"I do," Erin said, remembering Sarah coming in during that night
shift to help with the babies. The same day she fell asleep at work and
Erin sent her home-after she'd had a bout of near fainting and that
strange late arrival for work. Erin's stomach twisted against another
wave of guilt. Something had been going on with Sarah, and she
hadn't paid attention. Could I have prevented this? Could her judgment be trusted at all these days? Look at the fiasco with Brad; didn't that prove it? Erin pushed the thought aside. If she started down that
path, she'd be worthless, and today everyone had to be right on target. She sighed, thinking out loud. "I should go relieve Keeley."

Logan's frown returned. "Do better. Replace her. She's slow.
And indecisive too...."

Erin narrowed her eyes. "Give me one concrete complaint."

"I don't trust her."

"It's Keeley's second day. She's completely qualified. And she's
doing great considering we've thrown her in on a critical trauma
when she was supposed to spend several days in orientation, following Sarah around." The irony of the situation hit her like a
punch in the gut.

Logan flattened his palm on the desk. "My point exactly. It's
Sarah in that bed. One of the few nurses I'd trust completely with
a critical patient is that critical patient. If things go south, I want a
nurse assigned to Sarah I can count on. Make that happen."

"I don't have anyone to offer right now. Look, I'll be with
Keeley as much as I can. I promise. You know how much I care
about Sarah. But I'm also responsible for troubleshooting out here,
answering the radio, and overseeing triage until our disaster status is cleared." She pressed her fingers to her forehead. "Merlene
thinks she might be able to pull a nurse from ICU, but until then
I'm afraid you'll have to deal with-"

"Give me Claire," Logan said abruptly. "Put her in with Sarah.
Keeley comes out here with you. Problem solved."

Erin hesitated. How could she tell Logan that forcing Claire
back into critical care nursing might be the worst solution of all?
"I don't know if she'll agree to that. I could ask, but-" She halted
midsentence, turning toward the nurses' station as the medic radio
began to shrill.

"Sierra Mercy, this is Medic 5. We're coming in Code 3 with a
bystander from the accident site. Seventy-year-old male in thirddegree heart block. Hypotensive, diaphoretic, and complaining of
chest pain."

Erin's mouth sagged open. "Unbelievable." She turned to Logan, a
game plan already whirling in her brain. "Okay, it's like this: we set up
cart two with the backup crash cart; I'll page respiratory therapy."

Logan nodded, the look on his face defying argument. "Assign
Claire to Sarah. Right now."

"Sarah? It's Claire. You're going to be all right. I'm here." Claire
studied the overhead monitors, her heart leaping to her throat.
Sarah's pulse rate was fast-114. Why was it climbing? How many
liters of oxygen were running? Claire's gaze flicked to the oxygen
gauge on the wall beside the bed, then back to Sarah's chest to
count the rate of her breathing. Twenty-eight. Had it always been
that labored? Was her skin paler than before? You know I can't do
this, Lord. It's so far outside the plan.