Critical Care (4 page)

Claire dragged her pen under several key words, underlining
them three times with the same red ink she'd used on her lists of
career plans. She was relieved that so far the staff-from the physician's assistant in the adjacent urgent care clinic to the admitting
clerks-seemed to be in fairly good shape, considering. Even Inez
Vega, who'd thanked Claire for the pamphlet and put the baby
blanket into a bag to give to the nurses. She'd sighed with relief,
along with Claire, when the Hester family's pastor hurried through
the waiting room doors.

The laboratory technician Erin said had fainted had admitted, with some embarrassment, that her swoon had been caused
by a newly diagnosed pregnancy, not emotional trauma. And the
agency nurse who'd threatened to abandon her shift hadn't. But
she'd told Claire in no uncertain terms that she would be speaking
with her supervisor regarding unacceptable working conditions at Sierra Mercy Hospital. Hinting, of course, that the conditions had
everything to do with one Dr. Caldwell.

Claire glanced away from her makeshift desk in the ER utility room and toward the open door of the code room only yards
beyond. The resuscitation had been continuing for more than forty
minutes, and even from a distance Logan looked powerful and in
control. She watched his big shoulders hunch abruptly, his head
lowering as he leaned over the waxy, still body of the unconscious
woman on the gurney. Grade school teacher, an admitting clerk
said. Collapsed on a playground full of kids. Claire's throat tightened, thinking of Kevin's fiancee, a school counselor. Gayle. Who'd
dressed for a funeral instead of a wedding.

Logan pressed his fingertips against the side of the teacher's
neck, checking for a carotid pulse as he watched the rhythm on
the cardiac monitor. He grabbed the paddles of the defibrillator,
pressed them against her chest, and delivered a shock. Her body
jerked and was still; then he checked the pulse again, nodded, and
waved his arm.

There was a corresponding flurry of scrubs as nurses and technicians responded, pulling medicine vials from the crash cart,
running monitor strips, and tearing open bags of IV fluids. Claire
didn't have to hear it to know Logan was shouting orders or that
this woman's life hung by a slender thread. Just as Kevin's had that
awful day.

Images rushed back faster than Claire could filter them. Sounds
too. The ones that still filled her nightmares: sirens, clattering
buckles on an ambulance stretcher, the stuttering rip of trauma
scissors against a hopelessly charred uniform, and a futile hiss of
oxygen. Her escalating horror in searching for her brother's heartbeat-wrist, neck, finally by pressing her stethoscope against his blistered chest-and finding none. Then her own voice screaming, screaming ... Oh, please. No. This department was stirring too
many memories; she had to get out.

Claire forced herself to her paperwork and wrote some notes for
Merlene Hibbert, the chaplain, and the social worker. She looked
up as someone spoke from the doorway.

"Claire?"

"Yes, come in." Claire smiled at a petite woman in her midtwenties wearing a rumpled scrub dress printed with angels. Her
shoulder-length blonde hair was tucked haphazardly into a huge
clip, and freckles dusted the bridge of her nose. Her fair lashes were
barely visible, making her look wide-eyed and childlike. Claire had
noticed her taking over Jamie's burn care and then again in the
code room. A nurse-an incredibly efficient one from what she'd
seen. Thankfully she was the very last person on the interview list.
This nurse was Claire's ticket out. "You're Sarah, right?"

"Sarah Burke," she answered, extending her hand. Her fingers
trembled slightly as they met Claire's and then steadied into a firm
grip. Her other hand clutched a Diet Coke can. Caffeine, emergency department lifeblood. Claire understood. "I know you were
looking for me earlier, but ... I haven't had time for a break." She
gave a short laugh and patted the pocket of her scrub jacket. "Good
thing I'm packing M&M'S."

"You bet." Claire knew all too well the demands of a busy shift
and how things like meals and even bathroom breaks got pushed
way down the priority list. Adrenaline was a rugged enough taskmaster without the infamous Dr. Caldwell. "So how did things go
with the resuscitation?" Claire asked, moving slowly according to
protocol. She'd start with the current situation and feel her way
toward the critical incident with the day care children.

Sarah sighed. "She's on a ventilator, but the heart rhythm finally
looks decent. It kept going back into pulseless V-tach, so we gave a
bunch of meds: epi, amiodarone, magnesium ... bicarb. Shocked
her a lot. She went to CCU on an amiodarone drip." She glanced
down at her slim fingers and shrugged. "Out of our hands now."

Claire turned toward the code room, eerily empty now that
the resuscitation team had moved the patient to the CCU. An
elderly housekeeper wearing a knee brace over purple denim scrubs
pushed a broom to clear the residue of lifesaving procedures: discarded tourniquets, syringe caps, iodine swabs, gelled defibrillator
pads, and monitoring electrodes. The patient's clothing, snipped
from her body by the paramedics, lay in a heap in the corner of the
room. It looked like a soft pink tweed pantsuit, carefully chosen for
a day ending in a way this teacher would never have dreamed.

Claire looked away, fighting the image of Kevin's uniform suspenders and his pewter cross on its knotted leather cord lying on
a sooty pile in that Sacramento trauma room.

"I know you want to help us," Sarah said. Her voice was husky,
soft. "But I don't have time for-"

The PA crackled overhead and Sarah jumped, startling as if
stung and sloshing her Coke onto her scrub dress. The system
droned a simple page, and her shoulders relaxed. "Sorry," she murmured, her face coloring as she turned back to Claire.

Sarah set the can down and reached for the paper towel holder
on the wall, snatching a handful and mopping at the front of her
scrub dress. "Really. I'm already late for my overtime shift upstairs.
Besides, I'm fine. Did someone say I wasn't or something? Not Dr.
Caldwell?"

"No," Claire said quickly, reminding herself that peer counseling was free of fact-finding or implied blame. Not that there had been anything amiss. It was simply a release valve for staff, a
pulse check for the caregivers. Acknowledge, validate, reassure. "I'm
just here to see if there's anything I can do to help any of you."
She paused and smiled gently. "The explosion at the day care, the
injured children, and the one who died. . . " She watched Sarah's
eyes for a reaction. "It's normal to feel strong emotions related to
that, even days afterward, so I'd like to offer-"

"I'm fine," Sarah interrupted, reaching for her drink. "I've been
in the ER for a couple of years now. Nothing gets to me much
anymore." She took another halfhearted swipe at a soggy angel
before folding the towel and pressing it to her forehead. "Can I
just go now?"

Claire touched her notes, making certain she'd covered all the
bases. "Would you mind telling me what your part was in the day
care incident today?" she asked, knowing that having a person
retell the event allowed the related emotions to surface in the process. Exactly why she never talked about Kevin-to anyone. "Were
you assigned to the child who died?"

"Yes," Sarah said, her eyes meeting Claire's directly for the first
time. "But I was also part of saving the kids who lived. That's what
I'm remembering. Only that. Look, I'm a nurse." She shrugged and
tossed her empty can in the wastebasket. "I do what needs to be
done. Then I come back the next day and I do it all again. Except
for those lucky days when I get to do it for two shifts in a row. And
that's today. Honestly, I'm fine and I've got to go." She smiled ruefully. "Literally. I'm heading to the bathroom next door."

Claire smiled back, despite a sinking feeling that she'd done
nothing to help this woman. Offered her exactly ... zip. But Sarah
seemed to be made of stronger stuff than most. Some people were.
What was it that Logan Caldwell said earlier? "Tough comes with the territory"? Yes, and maybe Sarah was simply asking the same
thing he had: "Do you see me crumbling here?" It was possible that
Sarah Burke and Logan Caldwell were simply two tough cookies.
Who was Claire to argue with that?

"May I at least offer you a pamphlet?" she asked. "Maybe some
tips for taking care of yourself: exercising, eating right, avoiding
alcohol?"

"No thanks." Sarah gave Claire a thumbs-up. "I'm good."

"But. . ." Claire waved the trifolded paper at the nurse's retreating back and watched until the angel scrubs disappeared down the
hallway.

It was her farewell salute to Sierra Mercy ER. Back to the plan
for her future.

Half an hour later, Claire finished her notes and gathered her notebook and papers, realizing as she tucked them into her briefcase
that she was totally exhausted. Bone-deep, like she'd just finished
one of her long runs through the oak-studded foothills. Nerves, she
supposed, from being in an ER after dreading it for so long. Still,
she hadn't done so badly, had she? It was after four o'clock, and all
that was left was to leave a reassuring voice mail for the hospital
chaplain. She could do that from the education department.

An earlier conversation with Merlene made Claire fairly certain
she'd scored points by going the extra distance in ER. Not that she
was going to make it a habit. But the director of nursing's opinion
might help in Claire's bid for the full-time clinical educator position. In truth, it could all dovetail nicely with her plans.

Claire turned toward the sound of footsteps, which was followed by the rich, enticing aroma of coffee.

Erin Quinn stood in the doorway. "Figured you could use this," the charge nurse said, stepping in to hand her a plastic-topped
cardboard cup. "Raspberry mocha."

"Wow, wonderful. Thanks." Claire noticed that Erin's ponytail
was gone, allowing the nurse's copper hair to spill casually across
her shoulders. She'd pulled a zip-front white hoodie sweatshirt
over her scrubs and carried a red stenciled canvas tote over her
shoulder. End of the day for Erin too.

Claire spotted the familiar green label on the coffee and
grinned. "Starbucks? Where'd you find something like that in a
joint like this?"

"Gift from an ambitious pharmaceutical sales rep," Erin
explained, then shook her head. "A real sales rep. Look, I'm sorry
Logan called you a rep and made fun of your pamphlets."

"Not a problem," Claire fibbed with a wave of her hand. The
last thing she wanted now was a discussion about Logan Caldwell.
She'd survived her first brush with Dr. McSnarly relatively unscathed
and was finally just minutes from her last walk through this department. "It all worked out," she reassured Erin with a genuine smile.
Then she tipped her head sideways, studying the artsy stencil on
Erin's tote bag. It was sort of like a genie lamp-no, more like the
old Florence Nightingale nurse's lamp but with the symbol of a
cross in the handle. "What is that?" she asked, pointing to the
white design.

"Huh? Oh, this." Erin slid the strap off her shoulder and turned
the bag so Claire could see. "I designed it myself. Sketched my grandmother's graduation lamp. I've even put it on some T-shirts."

Claire looked closer. A Florence Nightingale lamp overlaid with
a cross.

Erin pointed to the design. "It says, 'Faith QD.' You know, medical shorthand for 'every day,' the way medicines and treatments are
ordered. Kind of a play on words."

"Pretty ingenious," Claire said, impressed. "But what's it for?"

"It's a new idea I'm trying out," Erin answered, her green eyes
lighting up. "A nondenominational Christian fellowship group for
nurses, aides, techs, doctors, anyone really. Nothing that could be
viewed as pushy or preachy. But something to sort of jump-start
our days. Anyway, we've been meeting in the chapel fifteen minutes before our shifts start. Logan calls it my God huddle, but-"
She glanced at her watch. "Oops."

"Gotta go?"

"Brad's picking me up. New guy, and he doesn't get it that a
charge nurse's shifts don't run like clockwork. I'm breaking him in
gently." She touched Claire's arm. "Hey, I appreciate your doing the
peer counseling today. Really. And if you want to stop by Faith QD,
you know where to find us. Just say the word and I'll order you a
T-shirt." She hoisted the tote over her shoulder and strode away,
leaving Claire feeling suddenly very alone.

She took a sip of her coffee, savoring the berry-sweet cocoa
flavor and wondering how this gutsy and dedicated charge nurse's
idea for a hospital fellowship would play out. Claire frowned at
Logan's cynical and sarcastic remark. God huddle. But then, Claire
already knew Erin well enough to believe she'd move ahead with
it, no matter what the insensitive ER director thought.

And Claire was just as sure that she wouldn't be joining the
Faith QD gatherings. No need to gird your loins to write policy
manuals or help develop nursing procedures. Thank heaven she
was on her way back to those tasks right now. Out of the ER and
away from Logan Caldwell. A winning combination.

As Claire stepped out of the utility room and walked past the temporary morgue, she noticed its door was ajar. It was only a crack
and barely wide enough for a faint light to escape from the inside,
a quiet vacuum now. The Do Not Enter sign was still in place, but
no doubt the poor child had finally been moved. That would help
put things back to normal for the staff, if there ever were such a
thing as normal in ER.

Oh, great. Claire stopped short in the trauma room as she recognized him.

The ER director, seeming even bigger if possible, stood there
in street clothes, chambray shirtsleeves rolled back over tanned
forearms, faded jeans, cowboy boots, and a pair of sport sunglasses
dangling from a blue cord around his neck. His dark hair looked
damp, like he'd just showered. Logan Caldwell, standing beside the
gurney of Jamie, the little burn victim with asthma.