Family Practice (16 page)

The computer chimed an incoming call from the hospital’s network. Zach closed out Karen’s chart and keyed in the clinic’s password. The screen went dark for a moment and then a tired but pleasant-faced man of middle age appeared on a split screen. The other side of the screen showed Karen’s X-rays. “Zach, good to see you. What can I do for you?”

“Dr. Assad. I didn’t expect you to be on call on a Saturday night.” Zach’s smile was wide and genuine. Ahmed al Assad was the head of the orthopedics department at the Petoskey hospital. Callie knew of him, but she’d never met the man in person.

“I got called in for an emergency this afternoon and haven’t been able to get away again. We’re swamped here tonight—a couple of ATV accidents and a senior who fell down her apartment steps and broke her hip. And it’s not even midnight. Who is the lovely lady beside you?”

“Our new physician in charge. Dr. Callie Layman, may I present Dr. Ahmed al Assad.”

Callie moved into range of the computer’s small camera lens, just inches from Zach’s face. She tried not to be aware of his warmth and the clean, masculine scent of him. He was so close, all she had to do was turn her head slightly and she could kiss his ear. “It’s a pleasure to meet you, Doctor.”

“The pleasure is mine, Dr. Layman. Rumor has it you are considering becoming a permanent member of our team.” His accent was decidedly British, although Callie knew he was Canadian by birth.

“I’ll be making my decision soon, Doctor.” Dr. Assad was a member of the hospital board of directors. The Physician’s Committee had to keep the governing body apprised of their plans and must have informed the board of their offer to her. She wondered how many other staff members had heard about the offer before she had. Several, at least, she supposed.

He pulled a pair of half-glasses from the pocket of his white coat and set them on his nose. “Want to give me the details on your patient, Zach?” He listened closely as Zach recited Karen’s vital statistics and described her injury, nodding as he continued to study the images he was viewing. “Your diagnosis is spot-on, as usual,” he said as Zach finished speaking. “Clean break, it appears to me. Could have been much worse if the window had caught her a few centimeters closer to the distal radius. There are as many treatment options for this kind of injury as there are physicians to treat them. I’m old-school, you know. Make sure the bones are in alignment, continue the meds as required, immobilize for four to six weeks and then some intensive physical therapy. Bring her in Monday. That will give us some time for the swelling to go down before we repeat the X-ray and cast it permanently. Unless you want to make the trip tonight? I am not going anywhere.”

“I think it will be better for my mother to rest in her own bed tonight, Doctor,” Callie said, ignoring the offhand manner of his pronouncements. It was a common enough injury, after all, and he was a highly trained surgeon; arrogance came with the territory.

“The patient is your mother?”

“Yes, Doctor.”

“Callie’s mother doesn’t like hospitals,” Zach said with a grin. He was as adept at dealing with high-strung surgeons as he was with nervous middle-aged women and small children.

Dr. Assad nodded. “Call my office first thing Monday morning, Dr. Layman, and we’ll work her in after lunch,” he promised, proffering a consult as a professional courtesy.

“Thank you.”

“No thanks necessary, Doctor.” Assad gave the screen a wolf’s grin. “Anything else I can do for you, Zach?”

“That’s all for tonight, Doc. Thanks for the second opinion.”

“A pleasant night to you both.”

“Good night.” Callie smiled her farewell, but instead of ending the call, the surgeon leaned back in his chair and laced his hands behind his head.

“How much longer are you going to be in exile down there in White Pine Lake, Zach, especially now that they’ve got someone to take your place?” His tone was friendly but nonetheless carried an undercurrent of interest that wasn’t lost on Callie.

“I’ve got a year and a half to go on my contract,” Zach said, but he had suddenly gone very still and she could sense he didn’t want to pursue the topic.

“Doesn’t your contract include automatic opt-outs every six months? I’m positive Parsons told me something of the sort,” Dr. Assad probed, his grin disappearing completely. “Surely you aren’t planning to be away from here for that long? Hasn’t Parsons been in touch? He’s going to be taking that position at the University of Michigan before the end of the year. Don’t tell me you’re going to pass up making the move with him?”

This time it was Callie who stiffened. Zach had told her nothing about the opt-out clauses. Nothing about an offer from Parsons, the hospital’s hotshot neurosurgeon who was heading to Ann Arbor to set up a practice associated with the medical school’s world-famous neurosurgical program. It would be a prestigious posting for Zach.

“Dr. Layman, help me out here,” the orthopedist said genially. “Zach’s on the fast track with Parsons. You’ve worked with him for what? Six weeks now?”

“A little less than that.”

Assad waved his hand in dismissal of the technicality. “Surely you agree he’s wasted setting broken wrists and conducting high-school physicals and scolding overweight seniors about their cholesterol numbers. If I had my way, I’d talk him into going to medical school. He’s underutilized as a PA.”

“Med school’s not for me,” Zach said, as if that simple statement settled the argument. But Callie was close enough to him to sense the sudden tension in the muscles of his neck and shoulders. Why hadn’t he said anything about this offer? He’d never mentioned it, never hinted at it. Was that why he hadn’t helped her make her own decision about staying on in White Pine Lake, because despite what he said about falling in love with her, he was going to leave her here and make a new life for himself three hundred miles away?

“We’re lucky to have him in White Pine Lake,” Callie said, realizing her dismay had worked its way into her vocal cords. “I would never stand in the way of advancing his medical career, though. If you’ll excuse me, Doctor, I should check on my mother. It was nice meeting you, and thanks again for your assistance.”

“Of course.”

Callie straightened and started walking blindly to the doorway. Zach could leave the practice whenever he chose with barely enough notice for them to find a replacement, even a temporary one.

He’d kept it all from her even as he encouraged her to stake her claim on a life and a future in White Pine Lake. She’d let herself trust him almost to the point of admitting she was in love with him, too. And now this. It felt like betrayal. It was betrayal.

The sudden, sharp pain in her chest and the faint cracking sound that echoed through her mind was easily diagnosed. It was her heart shattering.

CHAPTER FIFTEEN

D
R
. A
SSAD
HAD
BEEN
RIGHT
. It had been one heck of a night. How had he gotten himself into this predicament? Zach hadn’t meant to keep secrets from Callie; he had just been waiting for the right opening, the right moment, to come clean about the job offer. He had never intended to take it or to leave White Pine Lake, but he owed Donnell Parsons a lot. The neurosurgeon had given him his chance at a normal life, stuck by him when the PTSD was at its worst. He wanted to talk to the man before he turned him down, offer his thanks and his regrets in person. But Callie wasn’t aware of any of that. To her, the revelation came as a betrayal of their newly forged trust.

He stared out the rain-streaked window of his bedroom, then at his bedside clock. A battery-operated one he’d picked up in the dollar store when he got to White Pine Lake and found out the electricity wasn’t all that reliable. It was a little after 1:00 a.m. It was going to be a long night.

He couldn’t sleep, so he might as well get up and make himself a cup of coffee. His friends might have recommended a stiff drink, but he didn’t drink on the nights he was on call as a first responder for the White Pine Lake EMS. He’d been taking weekend duty once or twice a month since he came to town. It kept his emergency skills up-to-date and eased a little of the pressure off the core group of EMTs and volunteer firemen who were responsible for their friends and neighbors.

Was Callie sleeping or was she lying awake, too? She had insisted on her mother coming home with her, since it had been raining hard when they left the clinic and she didn’t want to make the drive out to the farm again that night. As they fitted Karen with a temporary air cast, the two women had argued back and forth about Karen staying with Callie—Callie gently and firmly, Karen objecting more for form’s sake than anything else. Callie had won. Now Karen was sleeping at the duplex and he and Callie were back to square one with no chance of him explaining himself anytime soon.

“How the heck did it all go wrong so fast?” Man, now he was talking to himself. He rolled out of bed and pulled on sweats and a T-shirt and wandered out into the main room.

She hadn’t ranted and railed at him. He had helped Karen into the Jeep and shut the door, and then Callie had just looked at him, raindrops glittering like diamonds in her hair. She’d folded an umbrella she had found in the lost-and-found basket—a kid’s one, bright yellow with jungle animals all around the edge—and said, “You could have told me you were keeping secrets before you demanded I admit I’m in love with you.”

“I kept it a secret from everyone because of how information flies around this town. And no, I’m not accusing you of not being able to keep a confidence, so don’t even go there.”

“I wouldn’t, of course, but this just proves my point. I make my decision to stay. I find you might leave. We don’t really know each other, our hopes and dreams. We are only beginning to trust. It’s not enough, not yet.” He had shivered, and not just from the cold rain on his nape. It sounded so final the way she’d said it. She’d closed the silly little umbrella, handed it to him, got into the Jeep and drove away.

He rested his hands on the windowsill and stared out into the night. They had stood together, really together, in the same place just twenty-four hours earlier.

There was a storm somewhere out over Lake Michigan again, the same as last night. But tonight there was a difference; the lightning and thunder playing off in the distance caused him no anxiety whatsoever. His thoughts were all on how to redeem himself in Callie’s eyes, not the brutality and horror of a faraway war.

The beeper he’d left on his bedside table went off. He waited, tensed, as the usual static and undulating tone that preceded an announcement from the emergency dispatcher played out. A few moments later her voice came through the speaker, calm and measured. “Thirty-eight-year-old female. Eight and a half months pregnant. Symptoms of possible stroke. Conscious and responding. Address—White Pine Lake Bar and Grill, 55 Lake Street, White Pine Lake. Please respond.” Adrenaline shot into his system, banishing the last remnants of sleep.

Ginger Layman.

He snapped on the overhead light and found his shoes. Thirty seconds later he had his truck keys in his hand and was headed out the door. Callie’s door opened and she stood silhouetted in the light. “Do you want to ride with me?” he asked. She didn’t have an emergency scanner in her half of the cabin, but it didn’t take a genius to figure out that J.R.’s second call would be to his daughter.

She shook her head. “No, go on, don’t wait for me. I’ll be right behind you. I just have to make sure Mom is okay.” She was wearing the same clothes she’d had on earlier in the evening. It was obvious she hadn’t had any better luck sleeping than he had.

Five minutes later he slid to a halt in front of the restaurant. Off in the distance he heard the siren of the mobile unit as it pulled out of the firehouse two streets over. The town’s chief of police arrived, red and blue lights whirling. Two experienced EMTs, a married couple from a block away, slipped in behind his truck in a golf cart. Not bad response time for a group of volunteers in the middle of the night. He took the wet stone steps two at a time. J.R. met him at the front door. His expression was grim. “She’s in the dining room,” he said. “Hurry, Zach.”

The ambulance unit pulled up, adding more red and blue lighting to the scene, overpowering the flashes in the sky. Lights came on in a couple of the cottages and motel rooms along the shoreline, but people stayed inside the buildings, watching from behind the curtains, avoiding the rain while satisfying their curiosity.

The bar at the White Pine closed at 1:00 a.m., so only the staff was still on hand inside. Rudy Koslowski emerged from the ambulance along with Owen Carson. Rudy was the best driver they had. He’d have them in Petoskey within forty-five minutes of closing the doors on their patient. For anyone else it would be an hour. Rudy handed off the big metal toolbox that held their supplies and equipment to Owen, who hurried up the steps. Rudy followed more slowly. Zach took the heavy box from Owen. Just as he walked through the door, Callie arrived and double-parked beside the police cruiser.

The dining room was filled with shadows and the lingering smells of good food. Only a single bank of lights above one group of tables near the kitchen door was lit. He was relieved to find Ginger seated at one of the tables and not stretched out on the floor. She was as pale as a ghost, her head resting on her outstretched arm, her right hand draped protectively across her distended belly. She was conscious and appeared alert. Zach knelt beside her and laid his hand on her arm. He put his differences with Callie out of his mind. He shut out all the extemporaneous conversations and movements around him, focusing solely on the woman in front of him. “Ginger, it’s Zach Gibson. Can you talk to me?” He opened the big box and pulled on a pair of latex gloves as he studied her.

“Yes.” She attempted to sit up straighter. “I have the most incredible headache,” she gasped, resting her forehead on the palm of her hand. Zach pulled out a blood-pressure cuff and applied it to Ginger’s arm. He wasn’t aware that Callie had entered the dining room until she came over, pulled out a chair and sat down beside Ginger. She’d thrown a nondescript raincoat over the coral lace top, but she still smelled of lavender shampoo. From that point forward, a tiny portion of his consciousness remained aware of every breath she took and every move she made.

“Ginger, what happened? Dad said you got dizzy and fainted.”

“I did get dizzy. I’m still dizzy, but I didn’t faint,” her stepmother insisted. “I bet it was my blood sugar. I didn’t get a chance to eat anything because we were so busy this evening. Callie, will you go up to the kids? They’re probably scared to death. I’m sure Becca is awake. How could she sleep with all the lights and the commotion right outside her window?”

“I will, Ginger. In just a few moments,” Callie soothed.

Ginger’s blood pressure was too high—dangerously high for a woman in her condition. Zach was relieved that she was coherent and so far had shown no signs of a stroke, but they needed to get her to the hospital as quickly as possible. He glanced up and caught Callie watching him, the worry in her eyes mirroring his own. From where she was sitting, she would have been able to get an approximation of Ginger’s blood-pressure reading just by watching the way the needle on the dial reacted. “Can you move your arms and legs?” he asked, continuing his evaluation.

“Yes. It was just a dizzy spell.”

“You fainted,” J.R. said bluntly. “She scared the life out of me. I found her sitting here slumped over the table when I came out of the bar to lock the front door. When I spoke to her, she just mumbled. I couldn’t understand a word she said. I called 9-1-1 immediately.”

“I was just so dizzy it was hard to talk.” Ginger defended herself, but her voice lacked the force to be convincing.

While J.R. was telling his story, Zach had checked Ginger’s blood sugar. It was low, which could account for the dizziness and the confusion, but he wasn’t willing to let it go at that. His gut was roiling, his instincts on high alert. Ginger had been exhibiting symptoms of preeclampsia for the past few weeks. With her blood pressure so high, she could go into convulsions at any moment. Callie feared that, too; he felt it. No matter what kind of turmoil their personal relationship was in at the moment, when it came to their patients, they were in sync. They were a team.

“Have you had any contractions?” Callie asked her stepmother.

Zach didn’t have a fetal stethoscope, so he used the regular one to listen to the baby’s vital signs. The heartbeat, while steady, was not as strong as it should be. He lifted Ginger’s right hand and studied her fingers. The edema was worse than he had observed a few days ago.

“A few twinges now and then. I’ve been having them for a couple of days now. Everything’s all right with the baby, isn’t it, Zach?” she asked anxiously.

“You haven’t said anything about having contractions,” J.R. said. He had kept his distance while Zach performed his exam, but as Callie moved her chair to give him room, he dropped to the balls of his feet beside his wife.

“I didn’t want to get everyone all excited and worried.”

“Honey, I’ve been excited and worried since the day you told me you were pregnant,” J.R. said with uncharacteristic emotion.

“The fetal heartbeat is weak,” Zach said carefully. “Has the baby been moving as much as usual today?”

Ginger lost even more color. Her face was ashen. She reached out and grasped J.R.’s hand with her own. “No. That’s not a good sign, is it?”

“Let’s err on the side of caution. I recommend, and I’m sure Callie agrees with me, that you go to the hospital.”

“Do I have to? Can’t we wait until morning?”

“No, Ginger. Zach and I are in complete agreement. It’s not worth risking your health or the baby’s waiting around here.”

“We’re going tonight. Now,” J.R. said firmly.

“I can’t just disappear. I want my children,” Ginger said, stifling a sob. “Where are they?”

“I’ll run up and check on them,” Callie offered.

Ginger nodded. “Yes, please do.” Her eyes widened with dismay. “It’s so late. I’m sorry. I didn’t consider, we must have woken you from a sound sleep.”

Callie laughed as she stood up. “Do I look that bad?” Her hand went automatically to her hair. Zach hid a grin. She was so successful at projecting that hard-boiled M.D. persona it always caught him by surprise when she did something as purely feminine as worrying about her hair. “I hadn’t even gotten to bed yet, Ginger. Zach and I have been at the clinic. Mom broke her wrist. Zach had just finished setting it when Dad’s call came in. It’s like being back in medical school, pulling an all-night shift in the E.R.” Except these people were her own. Zach realized her anxiety was as intense as anyone else’s whose loved ones were endangered, but she didn’t let it show.

“Karen did what?”

“She broke her wrist,” Callie repeated patiently.

J.R. was reaching the end of his rope. “Is she all right? Is it a bad break?”

Callie smiled, attempting to put her father’s mind at ease. Callie had been balancing between Karen and J.R. for years; she made it seem easy. But he suspected—no, he was certain—it took a toll. “She’ll be fine. She’s asleep at my place.”

“Are you okay to leave her?” Ginger asked hesitantly.

“And what about the twins? Perhaps Mac can look after them?” J.R. said, searching for options.

“Don’t be ridiculous. I’m their big sister,” Callie responded with a catch in her voice. “They’re staying with me. Mom will be fine at my place. The three of us will follow you to the hospital. Remember, Dad, I can’t have any say in Ginger’s treatment,” she reminded him gently. “She’s in the best of hands with Zach.”

“We have all the confidence in the world in Zach. But I’d feel better having you there with us.”

Callie smiled; the wonderful transforming smile she saved only for those closest to her. “I’ll be there, Dad. After all, that’s what family’s for.”