Читать книгу Emergency: Single Dad, Mother Needed - Laura Iding - Страница 9

CHAPTER ONE

One month later…

DR. HOLLY DAVIDSON hadn’t even hung up her coat on the back of her office door when her pager chirped. First day on the job as the pediatric infectious disease specialist at the Children’s Medical Center and she was more than a little nervous. She glanced at the text message: Stat ID consult needed in ED.

Okay. She blew out a breath. Guess she didn’t have to worry about keeping busy. Trying to ignore her sudden anxiety, Holly tossed her purse into the bottom desk drawer and then quickly headed down the hall toward the elevators.

Several people nodded or smiled at her as she passed them. The anonymity of working with a sea of faceless strangers was a welcome blessing after the speculative looks and abruptly dropped conversations she’d endured for the year after her divorce.

She jabbed the elevator button with more force than was necessary. Well, now things would be different. She’d come home to Minneapolis, Minnesota after five and a half years to make a fresh start, and to keep an eye on her ailing mother.

Keeping her chin up, Holly entered the busy arena of the ED. A couple of residents hovered around the central nurses’ station, laughing and talking with the nurses. She wanted to warn them not to mix business with pleasure, but doubted her wise advice would be welcome.

“Excuse me, I’m Dr. Davidson. Which patient needs an ID consult?” she asked the unit clerk seated like a queen on her throne at the center of the main desk.

“Just a minute,” the woman muttered, before picking up the constantly ringing phone. “Emergency Department, this is Susan. May I put you on hold for a moment? Thank you.” Susan didn’t seem at all frazzled as she glanced up at the list of patients. “ID consult? Mark Kennedy in room twelve.”

“Thanks.” Holly let Susan go back to her incessant phone calls and walked over to the computer terminal near room twelve, one of the many isolation rooms they had in the ED. She needed to get a little more information about her patient before she examined him.

She logged into the system, relieved her brand-new passwords worked without a hitch, and quickly entered Mark Kennedy’s name to access his current medical record information. He was a fourteen-year-old who’d just entered his freshman year at a boarding school. He’d been brought in for nausea, vomiting, severe headache and stiff neck, complaints he’d had for the past two to three days.

Bacterial meningitis? Or the less severe viral meningitis? She hoped the poor kid had the less serious type but was afraid it was more likely he had bacterial meningitis, given his history of being a freshman in boarding school. They needed a lumbar puncture to make a definitive diagnosis. Had one been done? She scrolled down to read the notes, seeing there was a notation about the LP being performed. The name of the ED attending physician, Dr. Gabriel Martin, registered just as a deep male voice behind her said her name.

“Holly?”

Her heart leaped at the familiar sound of Gabe’s voice. She had to brace herself before turning to face him, knowing the smile on her lips couldn’t possibly be reflected in her eyes. “Hello, Gabe. How are you?”

The shock on his face didn’t make her feel any better. “You’re back?”

“Yes. I moved home a few weeks ago. My mother has some kidney failure as a result of her diabetes.”

“I’m sorry to hear that.”

They stared at each other for a long moment, the awkwardness painful. Hard to believe they had once been friends. A friendship she’d helped to ruin, long before Gabe had walked out as the best man on her wedding day.

“It’s good to see you.” His statement was polite but the reserved apprehension on his face said just the opposite. “Welcome home.”

“Thanks.” She hadn’t been prepared to see Gabe again, assuming he’d moved on with his life and his career. Since he was still here at the Children’s Medical Center, his career obviously hadn’t changed. On a personal level, though, she suspected they were both very different from the carefree residents they had once been. She swallowed hard and looked over toward the isolation room. “Is Mark Kennedy your patient?”

“Yes.” Gabe appeared grateful to get things back on a professional note. “He’s a fourteen-year-old boy who just moved into a boarding school dormitory six weeks ago. His symptoms are pointing to bacterial meningitis.”

She nodded. “I agree, although we need to isolate whether the source is Neisseria or Streptococcus. I’m leaning toward the latter, since it’s often the cause of dormitory-related infections. Do you have the results of his lumbar puncture yet?”

“No.” Gabe glanced at the computer terminal, which still displayed Mark’s information on the screen. “When I reviewed his history and examined him, I requested he be placed in isolation. Several of the nurses may have been exposed, though. If he does have bacterial meningitis, they’ll need prophylactic treatment.”

“Of course. You’ll need treatment, too.” She turned toward the isolation cart, opened a drawer and pulled out a face mask, gown and gloves. “Have you started him on antibiotics yet?”

“No. I thought I’d wait for your recommendation first. Especially as I don’t know the type of bacterial infection we’re fighting.”

“Start him on broad-spectrum antibiotics,” Holly advised, trying not to notice Gabe hadn’t changed much. Tall, with dark brown hair, bright blue eyes and broad shoulders, he had a rugged attractiveness that she’d always been drawn to. Maybe there were a few more wrinkles around his eyes, but otherwise he looked good. Too good. Distracted, she focused on the situation at hand. “Mark has already had symptoms for almost three days. I’m worried he’s going to take a turn for the worse if we don’t get a jump on this.”

Gabe nodded, agreeing with her recommendations. “I’ll get the antibiotics ordered right away.”

“Great.” Once all her protective gear was in place, Holly stepped into the patient’s room, leaving Gabe to enter the antibiotic order in the computer.

“Hi, Mark. Mrs. Kennedy.” She felt bad for the patient and his family, and could empathize with how it must feel to end up with an infectious disease. “My name is Dr. Holly Davidson. I’m the infectious disease specialist here.”

“Yes, Dr. Martin told me he was calling in a specialist.” Mark’s mom looked upset, her eyes red as if she’d been crying. “Is my son going to be all right?”

“I hope so. We’re going to start treating him immediately.” She approached the bed, shifting her attention to the patient. Gently, she placed a hand on his arm. “Mark? Can you hear me?”

The boy was very lethargic as he opened his eyes and slowly turned his head toward her. “Yeah,” he whispered.

Her stomach clenched. The poor boy was much worse than she’d originally thought. There was no indication in the record that he was this out of it, so maybe his neuro status had only just started to deteriorate. “Mark, we’re going to need to start an IV in your arm to give you antibiotics.” As she spoke, his eyes slid closed and he didn’t respond. She hid a flash of panic. “Mark? Are you all right?”

“Yeah.” He answered without opening his eyes.

She felt for his pulse, reassured herself that it was beating steadily beneath her fingers. She turned toward his mother. “Mrs. Kennedy, Mark seems to be getting worse. I’m worried the infection is affecting his brain.”

Mrs. Kennedy’s eyes widened in alarm. “What does that mean?”

“Just that the sooner we can start the antibiotics, the better.” As she finished speaking, a nurse came into the room carrying IV supplies. As she finished her exam, the nurse prepared to place the IV catheter into the antecubital vein in Mark’s arm.

“Mrs. Kennedy, I’m worried about you and your family. If this is a bacterial infection, as we suspect, it’s highly contagious. You’ll need to wear a face mask to help protect yourself from getting sick.”

The woman paled. “Contagious? What about the rest of my family?”

“I’m afraid they may need treatment, too.” Holly made her tone as reassuring as possible. “The good news is we can treat all of you so you won’t get sick. How many siblings does Mark have?”

“Two younger sisters. They’re only five and seven, children from my second marriage.”

“All right, we’ll make sure everyone gets the medication they need. And we’ll probably need to tell the school too. His roommates may also need antibiotics.”

The nurse placed the IV in Mark’s left arm, the boy barely flinching as she slid the needle into his vein. Once the IV was running, Holly hurried out and grabbed more protective gear for Mark’s mother, helping her to put the items on.

The mask was the most important piece, and Holly reiterated the need to keep the face mask on at all times.

Gabe walked into the room, carrying the mini-bag of IV antibiotics. The nurse took the bag from his hands and hung it on the IV pole, reprogramming the pump accordingly.

“Please, take a look at him. I think his mental status is much worse,” she said in a low tone.

Gabe approached Mark, calling his name just as she had earlier. After a quick exam, concern shadowed his eyes. “He needs to be intubated.” He glanced at the nurse. “Melanie, will you grab the intubation bin?” He turned toward Mark’s mother. “Mrs. Kennedy, I need to put a breathing tube into Mark’s throat to protect his airway. He’s so lethargic I’m afraid he’s going to stop breathing. I’ve already made arrangements for him to be transferred to the PICU.”

Watching Gabe in action, Holly had to admit he was impressive. Especially the way he took the time to explain everything to Mark’s mother. Emergency medicine wasn’t her specialty and she stepped back to stay out of the way and to give him the space he needed to take care of Mark, but Gabe stopped her. “Holly, wait. I’ll need your help.”

“Of course.” Her earlier anxiety returned as she walked back toward the bed, watching Gabe set up his equipment with deft fingers. She placed a reassuring hand on Mark’s arm, hoping and praying that somewhere deep down he’d feel her touch. “Mark, we’re going to place a breathing tube in your throat. It will be uncomfortable for a few minutes, but then your breathing will be much better.” Mark didn’t indicate that he’d heard her but that didn’t mean much. He might not be able to make his muscles obey his commands.

“Help me position his head. With his stiff neck, I’m going to have trouble getting his head tilted to the correct angle.”

She understood Gabe’s dilemma, and moved over to help. The nurse sat next to Mark’s mother, who’d started to cry. Holly wanted to cry right along with her but focused instead on helping Gabe place the lifesaving breathing tube in Mark’s throat. Gabe’s face was close to hers, the worry in his eyes contagious.

“A little more,” Gabe said urgently, as he tried to slide the breathing tube down. “I can’t quite get it.”

Mark’s neck muscles resisted the movement as she struggled to tilt his chin toward the ceiling. She met Gabe’s eyes over his face mask. “I can’t move his head back any more without hurting him.”

Gabe nodded. “All right, then, we need a paralytic. There’s some succinylcholine in a vial on the table. Give him a milligram and see if that helps.”

Holly’s hands were shaking as she tried to draw up the medication. She hadn’t been this involved in an emergency situation since she’d been a resident. The medication would help relax Mark’s muscles, but it would also stop him from doing any breathing on his own. She injected the medication and shot an apprehensive glance at Gabe. “How long before it works?”

“Not long.” He met her gaze, as he gave Mark several deep breaths, using the ambu-bag. “Are you ready?”

She nodded. After the third big breath, Gabe set the mask and ambu-bag aside and she helped tilt Mark’s head back to the correct angle. This time she was able to give Gabe the extension he needed. He slid the breathing tube into place, and pulled out the stylet. “Hurry. Hand me the ambu-bag.”

After disconnecting the face mask from the end, she handed him the bag. He clipped a small device to the end of the endotracheal tube before connecting the ambu-bag, giving several deep breaths. The end-tital carbon-dioxide detector turned yellow, showing the tube was in the correct place. “Listen for bilateral breath sounds, just to make sure,” he told her.

She tucked her stethoscope into her ears and listened as he gave more breaths. She nodded and folded the stethoscope back in her pocket with a sigh of relief. “Sounds good.”

“Melanie, call for a portable chest X ray,” Gabe directed. “And get a ventilator in here.”

“We have the breathing tube in place, Mrs. Kennedy. Mark’s breath sounds are good. I know this is scary, but Mark is better off now with this breathing tube in place.” Holly did her best to reassure her.

“We’ll give him some sedation too, so he doesn’t fight against the breathing tube,” Gabe added.

“Thank you,” Mrs. Kennedy whispered.

Holly was glad to help. She reached over to hold the ET tube while Gabe secured it in place. “Nice job,” she said in a low tone. Gabe’s quick action had helped to save Mark’s life.

His eyebrows rose in surprise and his gaze warmed, lingered on hers. “Thanks.”

For a moment the years faded away, the easy camaraderie they’d once shared returning as if it had never left. She’d missed him, she realized with a shock. She’d missed Gabe’s friendship.

And more? No. What was she thinking? Taking a quick step back, Holly decided it was time to leave.

“I’ll check on the LP results,” she murmured, before leaving the room. Glancing back over her shoulder, she saw Gabe was watching her with a speculative glance.

Her stomach tightened as she let the door close behind her and began stripping off her protective gear. She and Gabe had grown close in those months up until her wedding. But that had been nearly six years ago.

She’d learned two hard lessons since then. Men couldn’t be trusted and never, ever mix personal relationships with professional ones.

Unfortunately, Gabe lost on both counts.

Gabe instructed the respiratory therapist on the vent settings he wanted Mark to be placed on and spent a few minutes reassuring Mark’s mother that they were doing everything possible for her son. He took the time to make sure Mark was comfortable and that his vitals were stable before he left the room. While stripping off his protective gear, he glanced around the ED arena, disappointed to realize Holly was gone.

He opened Mark’s electronic medical record and read her note. She recommended changing the antibiotics now that the LP results were back, confirming streptococcal meningitis. She went on to recommend prophylaxis to any exposed staff and for all of Mark’s immediate family.

He finished arranging for Mark’s transfer to the PICU, and then followed up with the nursing staff who’d been exposed to Mark before he’d been placed in protective isolation. He wrote prescriptions for Mrs. Kennedy’s family and one for himself.

Once he was caught up with his work, he went over to the unit clerk. “Will you page Dr. Holly Richards for me again?”

Susan, the unit clerk, frowned at him. “Holly who? You mean the infectious disease doctor? Dr. Davidson?”

Davidson? She’d changed her name from Richards to Davidson? Had she been wearing a wedding ring? He didn’t think so. The truth hit him like a brick between the eyes. Holly must have divorced Tom, taking back her maiden name.

Guilt burned the lining of his stomach as he realized her divorce might be a part of the reason she’d returned home. He furrowed his fingers through his hair, not entirely surprised by the news.

Damn. It wasn’t too hard to figure out what had happened. He’d bet his life savings Tom had cheated on her. The jerk.

Guilt swelled again, nearly choking him. He should have handled things differently. Why had he believed Tom when he’d claimed he’d changed? Tom had always been too much of a womanizer, and Gabe suspected Tom hadn’t changed, even after Tom had asked Holly to marry him. But he hadn’t had any proof, just the deep niggling suspicion that wouldn’t go away.

On the day of Holly and Tom’s wedding, he’d noticed Tom flirting with Gwen, Holly’s maid of honor, and confronted him. They’d argued bitterly. Tom had sworn he’d given up other women, promising he’d gotten them out of his system once and for all. Gabe hadn’t believed him, telling Tom how Holly deserved better. Tom had turned the tables on him, accusing Gabe of wanting to cause trouble as he desired Holly for himself.

The accusation had been painfully true. More true than he’d wanted to admit.

He’d known the wedding was a mistake, but had figured there wasn’t anything he could do about it. But as the hour had grown closer, he’d realized he couldn’t stay. Couldn’t stand next to Tom at the altar as his best man, watching Holly marry a guy who didn’t deserve her love. So he’d handed the rings to one of the other groomsmen and left the church. In some perverse way he’d hoped Holly would get the message and do the same.

But he’d learned later that she hadn’t walked away. The wedding had gone ahead as planned. She and Tom had moved to Phoenix, Arizona shortly after the wedding, so Tom could take a position as medical director of a large surgical intensive care unit while Holly had taken a critical care fellowship position.

Only now she was back, as Holly Davidson rather than Holly Richards. And she was an infectious disease specialist, not a critical care intensivist.

“Did someone page?” Holly asked, walking back into the arena. She’d come from another room, and he felt foolish for interrupting her while she was seeing another patient.

“I did.” He hated this feeling of unease between them. “When you’re finished, will you give me a call? I’d like to talk to you.”

“I’m ready. I just need to write my note.” She was looking at him with a puzzled expression, as if she couldn’t quite figure out what he wanted to discuss. No surprise, since he wasn’t sure what he was going to say to her once they were alone either.

Regret, mingled with guilt, continued to weigh on his shoulders. He couldn’t help feeling her divorce was his fault. Especially since he suspected Tom’s infidelity might have started before the wedding. Maybe he could have prevented her from marrying Tom if he’d really tried.

“I’ll wait.” Luckily, the ED wasn’t too busy. He’d seen and written orders on all the patients who’d been brought back so far. Mark was the only serious case needing his attention.

Holly strode to the closest computer and signed in. His gaze roamed over her familiar features. She was more beautiful than ever. Her shoulder-length dark hair framed a heart-shaped face. Her dark brown eyes were always warm and smiling.

“Has Mark taken a turn for the worse?” she asked, logging off the computer.

“No, I just sent him to the PICU.” He took Holly’s arm and steered her toward the physician lounge, grateful to find it empty. “And I changed his antibiotics, as you suggested.”

“Good. I’ll go up to visit him in the PICU later. I’m still very worried about him, I hope he turns around with the antibiotics soon.” She glanced around at the empty lounge, then back up at him. “So what’s up?”

He hesitated. There was so much he should say, but part of the problem was that he should have told her his suspicions a long time ago, even without proof to back up his claim. Yet just like all those years ago, the words seemed to stick in his throat.

She sighed and jammed her hands into the pockets of her lab coat. “You don’t have to do this,” she said slowly. “I already know why you left the church the day of my wedding.”

His mouth dropped open in surprise. Had Tom told her about their fight? If so, he’d no doubt left out key details. “You do?”

She nodded, finally bringing her gaze to his. “It was my fault. Because of the night I ruined everything by almost kissing you.”