Authors: V.K. Sykes
Copyright © 2011by V.K. Sykes
Cover Art © Kimberly Killion of HotDamn Designs
Formatted by Jessica Lewis
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Holly Bell’s feet flew over the big red dots on the scuffed, white floor. The path markers were there to guide patients, parents, and visitors from the Cardiac Center to the ER’s trauma center.
They always reminded Holly of blood spatter.
Stupid thing for a surgeon to be thinking about
Still, if it had been up to her, she would have used another color, maybe yellow or orange or purple. Anything but blood red. What parent rushing to the ER needed that kind of visual reminder?
It was late, after ten, and she’d been at the High Speed Line station waiting for her train home when her resident paged her. A fast walk, almost a jog, had her back at the Children’s Hospital in six minutes.
She flipped a mental switch and envisioned Tyler Arnold. Caucasian male. Not quite five years old. She hadn’t met him yet, but she’d practically memorized his file. Congenital heart disease had trashed the poor kid’s heart in a half-dozen ways, the worst being the damage to the mitral valve. This crisis wasn’t his first, but Holly worried that it could be his last. That’s why when the resident called her on her cell, she’d taken off straight down Walnut Street, covering the six blocks to the hospital in a blur.
Two security guards monitored the doorway separating the waiting room from the trauma center—one outside, one inside. She recognized the outside guy, and he waved her through. The inside guy was probably new. But, then again, so was she, and she’d only been to the ER a handful of times. She gave him a quick smile and waved her ID card at him. She didn’t look like much like a doctor tonight. No lab coat. No stethoscope. Medium heels instead of hospital flats or sneakers. A red, lightweight sweater over the black, form-fitting dress she’d worn to the concert.
“Tyler Arnold?” she said a little breathlessly to one of the nurses at the central station. “I’m Dr. Bell. His surgeon.”
The young woman looked wary, obviously not recognizing her. “Uh, he’s in six.”
“Thanks.” Holly hurried around the central desk. Bed six was on the opposite side of the spacious, square room. She shoved the yellow curtain aside and stepped in. Katie Canizaro, one of her surgical residents, stood beside the bed, stethoscope in hand. Holly gave her a quick nod and began her examination.
The boy had been sedated and intubated, and was hooked up six ways to Sunday. Sweat matted his delicate blond hair, his face was pale, his form under the sheets slight and insubstantial. Normal saline dripped into his arm through an IV, and a bedside monitor recorded his vitals as stable.
Holly exhaled a relieved sigh.
For nine years, she’d watched children fighting for their lives, gripped in the maw of technology that often terrified them. She wouldn’t change her career path for anything in the world, but every patient like Tyler still affected her deeply. Holly welcomed the responsibility she had for their lives, because she knew she was good. But sometimes that responsibility threatened to swallow her up with fear.
Holly brushed the matted hair back from Tyler’s forehead, then turned to Canizaro. “What happened?”
“He complained to his father of chills, pain in his arms and legs, difficulty breathing. Shortness of breath. By the time he got here, his pulse-ox had crashed. The attending put him on the ventilator, then paged our service and got me.” Canizaro dropped her eyes toward the floor. “I’m sorry for calling you out, Dr. Bell. But I wasn’t sure, so—”
“You did the right thing.” Holly flicked a glance at the monitor. “Low grade fever. Did the father say how long he’s had it?”
“He wasn’t sure. Said he never took the boy’s temperature.”
“Nice,” Holly said with a grimace. “Sounds like Tyler needs a mother.”
Canizaro gave a fatalistic shrug. “Hasn’t had one since he was two.”
“I know. McMillan briefed me and I reviewed the file. Did you check his skin?”
“Yes. There’s been some hemorrhaging—fingers and toes.”
Holly nodded and held her hand out to borrow the resident’s stethoscope. Bending down, she listened to Tyler’s heart and lungs, lifting him gently with one hand as she slid the stethoscope under him. She didn’t like what she was hearing. Tyler’s heart was regurgitating blood. More than she’d expected, given his file and the briefing his former surgeon, had given her. The valve repair McMillan had performed some time ago had clearly broken down.
Still, new valve lesions wouldn’t be causing the fever.
She straightened up. “The valve’s failing.”
Canizaro nodded. “But new lesions wouldn’t account for the most of the symptoms.”
“No, they wouldn’t,” Holly said. “Did you order an echo?”
“Yes. And blood cultures.”
“Good. But I don’t want to wait for the cultures. Start him on gentamicin right now. He’s stable enough to remove the ventilator, so get him moved over to Cardiac ICU as soon as they can get a bed ready.”
“You’re thinking endocarditis?”
“Yes,” Holly said, handing her back the stethoscope. “On top of the frigging valve prolapsing again.”
Canizaro sighed. “That’s a heck of a combination.”
“Sure is.” Holly pushed back the strands of hair that had fallen loose in her mad dash from the train station. “I’m going to head over to my office. Call me as soon as you get the results of the echo. I might need to get him in the O.R. tonight, so book one just in case and make sure a team is on standby.”
Canizaro looked surprised, but nodded. “Will do.”
Holly glanced around the room. “Where’s the ER attending? Why are you all alone with Tyler?”
“The attending took off almost as soon as I got down here. In his defense, I did tell him you were only a few minutes away. It’s busy out there tonight.”
Holly gave a little snort. “I assume the nurse did the intake, not him?”
“That’s always the case.”
“So, he probably didn’t talk to Tyler’s parents. I mean parent,” she corrected herself.
“I’m pretty sure he didn’t.”
Holly grimaced, knowing she had to do it. What a time for a first meeting with a parent. She’d have to put a brave face on it, but she had nothing for Mr. Arnold that resembled good news.
* * *
Holly wouldn’t have recognized Lance Arnold as a parent if the ER nurse hadn’t pointed him out to her. She’d seen hundreds of parents stuck in ER waiting rooms, anxiously drinking endless cups of coffee, their eyes locked on the door to the trauma center. Rich or poor, old or young, male or female, they had one thing in common—their bodies vibrated with pent-up tension, and worry was carved in the lines on their faces. Until they received the news that their seriously ill or injured child was going to be all right, they always sat rigid in their chairs, or paced from one end of the waiting room to the other.
Not Lance Arnold. The bulky, bull-necked man was sprawled in a chair near the door, legs splayed wide, a men’s fitness magazine held up with both hands. The sleeves of his white tee shirt had been cut off, leaving frayed edges over powerful, bare shoulders. His biceps bulged and his forearms looked like small tree trunks, but the skin was pale. Not a construction worker or some other kind of outdoor laborer. He had the muscles, but not the tan. From twenty feet away, Holly could hear cracking sounds as he worked over what appeared to be a serious wad of gum.
He didn’t even glance up as she approached. She looked down at him, noting the amount of gel in his short, spiky blond hair. On top of that scent, the stench of stale cigarette smoke wafted up into her nostrils, and she had to school her features to hide her distaste.
“Mr. Arnold?” Holly tried for a completely neutral expression. A smile might present the wrong impression, while a frown or grim face could also convey an inappropriate message.
The man finally looked up. “Yeah.” He closed the magazine and tossed it onto the pile on the small table beside him. He ran his eyes from her head to her toes and back again, with a pit stop at her chest. “What’s happening?”
Holly’s teeth clenched at the mental undressing he’d just given her, but it wasn’t the time to push back. “I’m Dr. Bell, the surgeon assigned to Tyler’s case. Since Dr. McMillan’s retirement.”
She offered her hand and Arnold gave it a half-hearted shake. At the same time, his eyes flicked over her body again. “Like I said, what’s happening?”
Holly wanted to reach down and yank him to his feet. An anxious parent she could relate to and deal with. But this guy looked sullen and bored, and acted like a rude teenager. She remembered McMillan telling her that Tyler’s father had proven difficult at times.
She sat down in an empty chair next to his and swung around to look straight at him. “Tyler’s condition is stable at the moment,” she said. “We have him on a ventilator, but he’ll be taken off it very soon. We’re running a series of tests. I’ve also started him on an antibiotic.”
Arnold gave a small snort. “Yeah, I thought it was just some kind of bug he’d come down with. But his grandmother kept nagging me to bring him in.”
“His grandmother was right,” Holly said. “Tyler is seriously ill, and it’s much more problematic than a simple virus. I’m afraid he’ll have to be here for some time.”
Arnold frowned, looking more concerned. “His heart?”
Holly nodded. “If I’m correct—and we won’t know for sure until the lab results come back—Tyler has a bacterial infection of the heart. That’s always a serious matter, but it’s further complicated in his situation by the condition of his mitral valve.”
His eyebrows arched. “Mitral valve? Didn’t McMillan fix that?”
“Yes, Dr. McMillan repaired the valve, but sometimes repairs don’t work, or don’t last. Defective heart valves are tricky, especially in growing children.”
Arnold sat up straighter. “So, what are you saying?”
“I think it would be better to wait until the tests are completed before we discuss the options we may have.” She wouldn’t have that conversation in an ER waiting room, anyway. “Why don’t we meet in my office on Monday?”
“Is he going to have to be here overnight? In the ER, I mean?”
Holly shook her head. “No. We’re going to move him to Cardiac ICU as soon as a bed is ready. That should be fairly soon.”
Now Arnold looked more annoyed than concerned. “I don’t know about Monday. I work for a living, and the boss doesn’t give me much time off.”
Arnold said it without a trace of regret or emotion in his voice. Holly tried not to judge how families dealt with these situations, but he might have been talking about the difficulty he was having in taking the boy to soccer practice or the dentist.
“Well, let me know when you’re available,” she said. “As soon as you can, please.”
When he didn’t respond, she got up, tugging her dress over her thighs. His gaze dropped down to follow the movement of her hands.