Against Doctor's Orders Read online

  “Long night,” Harper said. “I thought it was supposed to be a quick callout.”

  Flann rubbed her face. “The arm wasn’t the problem. I splinted him and set him up for X-rays in a couple of days when the swelling goes down. But then a pickup and a Mini Cooper played chicken out on 46. They’re still picking up the pieces.”

  “Jesus,” Harper said. “Why didn’t you call me? I would’ve come and lent a hand.”

  “Glenn was on call, so I had plenty of help in the OR. The driver of the Cooper, a nineteen-year-old girl visiting from out of state, never even made it to the hospital. The young guy in the pickup—wife, and two kids in diapers—was coming home from a bachelor party for his cousin. They think maybe he fell asleep. Ruptured his spleen, perforated his colon, broke his femur all to hell. He’ll be rehabbing for six months.”

  “Anybody we know?”

  “Distant relative to the Durkees, I think. I didn’t know him, though.”

  “You get any sleep at all?”

  “Couple minutes while they got the OR set up and then for a little bit while I waited to see how he was gonna do in post-op.”

  “He going to make it?”

  “He ought to, barring unforeseens. His leg’s a mess. The ortho guys will have to take care of that. I got it stabilized, so they have a few days to fool around with it.”

  “You know, if you hadn’t been there, that guy would’ve died.”

  “Maybe. But you know the argument. He would have gotten a fast ambulance ride to the nearest level one or two, or maybe even a medevac hop. Statistically, if it didn’t take too long, his chances ought to be about the same.”

  “Yeah, except look at where we are. How long do you think it would’ve taken to get all that organized, even if it only meant a forty-five-minute ride in the bus? Tell me he wouldn’t have tanked en route.”

  “Sure, he probably would have the way his spleen was gushing. But EMTs and paramedics are as good as us most times handling that kind of crisis.”

  “True enough. But they’re not going to open up a belly if he crashes.”

  “Can’t argue. I do have the God factor going for me.” Flann drank some more coffee and stared at her, a bit of life sparking back into her eyes. “What are you getting at, Harp?”

  Harper flushed. “Not getting at anything. I’m just saying—”

  “You sound like you’re trying to put together a case. You think we’ve got a fight coming, don’t you.”

  Harper leaned against the opposite post, shoving her hands into her back pockets. The muscles in her jaw throbbed and she consciously unclenched her teeth. She’d lain awake half the night thinking about what might be coming, and what—if anything—she could do about it. Presley hadn’t revealed anything she could really sink her teeth into, but the trustees wouldn’t have wanted to unload the hospital if they hadn’t thought it was a losing proposition. Presley was a businesswoman, through and through, and everything about her said she was good at it. “I don’t think SunView is in the business of charity.”

  “I’m sure you’re right,” Flann said. “But they are in the business of business—and they want to make money. If the hospital can make money again, then what would be the point of not making that happen?”

  “I don’t know—a bigger profit margin? I don’t know what drives people like…” She almost said Presley, but she couldn’t lump Presley into the faceless mass of people she didn’t know and couldn’t understand. Presley was not a faceless name. She’d already become more than that. She was a flash of humor, a sudden brilliant smile, an unexpected gasp of wonder. She was a surprise and an enigma. Fascinating and frustrating.

  “She’s interesting, all right,” Flann said, as if reading Harper’s thoughts.

  Harper’s shoulders stiffened and her jaw tightened up again. Heat rose up the back of her neck. “I gathered you think so.”

  “Margie says you took her down to the tree house.”

  Harper focused on a doe and two fawns grazing at the edge of the cornfield. “Margie has a big mouth.”

  “Granted. So did you?”

  “Yeah. Mama ordered me to show some manners.”

  “I know, she said the same to me. I took Carrie on a tour of the house.”

  Harper flicked her a look. “You making some kind of point?”

  Flann didn’t grin, and that was a sure sign she was dead serious. “I might be. You could be headed for trouble there, Harp.”

  “I’m not headed anywhere.”

  “Maybe. What did she think of the tree house?”

  “She liked it. What’s not to like?” Remembering Presley’s delight, a quick stirring of pleasure raced through Harper’s belly. “She pegged you for the Tom Swift.”

  “She reads people. You got that, right?”

  “Yeah.” Of course Flann would see what she had seen in Presley. The two of them, for all their outward differences, had always thought alike. They competed because they loved the same things, and what was better than beating someone you respected and admired? She’d never been bothered by the competition before.

  “Did you try out the couch?” Flann asked casually.

  Harper shot her a look. “That’s your style, not mine.”

  “Now there’s something I’ve never noticed before.” Flann grinned. “One of these days that halo is going to slip, Saint Harper.”

  “You trying to piss me off?”

  “Did you at least make some kind of move?”

  “I just met her.”

  Flann pointed a finger at her. “So you thought about it.”

  “My heart’s beating, isn’t it?”

  “Sometimes I wonder.”

  “Yeah, yeah,” Harper muttered, going back to studying the deer.

  “I got no problem with you entertaining a beautiful woman while she’s in town,” Flannery said lightly. “But she’s not going to be here very long, and if things go the way we think they might at the hospital, the two of you are going to end up on opposite teams.”

  “I know that. And that’s why nothing’s going to happen.”

  “You sure about that?”

  “Unlike you, I don’t get led around by my gonads.”

  Flann’s grin, weary but irrepressible, widened. “You should try it sometime. Hell of a rush.”

  “Hear me on this. I don’t plan on pursuing a personal relationship with Presley Worth.”

  “Well then, you wouldn’t mind if I—”

  “Don’t test me,” Harper said softly, “because I can still beat your ass.”

  “Yeah, that’s what I thought,” Flann said. “And you haven’t been able to beat my ass since we were in middle school.”

  “Oh yeah? And what about that time—”

  “I’m not going there with her, Harper,” Flannery said, serious again. “I don’t think you should, either.”

  “Seeing how we both agree, we’ve got nothing to worry about.” Harper tossed the dregs of her coffee onto the ground. “Come on in. I’ll make you breakfast.”

  Chapter Fourteen

  All the office doors in the admin wing were closed and the halls deserted at eight on Saturday morning. Relishing the privacy, Presley unlocked the door to her new office and set up her laptop on the desk. After scanning her mail and deleting messages that required no follow-up, she keyed in the security information needed to give Carrie access to business accounts, insurance contracts, and admission statistics. Then she pulled up the summary Preston’s team had provided and confirmed what she’d suspected—the acquisition had been pushed through quickly due to ACH’s trustees’ panic over mounting debt, with only a superficial accounting of net profit. Preston had been in a hurry too, probably so he could get her out of the way while he wooed supporters. If she could find evidence that the buyout was financially risky and ill-advised, she could call Preston’s judgment into question. She pulled up the last five years’ financials and started to break down the data. When her cell phone rang, she checked the time
. She’d been working for three hours.

  “Good morning, Jeff,” she said, leaning back in her chair and stretching the cramped muscles in her back. She swiveled around to the window and was startled once again by the view. She half expected the glare of glinting steel and shimmering heat waves she was used to out the broad sheet-glass windows of her high-rise office in downtown Phoenix. Instead she found rolling hills a dozen shades of green, a crystal blue sky, and white clouds as fluffy as cotton candy. She turned back around.

  “How are things in the Appalachians?” Jeff Cohen asked.

  “The Adirondacks, not the Appalachians,” Presley said, smiling. Jeff was her counterpart in marketing, a vice president who had worked his way up from sales with amazing speed, and he’d done it without connections. He’d gotten the job because he was the son of one of her father’s college fraternity brothers, but unlike so many of the nepotistic appointments that littered the landscape at SunView, Jeff actually deserved the job and proved it. He was also one of her few friends in or out of the office, and she trusted him as she might have trusted a brother, had her brother been anyone but Preston. She’d known him most of her life, even though he was several years younger. Their families socialized, and while in college, she’d even dated him for a short period of time. When she’d realized she was never going to have more than friendly feelings for him, she’d broken it off. He hadn’t seemed heartbroken, and five years later he’d come out to her, although not to his family. Currently, he was dating the daughter of another well-placed family and would probably marry, produce heirs, and find his private pleasures elsewhere.

  “What’s the situation up there?” Jeff asked.

  Presley filled him in on what she knew and what she suspected in terms of the hospital’s financial status. “There are decades of loans, investments, debt, and collections to sort out. It will take me a while to untangle it all.”

  “I thought it was supposed to be a straightforward reappropriation of assets,” Jeff said. “The place sounds ripe for a long-term care facility.”

  “Possibly.” Presley would have agreed with him a few days before, but now she wasn’t so comfortable with a hasty decision. “There’s a lot more going on up here than we realized.”

  “There’s a lot more going on down here too,” Jeff said, “and I think you need to be here.”

  Jeff was the kind of person who somehow managed to be friends with everyone and never appeared to be choosing sides. Consequently, everyone talked to him, and he was always a font of information that was timely and accurate. If he said something was going on, then she needed to take him seriously. “What exactly?”

  “Word is Preston’s courting management heads nonstop. Since you’ve been gone, his schedule is packed with luncheons, dinners, and meetings with power players.”

  “I’m not surprised. With my father set to retire at the end of the year, he’s lining up supporters.”

  “The vote might be a ways off, but you’ll be starting from behind if this goes on for long. Can you get back here?”

  Her first inclination was to say absolutely. She could manage the dissolution of ACH from Phoenix once Carrie was up to speed, but she still had to decide what to do with the physical facility and draft plans for construction and restructuring the management team. She’d get Carrie started on investigating local contractors that week. “I don’t think it’ll take very long to get a handle on what needs to be done here. I’ll get back as soon as I can.”

  “Sooner will be much better than later.”

  “I appreciate you calling me.”

  “I’ll let you know if anything else develops. Be careful of the locals, I hear they might bite.”

  Presley laughed. “Everyone here is perfectly charming.” She’d been about to add perfectly safe, but when she thought of Harper and the way her pulse kicked up when she did, safe was the last word she would use to describe her.

  *

  Harper moved her stethoscope over John Prince’s broad, sun-speckled back, listening to the wheezes and crackles that filled both lung fields. Stepping back from the stretcher, she hung her stethoscope around her neck. “How long have you been short of breath?”

  John’s weather-beaten face twisted. He was forty-three but could have been a decade older. His chest and arms were ropy with muscles, his abdomen starting to soften with the effects of a few too many beers and burgers. “Not so long. Few days, maybe. The damn cough is making it hard for me to sleep is all.”

  She leaned back against the wall. “A few days?”

  He lifted a shoulder and didn’t meet her eyes. “Maybe a week.”

  “Have you been having chest pain?”

  “Sore muscles now and then, nothing unusual.”

  She was used to her patients, especially the men, downplaying their symptoms. Almost everyone in her practice were farmers, small business owners, and working poor. Their common denominator was they needed to work to survive, and very few of them had any kind of nest egg to tide them over if they didn’t have a steady income. Many of them went without medical insurance to pay for heat during the winter or seed during the spring or shoes and clothes for their children. And many of them ignored physical problems until they became so severe they were forced to seek medical attention. John was one of those. If he was here in the ER on a Saturday morning, something had happened to scare the hell out of him. She suspected it was more than a cough that had brought him in.

  “Coughing woke you, did it?”

  He nodded. “The wife’s been nagging me about it. Says she can’t sleep for the noise.”

  And his wife was frightened too. “We’ll get an EKG and a couple of blood tests. Then we’ll talk.”

  “Can’t you just give me some medicine for the cold?”

  “If it’s a cold, I might be able to,” Harper said. “But let’s see first.”

  “How much is it going to cost?”

  “We’ll work something out when the time comes. You need the tests, John.”

  He blew out a breath and gripped the paper-covered examination table with both hands. “All right, Doc. Whatever you say.”

  A few minutes later the nurse brought her the EKG strip. As she had suspected from the history and physical signs, the abnormalities suggested cardiac damage, possibly chronic. Silent MIs were not rare, and even those producing symptoms were often ignored by patients or written off as muscle strains or indigestion. John was lucky he wasn’t one of the high percentage of men whose first heart attack was fatal. When she went in to talk to him, his eyes were frightened. In her experience, people always knew when their condition was more serious than they wanted to believe until the moment when they were forced to accept they had a problem.

  “There’s some abnormalities on your EKG, John. What it tells us is that there have been some problems with your heart that you might not even have been aware of. We need to find out exactly what the trouble is. That means a few more tests.”

  He swallowed audibly. “Is it bad?”

  “The fact that you’re here means it’s not as bad as it could be, but we won’t know for sure until we can study the blood flow to your heart. I want you in the hospital while we do that so we can monitor you.”

  “I can’t stay now,” he exclaimed. “I’ve got new crops in the ground and more work than I can handle with the herd. I don’t have time to be away from the farm—who’s gonna look after things?”

  “I can’t let you go home. Right now there’s fluid in your lungs and that tells me your heart isn’t working as well as it should. We can take some of the load off that with medication, but we need to find out what the underlying cause is.” She’d heard a variation of this argument from the time she’d started following her father on rounds and had had it herself at least a few hundred times. She’d learned a long time ago, men like John Prince would not be persuaded out of fear for themselves. “You’ve got, what—three kids, all of them still in school? You need to take care of yourself so you can take c
are of them and Sally Lynn.”

  “Jesus, Doc.” He rubbed his face. “What am I gonna tell Sally Lynn.”

  “I can talk to her first if you want me to.”

  “Yeah, that would be good.” He stared at the floor. “I don’t want her worrying.”

  “She won’t if you let me take care of you.” She squeezed his arm. “We’ll get this sorted out and we’ll get you back to work. All right?”

  He lifted his eyes and searched hers. She held his gaze. He needed to see that she was confident. He needed to believe in her.

  “Okay.”

  “Good. I’ll go get Sally Lynn, and we’ll go over things together.”

  By the time she finished admitting him, it was almost eleven thirty. She hadn’t had anything to eat since she’d made pancakes and eggs for Flann at six in the morning. Flann had gone home to go to sleep, and her big plans for the day had been to plant a half dozen tomato seedlings in the back garden. That had been put on hold when she’d gotten the call from the PA in the ER who thought John Prince was on the verge of heart failure. After seeing John into the elevator to the ICU, she stopped in the cafeteria to grab lunch. As she carried her tray to a table by the window, she saw Presley sitting alone with a cup of coffee, a half-eaten sandwich, and her iPad. She hesitated, then headed for her.

  “Do you mind some company?”

  Presley looked up and smiled. “Not at all. Please.” She put her iPad aside. “Just finishing rounds?”

  “No, had a patient in the ER to see. You?”

  “Just finished up.”

  “I guess I can’t talk you into softball?” Harper asked, biting into her turkey club sandwich.

  “You’re nothing if not persistent. But no.”

  Harper grinned, twisted the top off her bottle of water, and took a swallow, studying Presley. She was dressed for work again—soft pale green shirt with a cream-colored jacket and black trousers. Her makeup was subtle, her hair loose and pushed back behind her ears. She wore a single ring on the ring finger of her right hand, a square-cut dark red stone in a gold band. Simple, elegant. Exactly like her. “Persistence is often rewarded.”