Against Doctor's Orders Page 8

  Presley stopped at the edge of the curtain as Harper hurried into the cubicle, taking in the eight-by-eight space in one quick glance. Her stomach plummeted. She didn’t belong here in this harshly lit place where the air crackled with foreign energy and fear. She belonged in the quiet, orderly realm of benchmarks, options, and margins. She didn’t look away, having agreed to see Harper’s world.

  A toddler, naked except for plastic training pants covered with multicolored polka dots, lay in the middle of a stretcher far too large for the tiny form, surrounded by towering adults who dwarfed the small body even more. Only the face was visible, haloed by blond ringlets, the features covered by a breathing mask that a grim-faced woman of fifty inflated with rhythmic squeezes to a gray football-shaped bag filled with air. A young woman, not more than twenty, stood staring with terrified eyes behind the people gathered around the stretcher, arms wrapped around her midsection, a keening sound rising from her throat.

  Presley tugged her lower lip between her teeth. Leaving was akin to surrender, and she would not do that while the struggle continued.

  The woman wearing the Snoopy smock, her name tag indicating she was Rose Aello, RN, said, “She came in with a URI. Her O2 sat was a little low. That’s why we called you. Then she just stopped breathing.”

  The older woman squeezing the bag, Paula Jones by her ID badge, said, “I’m getting a lot of resistance. We’re not aerating very well.”

  Harper pushed her way to the head of the stretcher and Paula made room for her. After a quick listen to both sides of the child’s chest, Harper slid both hands under the child’s shoulders and pulled her upward until her head was at the very edge of the stretcher. “Where’s the laryngoscope?”

  “Here.” Rose handed Harper an impossibly large-looking instrument with a fat silver handle and a curved extension with a light at the end. Somehow Harper got that enormous thing into the toddler’s mouth and peered inside. “I’m going to need a tube. Let’s try a number four pedi.”

  Rose rummaged in the cabinet and pulled out an assortment of long plastic tubes, individually wrapped in clear cellophane. She tore one package open and pulled out a tube. “Ready.”

  Everything was probably happening quickly, but to Presley time seemed to stand still. Breathe, breathe, breathe kept running through her mind, eclipsing all else.

  Someone pushed in beside her and Presley glanced away from the bed. Flannery Rivers, in scrubs, a paper mask hanging around her neck, her sandy hair tousled.

  “You need me, Harper?” Flannery said in a strong, steady voice.

  “Not yet.” Harper didn’t look up. She held out her hand and Rose handed her the tube.

  “Thanks,” Harper muttered.

  “Paula, honey,” Flannery said casually, “want to get a cut-down tray in here, just in case?”

  “Got one right over here,” Paula replied.

  “Good enough.” Flannery leaned back against the wall and crossed her arms, looking as relaxed as if she was waiting for a bus. Presley caught her eye and Flannery winked.

  Presley understood then that Flannery had total confidence in Harper and was content, despite her obvious instinct to take charge, to wait until Harper needed her. What an interesting and foreign dynamic that was. To trust and be trusted so completely. Presley turned back to Harper, a disconcerting ache in her chest.

  “Flann,” Harper said, peering into the child’s throat, “can you give me some cricoid pressure? I can’t see around the epiglottis it’s so swollen.”

  “Sure thing.” Flannery pushed away from the wall and pinched her thumb and forefinger in the center of the baby’s throat. “That help?”

  “Better,” Harper said, her focus absolute.

  The frightened young woman—the baby’s mother, Presley assumed—started to sway, all the color drained from her face. “Oh my God.” Her voice echoed with hollow horror.

  “Here,” Presley said, sliding an arm around the young woman’s waist. “There’s a chair right behind you. Sit down and let the doctors and nurses work. Everything will be all right.” The words came so automatically she couldn’t take them back and hoped she hadn’t lied. And yet, watching Harper and Flannery, she couldn’t believe anything else.

  Alarms rang, jagged green lines jumped across a monitor on a high shelf above the bed, and the child lay so still. Never had stillness been so terrifying.

  “I think I’m in.” Harper hooked a line connected to an oxygen tank up to the tube she’d inserted in the child’s throat. “Somebody listen.”

  Flannery tugged the stethoscope from around Harper’s neck and placed the end on the toddler’s chest, the instrument looking far too large against the miniature rib cage. She moved it quickly over both sides of the tiny torso. “Sounds good.”

  “Color’s coming back,” Rose said.

  Flannery glanced up the monitor. “O2 looks good too. Nice job.”

  Harper looked up at her sister and flashed a quick grin. “Thanks. Appreciate the backup.”

  “No problem. Need anything else?”

  “We’ve got it.”

  Flann nodded and stepped over to Presley. “I see you’re getting a firsthand, up-close-and-personal introduction to the place.”

  “Yes.” Presley took a deep breath. The room jumped into stark relief, as if a curtain had been swept aside. Harper’s hands moved with quick certainty as she secured the tube to the child’s cheek with strips of tape. Her fingers were long and tapered, elegant as an artist’s at work. “A bit more dramatic than I’d expected.”

  “Harper has always been the showy one,” Flannery murmured.

  Presley laughed softly at the obvious lie. “I noticed.”

  “I’m still free later.”

  “I’ll have to see how my schedule is running.” Presley wasn’t certain she could take any more of the Rivers clan in one day. There was something so raw about them, as if they’d somehow escaped the veneer of civilization that created an invisible shield around everyone else she knew. Their intensity scraped against her nerve endings and stirred feelings both uncomfortable and intriguing.

  “I’ll look forward to hearing from you when you’re free.”

  Flannery disappeared and Presley knelt by the young mother. “Everything is going very well. Do you need anything?”

  The young woman, a girl really, turned eyes dilated and nearly blank with shock to Presley. “She was fine last night. Just a little runny nose. Then this morning she had a cough, and I didn’t like the way it sounded. All raspy, like. My husband said I should bring her in. Maybe I waited too long.”

  Presley searched for the right words. God, this was awful.

  Harper squatted down and took the mother’s hand. Her shoulder touched Presley’s and for an instant, Presley absorbed the hard strength of her. The unexpected comfort shocked her into pulling away.

  “You didn’t wait too long,” Harper said. “She developed swelling at the back of her tongue, and it blocked her airway. Kids get this sometimes and it happens really quickly. You brought her in and that’s what matters.”

  The mother clenched Harper’s hand so hard her knuckles turned white. “She’s going to be all right?”

  “We’re going to put her in the intensive care unit and watch her really closely. She’ll be getting antibiotics. You should go to the cafeteria and have something to eat. One of the nurses will come down and find you when it’s time to see her.”

  “You’re sure?”

  “I’m sure.”

  Rose came over and took her by the arm. “Come on, sweetie, I’ll walk you down.”

  Presley waited at the nurse’s station while Harper wrote notes and orders and called the intensive care unit to tell them about the little girl. Finally, Harper pushed back her chair and stretched her shoulders. She seemed completely calm, as if she hadn’t just saved a child’s life. Her disheveled hair was the only sign she’d just been in the middle of an emergency, and on anyone else the look would probably have been a st
udied effect. On Harper the result was rakishly appealing.

  “What was that?” Presley asked, squelching the flicker of unsettling allure.

  “Acute epiglottitis—it’s uncommon, but not really rare. Kids decompensate really quickly. If she hadn’t been here when the episode started…” She raised her shoulder.

  Presley got the message. Harper was conditioned by generations of tradition to believe the hospital was essential to dispensing care, but in twenty-first century America, there were other more cost-effective models. “What about urgent care centers? According to our geographic searches, there are quite a few within reasonable driving distance.”

  A muscle in Harper’s jaw jumped. “Urgent care centers have their place. They’re great for routine problems, but they’re not designed for emergency care. They transfer out anything of a serious nature. And this?” She shook her head. “I had trouble getting that tube in.”

  “And if you hadn’t been able to? Couldn’t she have been transported to a medical center with pediatric intensivists?”

  “Not safely. Flann would’ve had to do an emergency tracheostomy. In the emergency room, on a child? Not many people could do it.”

  “I see,” Presley said. “And what if you and your sister hadn’t been immediately available? I’m guessing no one else here could have done what you did.”

  “We’re always available.”

  “Unusual, and admirable. All the same, let’s say the mother hadn’t had the option of coming here. Then she would have driven to a tertiary care center to begin with.”

  “Why would I want to assume that?”

  “Just hypothesizing, Dr. Rivers,” Presley said carefully. “We consider such things when determining risk management, for one thing.”

  Harper rose, her expression shuttered. “Peggy. That’s the little girl’s name. Peggy Giles is going to be fine. Her mother brought her to the right place.”

  “Of course.” Presley couldn’t argue, at least not now. She’d seen the truth of Harper’s statement. “You—all of you—were impressive.”

  Harper’s gaze captured hers. “Will you take the time to know who we are? What we do?”

  “That’s why I’m here.”

  “Is it?”

  Presley searched for a truthful answer. “We work on different sides of the same street, Harper.”

  “Then walk on mine awhile. A month—spend a month with me in my practice.”

  Presley laughed. “I can’t do that—I’ve got a schedule to keep. I…” I need to wrap this up before Preston shuts me out.

  “Afraid to see the faces of the people behind the numbers?”

  “That’s not fair,” Presley shot back. “You don’t know me or what I do.”

  Harper raked a hand through her hair, her jaw clenching. “You’re right. So educate me.”

  “Fine. I will.”

  Harper grinned and Presley glowered. What had she just agreed to?

  *

  Presley left the ER and, halfway back to her office, abruptly changed her mind. She followed the exit signs to the side entrance and walked around to where she’d parked her car. She had too much nervous energy to sit behind her desk. The restlessness was a totally alien sensation. Work was her touchstone, her office the place she escaped to when the emotional ups and downs of dealing with her parents and the mental stress of jousting with Preston wore her down. But right now, her body refused to settle, and she climbed into her car and drove down the winding road away from the hospital with the windows open and the wind whipping through her hair. The image of Peggy Giles, so limp and lifeless, and the primal keening of her mother pursued her.

  She pulled into the long dirt drive leading to the Whites’ and sat gripping the steering wheel, the faint mechanical ticking of the cooling engine loud in her ears. She hadn’t really let Harper goad her into wasting hours trailing after her, had she? She’d have to find a plausible excuse to withdraw. The more time she spent with Harper, the more she’d have to defend a position Harper could never appreciate or accept. Harper was an idealist, the worst kind of person to involve in business decisions. God. She needed to draw a firm line in the sand before a simple job got out of hand.

  When she finally looked up and saw the rental car parked by the barn, she almost cheered. A little bit of normality at last. Carrie was here, solid, reliable, dependable Carrie, who understood the way she thought and didn’t take issue with her simply for being realistic. She hurried up the walk into the house. “Carrie?”

  “Out here,” Carrie’s lilting voice announced.

  Presley left her briefcase by the stairs and strode to the kitchen. The room was empty, a covered plate of what she hoped were more of Lila’s muffins on the table, and the screen door open. Outside, Carrie leaned against the back-porch post. “Hi! You found the place, I see.”

  Carrie turned, her deep green eyes shining. Wisps of her shoulder-length red hair clung to her milky cheeks. “This place is amazing.”

  “That’s certainly one word for it.” Presley scanned the yard. It was empty except for patches of deep yellow daffodils that seemed to have cropped up in the last few hours. The temperature had climbed but was still absurdly cool for June.

  “Really! Everything is so green. And trees everywhere. It smells wonderful.”

  Presley studied Carrie suspiciously. What could she say to that? Everything was amazingly green and golden and brilliant blue and ridiculously idyllic. And clearly, Carrie had already breathed too much of the intoxicating air. Hoping to bring her back to earth, she asked, “Have you been upstairs? Either one of the open rooms is yours.”

  “I have. I took the one looking out the front. It’s an awesome view. Have you been exploring?”

  “Ah, I haven’t actually walked around the place yet, but it seems like all the necessities are here.”

  “What’s the hospital like?”

  “About what you’d expect—better maintained than most places that aren’t even half as old, with a fairly steady census.”

  Carrie pursed her lips. “I got the feeling Preston saw this as a quick turnover, maybe transitioning to long-term care or some kind of outpatient imaging center. Depending on the reimbursement profiles.”

  That was SOP for small outlying places like this, but simply hearing that it had been part of Preston’s plan made Presley resistant. She doubted he’d done more than look at the financials for the last several years. He wouldn’t have had the patience to do a geographic or demographic analysis of the area. “Yes, well, we’ll know more when we’ve had a breakdown of resources and usage.”

  “Yes, we ought to be sure we head in the right direction.” Carrie rose. “What about the staff? Any issues?”

  Presley immediately thought of Harper. She could handle Harper—she just needed to remain firmly in charge and remember why she’d come. “Not so far.”

  “Good. I’m ready to dig in, then.”

  “Are you sure?” Presley wanted to return to the hospital, but strangely, her first thought wasn’t of work. She wondered if she might run into Harper again. She quickly pushed the thought aside.

  “Totally. Can you give me fifteen to take a quick shower?”

  “Don’t hurry.”

  After Carrie disappeared inside, Presley sat on the stairs to wait. While she checked her mail, she half expected the rooster to appear to annoy her. After a few minutes he was a no-show. Maybe he slept in the barn during the day. She supposed she could go check while she waited.

  The big barn door slid back surprisingly easily as she pushed it to one side. The interior was huge, with a row of empty stalls along one side under a loft still piled high with bales of hay. Light filtered through the metal-mesh-covered windows in the stalls and slanted through the cracks in the board walls. The hot, steamy air smelled sweet.

  “Rooster?” Presley walked down the wide aisle and caught a flicker of motion out of the corner of her eye. Her pulse jumped. Empty barns didn’t have rats, did they? “Rooster?”<
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  The answering cry was distinctly un-Rooster-like. Stepping forward cautiously, she peered into a dim corner and shiny eyes stared back.

  “Oh!” She jerked back as her brain deciphered the shapes. Little heads, little faces. Kittens. Four—no, five.

  “Caw?”

  Presley spun around. Rooster hopped up. “Oh no. This is not good.”

  “What isn’t?” Carrie said from the doorway.

  “Livestock everywhere,” Presley said.

  Carrie joined her. “Look how cute! Where’s the mother?”

  “Not too close, I hope.” Presley flapped a hand at Rooster. “Shoo. Go. Cats. Birds. Bad. Go.”

  He cocked his head and didn’t move.

  “Should we feed them?” Carrie said.

  “No! Maybe they’ll go away.”

  Carrie’s face fell.

  “Fine. Why not!” Presley stalked toward the door and Rooster obligingly followed. “Why don’t we just give up business altogether and become farmers.”

  “Ah,” Carrie said, unable to hide a smile, “we can probably manage both. Multitasking is our specialty.”

  “Right.” Presley slid into her car and started the engine. Carrie jumped in beside her. Rooster watched as she U-turned around and roared away. Simply perfect.

  Chapter Nine

  Harper dictated Peggy Giles’s admission H&P and a procedure note, and headed for the ICU to make sure the baby was stable. She had no reason to go down the east corridor, although she wondered if Presley had gone back to her office and had to force herself not to wander over to check. What would be the point—they’d come to an impasse and they’d probably only argue. She wasn’t sure how things had unraveled quite so quickly. Presley had actually seemed interested and relaxed while they’d been making rounds, and Harper had enjoyed introducing her to patients and describing their care. Sharing her work came naturally, given that everyone in the family was part of it and always had been, but she’d rarely discussed it with anyone outside the family, not even the women she’d dated. There’d never seemed to be any need, when Flann or Carson or her parents were always around to bounce things off or share an exciting story with. Today had been different—showing Presley what the Rivers meant to her, to everyone within its walls, mattered on more than a professional level. Sharing her world with Presley had been satisfying in a way she hadn’t expected, at least until Presley had retreated into the alien landscape of budgets and cost-benefit analysis and other things that didn’t belong anywhere in the province of caring for patients. The thread of connection they’d been weaving had abruptly snapped, and that bothered Harper more than she wanted to admit. Fortunately, she had more important things to occupy her mind.