Code Blue (11 page)

"Let's barter some more," he said. "Have dinner with me two nights a week, come to church and lunch afterward with me every Sunday, and cover my expenses for phone calls and such. The rest we'll call
pro bono."

"Tell you what," Cathy countered. "I'll have those dinners with you if you'll let me cook them. And they'll be working dinners. I'll pay all your expenses plus a five hundred dollar initial retainer. I can afford that, I think."

Will nodded. "And church, with Sunday lunch afterward?"

"When it includes your mother's fried chicken? That's a no-brainer. It's a deal."

Cathy stood at the exam room sink drying her hands when she sensed Jane standing behind her. She finished, tossed the paper towels in the waste container, and leaned against the sink. "What's up?"

The nurse's voice was as hushed as an acolyte's in a cathedral."Dr. Harshman's secretary called."

Cathy supposed that even the mention of Arthur Harshman inspired awe throughout Dainger's medical community. Awe, sometimes mixed with fear. She determined not to let him have that effect on her. "What did she want?"

"Emma Gladstone's surgery is scheduled for next Wednesday morning. First case on the schedule, 7:30 a.m.Dr. Harshman wants you to meet him in the surgeons' lounge at 7:00 a.m. to go over details."

"I'll bet he does." Cathy made no effort to keep the sarcasm out of her voice. "What he wants to do is grill me about the surgery: anatomy and technique and all the details I had to memorize when I was a senior medical student.He's angry that Emma Gladstone insists on having me present during the surgery, and he plans to do his best to make me so miserable that I back out."

Jane apparently decided to let the topic drop. She waited a couple of moments before pulling a second pink message slip from the ones in her hand. "Dr. Bell called. He wants you to call him back this morning."

"Okay. What about the rest of those calls?"

"Same as usual. Insurance companies wanting more information before they'll pay our claims. I've done all I can, but for these you'll have to talk with the medical directors and justify the charges."

Cathy's shoulders sagged. Growing up, she'd seen her father as a hero—a surgeon who saved people's lives, a man admired in the community. There had always been money in the household. For some reason, she had pictured this as the pattern for her practice as well. Apparently, she'd been wrong. Dreadfully wrong. Money was tight. And she certainly wasn't getting much respect, either from her colleagues or from patients like Mr. Phillips. That triggered a memory.

"Did Mr. Phillips ever call back for a follow-up appointment? Or write to have copies of his records sent to another doctor?"

"Nope. I guess he's too busy to take care of himself."

Unfortunately, the old adage held true in medicine. You can lead a horse to water— Cathy shrugged. "I'll be in my office." She took the pink slips and the charts that went with them and headed offto do battle with the insurance companies.On the way, she tossed her soiled lab coat into the hamper and shrugged into a fresh one, nicely pressed and starched. Maybe she'd feel better if she looked professional while she made the calls.

Cathy couldn't believe that Marcus would have anything good to say. She'd talk with the insurance companies first.An hour later, her coat and psyche both a bit wrinkled, she hung up and tossed the last of the charts into her "out" box. She'd received promises to review all the claims and possibly—just possibly—issue supplemental checks for the balances due. Ah, the romance of medicine.

"Let's see what Marcus wants," Cathy murmured. She dialed the number and leaned back, wishing she could put her feet on the desk as she'd seen so many male colleagues do. But she was determined to project a professional image, even when alone in her office.

She endured a full two minutes of music on hold before she heard Marcus say, "Thanks for calling back."

"No problem. What's up?"

"I wanted to give you a heads-up and remind you to be at the Morbidity and Mortality Conference tomorrow at noon."

Warning bells clanged in Cathy's head. "You mean to discuss the Nix case? Can't do it, Marcus. Milton Nix has filed a malpractice suit."

"I'm sorry to hear that, but we still have to review it. That's hospital policy. When the inspectors come around for our accreditation visit, they look at all those records. I don't want them to find that we didn't discuss that one. It would look like we're making an attempt to hide our mistakes."

"Discussing that case in front of the medical staffwould guarantee that the details would be all over town by sundown.If the malpractice action goes to trial, there's no way we could get a fair jury pool." Cathy thought for a moment."Tell you what. You and I and Dr. Baker have talked about it. Why don't you write up a memo and put it in the M&M records with the gist of our discussion and a note that the case is under litigation."

Marcus cleared his throat. "I'm not sure I can do that."

"Look, I really need your help here. I'm not asking you to sweep anything under the rug. Just keep the records sealed until this action is settled. Will you do that for me?"

There was silence for a long moment, and Cathy wondered if Marcus had hung up. Then he said, "Okay, I'll do it."He paused. "I realize you're having a tough time right now.How about having dinner with me tonight? Relax a bit. Cry on my shoulder if you want to."

She needed Marcus's support, and dinner with a colleague would be a nice change. But she hesitated once again. Was it still because she was wary of getting close to a man? Or had Marcus's behavior at the credentials committee meeting tipped her offthat he might not always be the ally he purported to be? She wondered if he wasn't really in the camp of the doctors who wanted her gone. And there was also her relationship with Will, though she wasn't sure where that was going.

"Thanks, but I have plans." Of course, those plans were Lean Cuisine in front of the TV, maybe a pint of Cherry Garcia ice cream, and a hot bath, but she figured she didn't owe Marcus a detailed explanation. Let him think what he wanted.

The yellow legal pad was filled with almost undecipherable scrawls. In contrast to the careful printing of her prescriptions, Cathy's notes to herself were hastily scribbled words and symbols, marching helter-skelter in all directions, sometimes connected to other thoughts by lines that gave the whole thing the appearance of a drunken spider's web. She'd eaten her microwaved dinner, at least some of it, although she couldn't recall what it had been. Now she sat cross-legged on the sofa with a pint of ice cream slowly melting on the coffee table in front of her. She couldn't make sense of the who and why and how of the prescription that nearly killed Milton Nix.

Cathy looked up as she heard footsteps climbing the stairs outside, followed by a rapping on the door. She detoured to the mirror to check her appearance. Comfortable old sweats, bare feet, blonde hair pulled back and held by an elastic band, face scrubbed free of all makeup. Unless it was the UPS deliveryman, she was in trouble.

It wasn't the deliveryman. It was Will Kennedy, a bouquet of fresh flowers in one hand, a briefcase in the other.

He stepped through the door. "I take it that this evening is informal."

What a total idiot she was. Of course, this was supposed to be the first of the working dinners for her and Will. A dinner she was responsible for cooking.

"I . . . That is, you have to . . . I'm so sorry. I completely forgot."

Will smiled the same smile that had melted her heart when she was younger—a smile that touched her as she never thought a man could do again. "I sort of figured that.And I'll bet you've eaten." He didn't wait for an answer. "No problem. I'll just order pizza. Shall we set up on the kitchen table?"

An hour later, Will looked at Cathy across the remnants of a pepperoni pizza and said, "I've enjoyed my dinner with you even if Pizza Hut did the catering, but I guess it's time to go to work. First, I need you to sign these forms. I'll send one copy to your malpractice insurer so they'll know I'm on board as your personal attorney. Since the suit's already been filed, I can schedule discovery depositions."

"You'll have to educate me," Cathy said. "Discovery?"

"We have the opportunity to subpoena witnesses and ask them questions under oath. Not just Nix and his wife, but anybody who might have knowledge pertaining to our case.So who should that be?"

"I guess the first people we need to subpoena are the ones who might have had access to the prescription." Cathy flipped several pages and found the chart she'd made. "Here's the list."

Will came around and read aloud over her shoulder."Milton and Gail Nix. The two pharmacists: Jacob Collins and Lloyd Allen. Anyone else?"

"Not really. And I don't see Mr. Nix playing fast and loose with his own heart medicine."

"We're working on the premise that it was done to hurt you. Who in this group doesn't like you?"

"How about asking if there's anybody in town who does like me?" Cathy heard the self-pity in her voice and hated it."I thought Milton Nix wanted me to do well enough in my practice to pay offmy note at the bank." She gave a sarcastic laugh. "But now he's suing me."

"Any problems with Gail Nix?"

"Not that I know of."

"Lloyd?"

"No."

"Jacob?"

Cathy recalled her last conversation with the pharmacy owner. He'd seemed a bit too pleased when he had said, "I suspect it will be an important piece of evidence in the near future."

The hairs on the back of her neck bristled. "Yes, I think Jacob has to be a suspect."

C
ATHY WATCHED JANE ESCORT THE MORNING'S LAST PATIENT TO THE front and begin the checkout process. Ten o'clock and she was through for the morning. At this rate, she wondered how much longer she could maintain her practice.

She slumped down behind her desk and brushed her hair out of her eyes. Might as well tackle some more of the paper-work that never seemed to end. Cathy had just added her signature to the last insurance form when Jane tiptoed in with a bulging manila folder.

"Here are the checks for you to sign." Jane's sad eyes conveyed a message that was confirmed when Cathy opened the folder.

She thumbed through the checks: withholding tax, answering service, cell phone, office phone, supplies, rent, Jane's salary. The check on the bottom of the stack was the monthly salary Cathy had allotted herself—not much— just enough to cover her living expenses. Then she looked at the adding machine tape clipped to the front of the folder and compared it with her bank balance. She shoved the last check across the desk. "Here, rewrite this check for half that amount."

Jane shook her head. "This is the second month in a row that you've reduced your salary check."

"I knew going in that it would take some time to get the practice on a good financial footing. Eventually my practice will grow. Someday those insurance claim checks will start coming in. In the meantime, the boss is the last person to get paid. That's simply the way it is."

Cathy picked up her pen and signed the top check in the stack. She looked up when she heard the office door open."Jane, do we have someone else coming in this morning?"

"Not until after lunch. Let me check."

Cathy couldn't quite hear the mumbled conversation in the waiting room. In a couple of minutes, just as she signed the last check, she heard Jane's voice again.

"Come on in here and lie down. I'll get the doctor."

Cathy was out of her chair in time to meet Jane in the hall. "What's going on?"

"Mr. Phillips. Severe chest pain, difficulty breathing.Sweating and weak. Probably having that MI we predicted."

"Let's see."

Phillips lay on the examination table, his complexion as pale as the sheet beneath him. Large drops of sweat dotted his forehead. His coat lay rumpled on the floor. He'd loosened his tie and unbuttoned the top buttons of his shirt, but his chest heaved as he struggled for air.

Cathy rolled the portable oxygen tank out of the corner, turned the valve to start the flow, and cinched the plastic mask over Phillips's face. "Jane, give him an aspirin to chew and swallow. Then call 911. We need them here—fast. After that, call the hospital and alert them that we're coming in."

While Jane gave Phillips the aspirin, Cathy slipped a blood pressure cuffon his arm. His pressure was 116 over 70.Down from his previously high pressure, but not in shock— yet. Pulse 84 and a bit thready. Just what she'd expect with a myocardial infarction. She pulled the man's shirt open the rest of the way and applied her stethoscope to his bare chest.She frowned at what she heard: S3, a third heart sound. A classic sign of an early MI.

"Mr. Phillips, I think you're having a heart attack." She applied the leads for an EKG as she talked. "I'll check an electrocardiogram to see how severe it is. We'll transfer you to the hospital as soon as the paramedics get here. Are you with me?"

Phillips nodded weakly but did not speak. The muscles in his temple were knotted, and Cathy could hear his teeth grinding.

Jane bustled in. "EMTs are on their way."

"Give him a nitroglycerine to hold under his tongue."Cathy's eyes never left the EKG tracing. Rhythm stable.Slight ST segment elevation. A few isolated T waves flipped.Still early, probably no damage to the heart muscle yet—if she worked fast.

She hurried to get an IV going before his pressure dropped more and all his veins collapsed. When she had it running, she said, "Mr. Phillips, I'm putting some medicine into your IV."

"Whatever you say, Doc."

"Jane, add a vial of atenolol into a small IV bag, and I'll piggy-back it onto this one."

Phillips's color was better now. What else? Oxygen.Aspirin to slow down clot formation in his coronaries. Nitro for pain relief. Beta-blocker. The next step was an angiogram, but where was the ambulance?

She fixed her eyes on the EKG. No change. Good.

Sirens screamed in the parking lot, and in less than a minute, two paramedics wheeled a gurney into the treatment room. "What've we got, Doc?"

Cathy recognized the lead EMT as one of the team that responded after her accident. "Acute MI, Mark. Let's get him to the hospital right away. I'll ride with him."

Phillips plucked weakly at her sleeve. "Doc?" His voice was barely audible.

"I'm right here, Mr. Phillips. I'll ride to the hospital with you and turn you over to the specialists there."

"Whatever you say. But I want you around too." He swallowed hard. "And thanks."

Cathy stuffed her white coat into the laundry hamper."Jane, I'm gone. I'll have my cell phone on if I'm needed."

"How's Mr. Phillips?" Jane called from her desk.

"He's doing well. I saw him this morning on rounds."

Cathy reached into the workroom refrigerator and popped the top on a Diet Coke. After two deep swallows, she held it against her forehead and leaned against the wall.

Jane appeared in the doorway, took one look at her boss, and opened the cabinet above the sink. She pulled down a bottle and held it out to Cathy. "Would you like some Tylenol?"

Cathy shook her head. "Had some earlier. I'll be fine.Stop worrying about me."

"Someone has to. Now tell me about our star patient."

Cathy leaned back against the cabinet. "Dr. Rosenberg did a cardiac cath yesterday. Fifty percent blockage of the left anterior descending coronary artery. He did a balloon angioplasty and put in a stent. Phillips should go home soon."

"Who'll do the follow-up care?"

"Dr. Baker was the internist on call. He saw Mr. Phillips with me in the ER."

Jane snorted. "So he's stealing your patient. You know you're qualified to take care of post-MI patients."

Cathy shook her head. "It's been the practice here that myocardial infarctions are the province of the internists.Family practice docs diagnose them, give the patients acute care, and get them in the hands of the specialist. After Phillips is stable, Evan will send him back to me. Or not."She rolled her eyes. "Maybe I should settle for doing what all the other GPs before me have done." But she knew in her heart that she couldn't be satisfied with that. She'd worked too hard.

In the parking lot, she climbed into the little Chevy and buckled her seat belt. As she backed out of her reserved slot, Cathy pictured her Toyota resting with dozens of other junked cars, consigned to the scrap heap after serving her so faithfully. As she wheeled out onto the road, she looked carefully in all directions. No black SUV in sight.

Will was scheduled to come over tonight for another working dinner. Cathy smiled to herself as she remembered the sight of Will Kennedy, a bouquet in his hand, like a teenager calling on his first date. She might not have been prepared for him on that last visit, but this time she'd be ready. Cathy steered a course for the grocery store, her mind already turning over the choices of what she could prepare.

She was in the frozen food aisle when she saw a familiar face. Might as well try to make nice. "Sherri. Hi. How are you?"

Sherri Collins looked up from her shopping list. "Hello, Cathy. Or I guess I should say, Dr. Sewell."

"Cathy's fine. How are things?"

"Well—" The ring of her cell phone spared Sherri from what was obviously uncomfortable small talk. She gestured an apology to Cathy, answered the call, and moved away.

Cathy hurried through the rest of her shopping, loaded her groceries, and drove off, still wondering if she'd made the right decision in returning to her hometown. She'd thought it might be a safe haven, a welcoming place, after her world had crashed around her. But it appeared that small towns had long memories, including at least one that made Cathy unwelcome. She forced the problem from her mind and concentrated on her driving.

As she approached the next intersection, a black SUV shot out of a side street directly into her path. Cathy stood on the brake pedal. Her car immediately skidded to the right. A lesson from Driver's Ed flashed across her mind: steer into the skid. Still braking as hard as she could, she pulled the wheel to the right. She felt a massive bump and heard a loud bang. The car rocked once before coming to rest, the right front fender tilted like the bow of a sinking ship.

Cathy closed her eyes and rested her head on the steering wheel. She felt the cold sweat that adrenaline brings. Her heart raced a mile a minute. Deep breathing didn't seem to help. How much of this could she take?

When she heard an insistent tapping on her window, Cathy finally raised her head. A man stood outside her door, wearing a worried expression. She pressed the button to lower the driver's side window.

"Ma'am, are you all right?"

She made a tentative inventory of her body parts.Everything seemed to move. No blood anywhere. "I think so. Did you see what happened?"

"Sure did. They pulled out right in front of you. Good thing you swerved." He peered over the hood. "I'll check and see, but it looks to me like you hit the curb hard enough to blow out a tire. Probably bent the wheel too."

Cathy pulled her cell phone from her purse and thought of the calls she needed to make: insurance company, wrecker . . . It seemed like there was something else, but her addled brain refused to cooperate.

Her insurance agent seemed shocked by yet another accident but remained professional enough to assure Cathy that this time she was covered. He asked for details, but she was able to beg offby promising to furnish a full report tomorrow.Right now she wanted to get home.

The service manager at the dealership where she'd bought the car was sympathetic and helpful. He promised to dispatch a wrecker right away. If she'd ride back to the shop with the driver, he'd have a rental car waiting for her.

"How long do you think it will take you to do the repair?" Cathy asked.

"A day, two at the most. That is, if the frame isn't bent.Then it's a whole different ballgame."

Two hours later, Cathy climbed the stairs to her garage apartment, weary and punch-drunk. She dropped her purse and briefcase on the sofa, pulled a soft drink from the refrigerator, and ran a hot bath. She was still soaking in the tub, half asleep, when she heard knocking at her door. She tried to block out the sound, but whoever it was seemed to have more resolve to knock than Cathy had to ignore the noise.

"What now?" she muttered. She eased out of the tub, slipped into a terry-cloth robe, and padded to the door. "Who is it?"

"Will."

Oh, no! Not again. How could she possibly have let this happen? Will would think she was an absolute airhead. She'd fought against the stereotype of dumb blondes all her adult life. Now she seemed to have become a prototype.

Cathy belted her robe tighter before she opened the door and gestured him in. "Will, I'm really, truly sorry. I was all set to cook for you, really I was, but then I had an accident on the way home. When I finally got here, I just collapsed."

Will dropped his briefcase beside the door and took her by the shoulders. "Are you all right?"

"Just sore and shaken up." Then it struck her. Her groceries were now sitting in the body shop of the Chevrolet dealership. "Give me a few minutes to get dressed, and I'll find something in the freezer that I can cook."

"Never mind dinner," Will said. "Tell me what happened.Are you sure you're not hurt?"

"Will, I'm fine. Really I am."

"Then get dressed, and I'll take you out to eat. Someplace quiet, where you can tell me all about it. You need to relax."

The prospect of having someone else cook sounded wonderful to Cathy. "Okay, but I owe you a dinner. I want you to include the cost of this meal with your expenses for my case."

Will seemed to think that over. She noticed that he still had his hands on her shoulders. He'd made no move to release her, and she hadn't felt inclined to step away. Finally, he said, "I guess that depends on whether the dinner this evening is business or pleasure."

"I thought it was business. What would make it pleasure?"

"This."

She watched him move closer to her, felt his lips on hers.His hands moved to encircle her in an embrace that made the years drop away.

"Cathy, I want us to pick up where we left off," he said. "I've missed you. When I heard you were engaged, it was like someone I loved had died. And now that you're back here and you're free, I don't intend to let you get away from me."

She looked up at him, into those blue eyes that had always seemed able to read her thoughts. Part of her—a big part of her—wanted to stay in those strong arms forever. But she had to be honest.

"Will, I can't make a commitment. Right now my life is a shambles. I'm teetering on a knife-edge, doing my best to maintain my balance. I don't know who to trust. Not even—."