Critical Care (3 page)

Erin smiled. "Hey, I really appreciate your coming here. We've
had a horrible shift, and my staff are workhorses, but the Hester
child was a real heartbreaker. We worked a long time to save her, but
it didn't happen. And only last weekend we had the first drowning
of the season. Junior high boy fishing on the river. Overall my crew
seems to be coping fairly well, but today might be that last straw, you know? So I have a couple of issues I'd like to discuss with you.
I can spare about ten minutes to fill you in. Will that be enough
to get you started?"

"Yes ... okay." Claire tried to recall the details of her review.
How much could she offer here? One person couldn't do more
than a brief assessment and let the staff know more assistance was
available. At least she'd found the self-help pamphlets. "But first I
should tell you that I left a message for the hospital social worker
because if an actual debriefing is needed, then a mental health
professional is required. That's policy." She swallowed, hoping she
sounded more confident than she felt. "The debriefing should be
done tomorrow or the next day."

"What?" Erin shot her a look that clearly implied Claire was
the one who needed mental help. "Tomorrow? I called you here
because we need help now. Didn't Merlene tell you that?" She
pressed her fist to her lips. "Look, I've had a lab tech faint, the
media's harassing family members in the waiting room, and an
agency nurse threatened to walk out. Walk out, when I'm shortstaffed already! I'm sorry if I seem testy, but I'm responsible for
the quality of nursing care here. My team needs help, and I'll do
everything it takes to make that happen. Merlene told me you were
a trained peer counselor. Aren't you?"

She hated herself. Erin Quinn was right. Claire needed to do
whatever she could for these people. Somehow. She reached into
her briefcase and grabbed a sheaf of glossy pamphlets. "Yes, I've
been trained. And I can start an initial assessment, get things
going in the process. I promise I'll do as much as I can to help,
and . . ." Her voice faltered as heavy footsteps came to a stop
behind her. She fought an unnerving sense of dej a vu and impending doom.

"Help?" A man's voice, thick with sarcasm, prodded her back
like the devil's pitchfork.

Claire turned, several pamphlets slipping from her fingers.

It was time to officially meet the newest threat to her plan, Dr.
Logan Caldwell.

Dr. Caldwell knelt down a split second before Claire did, and their
fingers brushed as they reached for the same pamphlet. She pulled
back, her face flushing. "I've got them, Doctor. I ..." Her voice
failed as she met his eyes.

Logan Caldwell's eyes were impossibly blue. Intense, almost
crystalline, like the still surface of Lake Tahoe after a first snow.
Fringed with black lashes, they seemed mismatched with his dark
brows, curly hair, olive skin, and wide-bridged nose. And now
they were narrowing, with tiny crinkles forming at the edges, as
he began to ...

Laugh? Claire heard him chuckle deep in his throat. He's
laughing at me? She clenched the handle of her briefcase.

"I guess you figured out why you're here," Dr. Caldwell said,
his tone making it clear he recognized Claire from their earlier
skirmish in the corridor. He held out the pamphlet, then tipped his
head, trying to read her name badge. He skimmed her fawn linen
business suit. "So what are you, a sales rep?"

What am I? Claire's lips pressed together. How dare he. He was
leaning so close now that she could smell him-surgical scrub soap,
coffee, and a trace of some woodsy cologne that ought to come
with a surgeon general's warning. Masculine and intentionally knee-weakening, she suspected. Maybe. For any woman but her.
Claire snatched the pamphlet and stood. "No. I'm a registered
nurse with the education department."

He gathered the remaining papers and stood as Erin Quinn
attempted introductions. She was interrupted by the loud squawk
of the base station radio announcing incoming ambulance traffic.
A cardiac patient? Hard to tell; the report was garbled by static.

"Claire Avery," Erin continued, "this is Dr. Caldwell, our ER
director."

"Logan," he said, shifting the stack of pamphlets to one
hand and extending the other toward Claire. "I'm not much on
formality."

"Logan, then." Claire felt his hand engulf hers as she looked
up-way up-into his face. The man was huge, easily towering over
her own five feet eight inches and making her feel small for the
first time in a long while. She hated it.

She straightened her shoulders, lifting her chin and stretching
taller. Then pulled her hand away. "I'm here because I was told you
needed some help." As quickly as I can; then watch me run the other
way, Goliath.

Logan lifted the sheaf of pamphlets and scanned a cover. His
dark brows furrowed and he searched her eyes warily. "'Healing
the Healers'?"

Erin intervened. "She's with the CISM team. I told you I
requested that." She glanced at the treatment cubicles and then
toward a closed door marked Do Not Enter at the far end of the
trauma room.

Claire's stomach sank. No doubt it was a temporary morgue,
where they'd placed the little girl who'd been killed. It reminded
Claire of the painful realities of every ER-body bags, lists of personal belongings, and impossible explanations to family members forced
to wrap their arms around the clinical facts of death instead of
around their loved ones. Don't make me do this. Not again.

Erin nodded with certainty. "I'm asking for Claire's help with
our staff. Because this day care incident's been tough on all of us."

Claire studied Logan's expression and knew Erin was wasting
her energies. She'd dealt with this kind of hard-driving, unbending, and callous physician before. Like the doctor who'd repeatedly
questioned her competency in the weeks after Kevin's death.

"Tough?" Logan shook his head. "This is what we do, Erin.
Tough comes with the territory. And death is always a factor. Do
you see me crumbling here?" He smacked the pamphlets against
the leg of his scrub pants and frowned. "The only kind of help we
need here is more staff, more warm bodies. Real nurses. Not administration's attempt at some ... touchy-feely counseling."

Touchy-feely? Real nurses? Claire dug her nails into the leather
of her briefcase. She reminded herself she'd soon be back in the
education department and out of here for good. Otherwise, she'd
have to make this man, giant or not, eat his words.

"Here," he said, handing Claire the pamphlets, then rubbing
the side of his jaw. The hollows of his eyes were shadowy dark.
He looked suddenly weary, a caregiver nearing the end of a bruising shift. If he'd been someone else-anyone else-Claire would
have felt compassion. She'd been in that situation herself plenty
of times. "I'm sorry, but we just don't need-"

The base station radio crackled with static and then shrilled an
update on the incoming ambulance traffic. Four minutes. Sixtyyear-old female in full cardiac arrest.

Erin widened her stance, and Claire half expected her to raise her
fists like a boxer awaiting the first-round bell. Claire smiled, feeling a rush of admiration for this feisty redhead so competent at running
her ER ... and determined to handle its stubborn director.

"I'm showing Claire around for a minute," Erin told him, "and
then I'll be there for the cardiac code. We need this help."

Logan's mouth twisted into a smile, and the corners of his tired
eyes crinkled again. "Sure. Why not? Keep the educator around.
Maybe her pamphlets double as defibrillator pads." He chuckled
and began walking away.

He stopped to look over his shoulder, his changed expression
leaving no doubt that his amusement had vanished. "But have
her start with the registration staff. I can't afford distractions
right now."

The registration office, which looked out onto the emergency
department waiting room, was a cluster of windowed cubicles filled
with computers, copy machines, and incredible stacks of clipboards
destined for avalanche.

Claire headed to the first open door, trying to convince herself
that she hadn't been thrown out of the ER by Logan Caldwell.
CISM policy clearly indicated staff contact was to be made away
from the action, so this sequestered niche-which smelled blessedly like coffee and printer ink instead of soot and scorched hairmight be the best place to get her feet wet in the staff assessment
process. It was a long way from the horror and heartbreak. Far safer.
And that suited Claire just fine. All she had to do was let these
office people know that help was available. Though she couldn't
imagine they'd be at risk for traumatic stress.

"Hello?" she called, peeking around a column of wall-mounted
plastic files labeled HIPAA, Emancipated Minors, Dog Bite Reports,
and Workers' Comp.

"Come on in."

Claire stepped inside the cluttered space, then smiled at the
sight of a tiny clerk leaning back in her chair, feet propped on a
stack of copier paper boxes, and holding a Tupperware bowl. Her
gray-streaked black hair was looped in long braids across her head
and sported at least three ink pens, one topped with a jiggling
plastic Cookie Monster. On the desk beside her computer a collection of framed photos of children flanked a ribbon-tied canning jar
overflowing with mustard flowers. The clerk's name tag, studded
with service pins, read Inez Vega.

"I hope I'm not disturbing you. I'm Claire Avery, and-"

"No, no," Inez said quickly, sitting upright and setting her
food aside. "Erin said you were coming. And it finally settled
down enough so I could take a little break." She smiled, revealing a glimpse of a gold-rimmed front tooth. "Been quite a day. I
feel so bad for the nurses and Dr. Logan. I'm glad you're here to
help them."

Claire looked past her into the sparsely populated waiting
room. A woman rose from her chair to push an elderly man in
a wheelchair to the adjacent registration cubicle. "But things are
better now?" she asked, knowing from the looks of the waiting
room that it had to be true. And sensing, for the first time in an
hour, that this wasn't going to be so bad after all. Maybe Erin had
underestimated her staff. "No more injuries from the day care?"

"Oh no. That's finished. There's nothing serious waiting right
now." Inez glanced at her computer screen. "Just a lady who tore
her acrylic fingernail, that old gentleman with gout, and-"

Before she could finish, a middle-aged woman appeared at the
window and tapped anxiously.

"Oh, dear, excuse me." Inez opened the window.

Claire stepped back to allow them privacy, but she could see
that the woman was distraught. Her mascara was streaked, clothes
rumpled, and her reddened and swollen eyes fixed on Inez like she
was her last sliver of hope in the world.

"I'm sorry to bother you." The woman placed a small satintrimmed lavender blanket on the counter in front of Inez. "You
probably don't remember me."

"I do, Mrs. Hester," Inez said, one hand moving discreetly
toward a box of Kleenex.

Hester? Claire's breath snagged. The dead child's name.

"But I thought you'd gone home." Inez's voice lowered to a
whisper. "After your family ... spent time with Amy, I thought you
went home. Do you want me to call the nursing director?"

"No, don't bother her. You can help me." Mrs. Hester lifted
the blanket and clasped it to her chest for a moment, her eyes
filling with tears. "This is my granddaughter's blanket. She calls
it her baba, and-" a tear slid down her face-"she can't sleep
without it."

Claire's chest squeezed tight.

"She usually takes it to day care, but I was replacing the satin
trim-purple's Amy's favorite color." Mrs. Hester raised the blanket
to her face, and a low sob escaped her lips. "It smells ... like her.
Oh, please. Please, she needs this. Will you make sure she gets it?"
Before Inez could answer, the woman reached through the window
and grasped her hand. "They're sure she's dead?" she whispered,
her voice raw with desperation. "My baby's so still when she sleeps.
They're sure?"

No ... Claire swayed against a wave of dizziness, clutched
her briefcase to her stomach, and backed out of the office and
into the hallway. She leaned her shoulder into the cool, enameled wall, squeezing her eyes shut against a rush of agonizing images:
her mother standing beside Kevin's body, his leather-strung cross
dangling from her fingers; her father's confusion, repeated questions, and finally his guttural, anguished sobs ... stunned disbelief
morphing into terrible, final truth. "My son's ... gone?"

Claire opened her eyes and scanned the hallway, desperate to
leave but knowing she couldn't. She took a slow, halting breath,
then pulled the pamphlets from her briefcase. Why am I here? I
don't have a plan for this.

After contacting every staff member from the list Erin supplied,
Claire reviewed her CISM notes. She nodded. Peer counseling, if
performed within several hours after a critical incident, might mitigate the effects of post-traumatic stress. And it was voluntary; she
could offer assistance but not insist any staff member accept it.