Jennifer's Garden (19 page)

Jax tamped the dirt down around the plant with his boot.  He couldn’t disagree with her which is why she left.  With his blessing.  Finished, he turned and headed toward his truck.  At least in this case, the issue would never come up.  This woman was off-limits.

Glancing at the house, he had to admit he was pleased.  The fireplace was the perfect complement for the oasis he was creating out here and the fact she agreed made his job all the more rewarding.  Battling with clients over design elements wasn’t something he liked to do, though many times he found himself reminding them they hired him for a reason.

Incorporating their ideas into his vision and expertise usually made for a mishmash of plants and flowers.  Jackson Montgomery Landscape brought yards to life.  When he attached his name to a job, he wanted the end result to be a reflection of his artistry, not a jumble of plants.

Pulling his mobile from the dashboard of his truck, he was grateful on that count.  Dr. Jennifer Hamilton now seemed content to let him handle the job.  And handle it, he would.

# # #

Jennifer stood over her patient.  Completely covered in blue sterile paper, save for the small opening at his groin, she held the catheter steady.  “How’s his pressure?”

“Steady, one thirty over ninety.”

“How are you doing, Mr. Nunez?”

“Good,” he mumbled from beneath his cover

“We’re almost finished.”  Jennifer slid the catheter free and handed it to the awaiting nurse.  “Everything looks great.”  She applied pressure to the incision area and patted his arm.  “The nurse will get you cleaned up, okay?”

He nodded, though she doubted he was fully coherent.  Most patients were able to follow and understand, but some, like Mr. Nunez, wouldn’t remember a thing.  He had been extremely agitated before the procedure, which required an extra dose of Versed and Fentanyl to calm him.  But she continued to talk her patients through the procedure, whether they remembered or not.

Jennifer stepped aside as the male nurse took over, pressing a gauze where her hand had been.  “Is the family here?”

“Yes doctor,” he said through his mask.  “In the waiting room.”

“Thanks.”  Jennifer picked up the chart on her way out.  She stopped in the control room and jotted down her notes.  Slapping it closed, she left it on the counter and headed for the family.  In the corridor, a blonde nurse hurried up to her.

“Dr. Hamilton—ER’s calling you.  Your patient Sarah Wiley just arrived by ambulance.”

She stopped short.  “What happened?”

“Paramedics called it in.  Cardiac arrest.”

“Oh, no.”  Jennifer bolted down the hall.  “Get a room ready, stat,” she called back and punched a metal plate on the wall.  Double doors began to open.  “C’mon, c’mon.”  She edged sideways through the narrow opening and ran to the emergency room.  She strode past beds, checking each one.  “Where is she?”  Faces flipped up in question.  “Sarah Wiley—which bed is she?”

“Down here, Dr. Hamilton!”

Jennifer hurried toward the voice at the opposite end of the room.  Curtain shoved aside, paramedics worked with hospital staff to transfer the lifeless body from bed to bed.  “One, two, three—move!”

Their pace was quick, controlled.  A female nurse started attaching electrodes to Sarah’s chest.

Breathless, Jennifer asked, “How is she?”

“Stabilized.”  The male paramedic hooked Sarah’s IV next to the monitor and reeled, “Pressure’s one thirty-eight over ninety-one.  Rate’s eighty-two.  We ran a 12-lead.  ST elevation.  We gave her two milligrams nitro.”

“When did this happen?” she demanded.

“About an hour ago.  Daughter was with her when it happened.  Gave her an aspirin.”  He pulled his sheet clear as the nurse laid another in its place.

Daughter.  Jennifer ground her thoughts over the mention of the woman.  “Is she here?”

The paramedic tipped his head toward the waiting room.  “She’s in there.”

“Cath lab is prepping for her now.  I’m going to talk to the daughter.”  Pushing through a glass door, Jennifer searched for Sarah’s daughter.  Comfortably seated in an end chair below the television, she was leafing through a magazine.

Jennifer marched up to her.  “Your mother’s in bad shape.  She needs a stent.  I need you to sign the papers for the procedure.”

“Is she okay?”

So nice of you to ask.  Jennifer crossed her arms and looked down at her.  “Considering she almost died, yes, I’d say she’s okay.  But she needs a stent and she needs it now.”

To her credit, the woman looked relieved.  She lowered the magazine to her lap.  “Are you sure she needs it?”

“I was sure she needed it last week,” Jennifer shot back. 

“I gave her an aspirin.”

“That was wise.”

“If you’re sure...”

“She needs the procedure.  Wait here.  They’ll bring you the paperwork.”  She turned on her heel.  It was time to scrub.

In the darkened lab, Jennifer stepped on the floor pedal and studied the flow of dark liquid as it passed through the squiggly lines on the monitor above.  The gray image moved in rhythm with Sarah’s heart, beat for beat.  Holding the catheter in place at Sarah’s groin, she pumped more contrast dye and watched as it squirted through the coronaries, catching in the same spot.  “That’s it.  Picture.”

From inside the control room, technicians recorded the image.  She detached the syringe-like injector and set it aside.  “Balloon.”  She held her hand out as a nurse placed the floppy catheter into her palm.  Checking Sarah’s rhythm running across a separate monitor, satisfied she was holding up, Jennifer carefully navigated through stiff arteries, but the balloon stopped short.

“Ectopy.”

Jennifer glanced at her patient’s pulse monitor.  It was to be expected.  Poking around a sensitive heart was bound to create irritability.  Checking the fluoroscopy image, she gently pushed through the calcified area until the balloon tip appeared onscreen at the location of the blockage.

Adjusting position, she inflated the balloon.  Satisfied it was enough, she deflated the pressure and pulled the catheter free.  The dye flowed through the artery with ease.  “Picture.”

“Got it.”

 “Stent.”  The next balloon was given to Jennifer, this one with a wire mesh stent wrapped around the balloon.  Blood was beginning to collect on her gloved hands which made it more difficult to glide the catheters in.  With short pushes, she advanced the stent into position.  This time as she inflated the balloon, it expanded the stent.  Deflating once again, she pulled the wire, leaving the stent inside the artery.  “Picture.”

“Got it.”

Jennifer rolled her neck back and forth across her shoulders to release the grip of tension.

“V-tach.”

She jerked her head forward.  Sarah’s pulse raced across the screen unchecked.  “Charge!”

The scrub technician charged the external defibrillator.  In seconds, it reached the standard 200 joules.  “Ready.”

Break, break, she willed the frantic bleeping to cease.  Shocking Sarah’s heart out of the irregular rhythm was the last thing she wanted to do.  But if it was necessary...

Watching the monitor, Jennifer held steady.

No one in the room spoke.  All eyes were on the monitor.

“Darn it, Sarah,” she murmured under her mask, then said aloud to the technician, “Shock.”

The patient’s body jumped from the bed.

No longer racing, the green line on the monitor lay flat.

“Pace.”

“Pacing, rate of eighty.”

Instantly, the monitor came to life.

“Bring pacing down,” Jennifer directed.

“Bringing pacing down to seventy.”

Sarah was still dependent on the pacer.  “Sixty.”

“Sixty.”

Sarah’s heart began beating on its own.  She sighed.  Good girl.  Jennifer looked at the gray picture image.  Now she’d be forced to make sure the shock had not altered the placement of her stent.

Chapter Sixteen

As she pulled into her driveway, the sight of Jackson’s truck warmed her mood a degree.  Jennifer inhaled deeply and released her breath in one long, fluid sigh.  She had missed him yesterday afternoon.  Shifting the car into park, she collected her belongings and slid out of the vehicle.  Funny how his presence was becoming something to which she looked forward.

Standing next to his truck, Jackson slipped a tool into the pocket of a black strap wrapped around his work bucket, then wiped a small triangular spade using a filthy gray rag.

Is he leaving for the day?  Jennifer quickened her pace.  “Hello Jackson!”

He turned at the sound of her voice and opened into his usual smile.  “Hey, Jennifer.” He gave her a brisk wave, but then continued with his cleanup.

“The flowers look great.”

“I’m glad you like them,” he said, lifting the cement crusted bucket from the ground and heaving it over the edge of his truck bed.

Her eyes jogged toward the house as she hesitated over the name of the flower.  “What do you call them again?”

“Lantanas.”

“Lantanas, yes.  You were right.  They really attract your attention when you drive in.”

He nodded.  “Good.”

Jennifer watched as he dumped the contents of his garbage pail into the disposal bin in the back, then tossed it in after.  Behind him, she could see brick pavers set neatly within wooden forms, the beginnings of her terrace.  She took a few steps in his direction, but stopped.  The humidity pressed in.  Smoothing a hand over her hair, pulled back into a low ponytail, she said, “The patio looks wonderful.”

“Thanks.”  He placed his tools in a built-in steel compartment box in the bed of his truck.  “The guys did a great job.”  He flipped the tailgate closed and turned.  “But let it cure for a good forty-eight hours before you walk on it.”  Wiping his hands clean with a fairly clean wet towel, he gazed at her, his pause pronounced.  As though he expected her to say something more, or head into the house.

“So then your day went well?” Jennifer asked, struck by the routine nature of the question, as though it were old habit.

“Better than yesterday.”  He knocked a chunk of dirt from his arm.  “The inspector showed up this afternoon, so we can get started on the fountain tomorrow.”

“Well, that does sound good.”  She smiled, aware her heartbeat had picked up its pace.

“It is.  Actually, it used to take a lot longer to get permits, but these days the internet facilitates the process.  You can get them for simple projects in no time at all.”  He smiled.  “Relatively speaking.”

She nodded.  “There’s still the human element to consider, isn’t there?”

“Always,” he agreed, though his smile had dimmed.  “How about you?  Good day?”

“Tough.  Too many patients squeezed into too few hours, plus two trips to the ER.”  Jennifer dropped her gaze, and scraped the bottom of her shoe over a small rock in the driveway.  “I nearly lost one of them.”

“Oh, no.”

She lifted her gaze back to meet his, struck by the emotion swimming in his eyes.  It was more than she would have expected from a stranger.  “It wasn’t good.  But we’re short-staffed at the moment.  One of my partners has been out on extended leave and another’s on vacation.  The workload is taking its toll.  My patients are getting shortchanged on their time with me and there’s not a
thing
I can do about it.  Nothing.”  Something that bothered her tremendously.  “I can only schedule them so late into the evening...  After that, you simply run out of time.”

“I know what you mean.  When everyone wants a piece of you, sometimes there’s not enough to go around.”

“Something has to give.  Unfortunately for me,” Jennifer frowned.  “It’s turning out to be my patients.”

“Is your partner coming back on line any time soon?”

Her dropped her shoulders in a shrug.  “We don’t know.  He had a massive MI and his recuperation will take awhile.  How long,” she held up her hands in question, “is anyone’s guess.”

“That
is
tough.”

“Life is short,” she added, though not particularly sure why.

“That it is.”

Allowing her gaze to wander, thoughts of Sarah and Aurelio and Sam and her mother swirled together.  A light breeze brushed the back of her neck.  “Do you ever feel like you can’t keep up with your own life?  Like you want to hit the rewind button so you know what’s coming beforehand, giving you time to react?”

“Sure,” he said.  “I’d eliminate a lot of headaches that way.”

“Yes.”  She glanced away.  Heat seemed to collect on her forehead.  “And heartaches.”

Jax peered at her. “You seem a bit rattled today.  Do you mind if I ask what happened?”

“Rattled,” she said, letting loose with a ragged sigh.  “I guess you could call it that.”  She smoothed the backside of her cotton scrubs, warm against her body in the afternoon sun.  With a small smile she returned her gaze to him.  “I had a patient land in the ER today.  She needed an emergency stent.  We succeeded, but she almost didn’t make it.”