Love Is in the Air (3 page)

“Um, no matter what it sounds like,” Maria said as she indicated the dressing that she tightened. “We’re doing our jobs, Sal.”

Of course they were. Frank applied pressure to an inguinal wound while helping Paul place a Foley catheter. Sal knew that the staff’s levity didn’t affect their efficiency at all. Anyone who thought Maria couldn’t joke and do her job well at the same time didn’t know the punk-haired nurse.

“That’s not what I meant,” Sal said.

Frank raised a questioning eyebrow. “If you weren’t busting our chops about patient care, then why the dig?”

“I… I’m…” Sal struggled to bring her previous concern into focus.

Something had weighed heavily on her heart. She could feel the pressure on her chest, making it hard for her to breathe. Yet for the life of her, she couldn’t remember what had made her feel so agitated.

Her best friend hooked up EKG leads as she grinned. “I think somebody’s getting the precoital jitters.”

“Maria…” Sal warned.

Her friend just shrugged her shoulders, feigning innocence.

As the patient’s pressures slumped, Sal had to get her head back into the game. “Do we have a current hematocrit?”

“Twelve percent, with total solids of three point zero,” Paul answered.

“Damn it, we’re going to have to add Hetastarch to the fluids.”

A skittish med student asked, “Hetastarch? That doesn’t make any sense. He’s losing blood, not fluid.”

Even though her nerves were still jangled, Sal steadied her voice.

Traumas, especially ones this severe, could easily overwhelm the greener students. No matter her own trepidation, it was her job to pull it together.

“We have to think of blood in three components—the red cells themselves, the water they swim in, and the protein that surrounds them. Without this protein to hold the fluid close, the water would leave the veins and flood the lungs and brain,” she said.

Sal placed a pressure wrap over the man’s shoulder as her eyes flickered over to make sure that the intern kept up.

“With sharp trauma blood loss, he is losing all three. We are replacing the red cells and the fluid rapidly enough, but not the protein, which is far harder to restore. The Hetastarch acts as an artificial molecule to hold the water for us until we can replace the protein itself.”

“Oh, that does make sense,” the student answered, much calmer.

Sal was about to expound on the principles of hydrostasis when an orderly popped his head into the room. “Security is coming down, but they’ve got some whack job cornered in the cafeteria. It could be a while.”

“Yeah, okay,” Sal answered tentatively as the orderly hurried along.

Maria scoffed. “Doesn’t he think we’ve got things under control?”

“I’ve already got him in soft restraints,” Frank stated. “Why would we need security?”

They both looked at her, but Sal had no idea why the orderly thought she had asked for a guard.

“Maybe he’s having some jitters himself,” her friend suggested.

Suddenly the addict grabbed Sal’s arm. “Don’t let him take me.”

“Sir, please. Just lie back down—”

The man’s eyes flared with mania. “Promise me!”

Sal squeezed the addict’s hand, trying to keep her own from shaking in panic. “I won’t let anyone take you. Promise.”

As the man flatlined, Sal feared that she couldn’t fulfill her pledge.

CHAPTER 5

Without a word, everyone changed gears into crash mode. Frank compressed the man’s chest while Maria tore open the intubation tray.

As Sal gloved up, the intern rushed back in. “The blood bank said they don’t have enough type O to spare.”

“That’s just bullshit,” Maria retorted as she got the tube ready for Sal.

“Tell them to stop hoarding it for freaking surgery.”

“You’ll have to wait for the cross-match for type-specific blood,” the intern stated.

“Does he look like he can wait?” Maria asked.

As the intern glanced down at the bloody, flatlined patient, he blanched an unnatural white. “I… They won’t… I mean…”

“Oh, seriously, grow a pair before you graduate!” Maria snarled, and then turned to Sal. “Chica, can you spare me?”

Sal opened her laryngoscope. “Just make sure it gets done, stat.”

“Stat, my ass. How about right fucking now?”

“That sounds just about perfect.”

As Maria exited, she bumped into someone entering. “Hey, look who’s here. Dr. Uptight.”

“Updike,” Sal and her fiancé corrected in stereo.

“And next you’re going to tell me that he’s not a Dick.” Maria had to have the last word as she trotted down the hallway.

“Sorry,” Sal murmured. But seriously, what were his parents thinking? Naming their son Richard Updike? Did they
want
him to get beaten up his entire adolescence?

Richard nodded knowingly. “She’s just using sarcasm to create a false sense of intimacy, since she can’t achieve it in her personal life.”

Which was probably true, but it didn’t make her friend any less funny.

“You know what Maria says?”

Her fiancé frowned. “Blood happens.”

Somehow, with Richard’s delivery, the line lost its humor. Or maybe it was the addict she couldn’t get tubed because his throat had swelled shut.

“Paul, can you give me a little articular pressure?” Sal asked.

“Yeah, sure,” the nurse answered.

With Paul’s assistance, Sal passed the tube smoothly into the patient’s trachea. “Let’s bag him at twenty.”

Quickly, she handed out another half-dozen orders. However, the urgency to her tone had died, along with her patient. Certainly, Sal would perform her due diligence. They’d run through three epinephrine rounds and shock up to three-sixty. Beyond that, she wouldn’t pursue any more heroic measures, such as cracking his chest open. That would no longer be treating the patient, but rather her ego. After a severe anemic event like this, once the heart gave out, the brain had no hope. Even if somehow you coaxed the pump to beat again, the mind was gone, never to return. What was the point?

If the man had any family, Sal would have them make their peace now. To her, the patient’s soul had already left. Whatever horrible, pain-filled life this man had was now past.

Eyes flickering over the dozen monitors and the myriad of tubing, her fiancé gave a resigned sigh. “Just give the word, and we can reschedule.”

“No,” Sal blurted.

This awkward limbo between them had dragged on long enough. She’d screwed up the courage to talk to Richard tonight, to talk about this huge, stinky, dead elephant in their relationship. It would be too easy to let their schedules get in the way of their lives.

“I’m just waiting for another R-3 to hit the floor, then I’m off.”

“What do you mean?” Richard asked, indicating the dim reception desk through the trauma bay window. “Stacy’s here.”

Sal looked across to find the leggy blonde leaning over the nurse’s desk at just the right angle to accentuate her butt. If they’d stayed together, Richard and Stacy could have made the most perfect Aryan babies ever.

She turned to the pale med student. “Get her.”

The young man didn’t seem to hear. Rooted in place, the student stood enthralled by the medical spectacle before him.

Snapping her fingers Maria-style, Sal got his attention. “Tell Dr. Manning to get her buns of steel in here.”

Her tone not only pulled the student out of his stupor, but caused him to turn and literally run out of the room.

“Sal, there’s no reason to misdirect your frustration onto your co-workers. I’m sure Stacy doesn’t realize how serious this patient’s condition is.”

“Please,” Sal chided her fiancé as she checked one of the EKG leads to make sure they weren’t missing a faint heartbeat. “Not only does she know the full extent of this man’s injuries, but she’s purposefully delaying coming in here so she that doesn’t have to sign a death certificate.”

“Clear!” Paul called out before he defibrillated the patient.

The flatline didn’t budge.

“Even if you were right to assign her motive, it doesn’t look like she could avoid signing one tonight,” Richard commented.

“Maybe they’ll frame it,” Sal muttered.

Richard gave her that disapproving frown.

“Okay, that sounded bitter even to me,” she admitted.

They shared a quiet smile. Could it be that they had just taken the first tiny step in repairing their relationship?

Then Dr. Manning walked in.

CHAPTER 6

“Hogging all the good cases for yourself again, Calon?” Stacy asked, with a mixture of syrupy sweetness and calculated recrimination.

Sal gritted her teeth, refusing to allow her bitterness to rear its ugly head in front of Richard again. This was how Manning worked, somehow always positioning herself as the victim. Worse, her blatant manipulations had made her the favored resident for the attending job next year.

Sighing, Sal tried to imagine what her fiancé would advise in a situation like this. He’d probably recommend that she not allow Manning’s ploy to affect her, to allow Stacy’s words to roll off her back like water rolled off a duck’s. Unfortunately, Richard didn’t seem to understand that it was hard to ignore corrosive, acid rain on your back, but she gave it her best shot.

“We’re close to replacing his blood loss at the scene, but we’ve had significant subsequent loss…” Sal looked around. “Maria’s not back yet?”

Heads shook all around her. That was weird. Her friend could usually pry the Holy Grail from the pope with a well-timed wink and smile.

“Have you run a PTT yet?” Manning asked as she very ceremoniously donned a full gown and double gloves. The starry-eyed intern attending her seemed naïve enough to think that the results of a blood coagulation test could somehow change the course of this poor addict’s fate. He was dead. They just needed a signature to make it official.

“No, but have at it,” Sal answered as she tried to snap her gloves off.

Sal had meant it to be a theatrical gesture to equal Stacy’s gowning spectacle, but her ring got caught, forcing her to awkwardly untangle it. Finally, the glove ripped loudly, turning everyone’s attention to her.

Manning smirked. “Maybe you should leave that big rock at home if you don’t know how to use it.”

A snicker came from behind. Probably from someone who didn’t realize that Stacy coveted the very ring that she mocked. Manning didn’t miss a beat as she held court. “Can anyone tell me the date of the Helsinki experiments that determined cardiac preload statistics of Hetastarch versus Dextran?”

“See everyone on Tuesday,” Sal said, but she was already forgotten by interns and students alike as they vied to answer Manning.

Then to brighten Sal’s hope for humanity, Paul made the motion as if he were hanging himself. The staff hated these long-drawn-out, flog ‘em codes. Unfortunately, they weren’t on the attending selection committee.

Sighing, Sal joined Richard out in the hallway. Surprisingly, he kissed her on the forehead. It was the most romantic contact they’d had in weeks.

“I know you’re exhausted, but I’m proud of you. It took a lot of courage to ignore Stacy’s bait.”

Glancing up at her fiancé, Sal realized that he must have come straight from his evening swim at the club. The stretch of his London Fog coat showed off his frame, sculpted by hundreds of laps. It almost made her feel guilty about never exercising. His sandy blond hair was slicked back, except for a single lock that curled on his forehead. He always said it looked childish, but Sal felt it gave him a rakish charm.

Between the diamond on her finger, his caring nature, and that ripped body of his, Sal had to consider that maybe there was more to Maria’s accusation than she wanted to admit. Who wouldn’t want to marry Richard?

After her previous tumultuous relationships, with their loud, screaming fights, Sal would have thought that she’d appreciate the fact that she and her fiancé never fought. Actually, Richard’s insistence that they “talk” through their issues felt not only foreign, but torturous. They usually ended up with her fiancé explaining how Sal’s need to feed her ego through work validation impacted his sense of masculine empowerment.

Maybe that was their problem. Never any makeup sex. Deepening intimate communication skills seldom left you hot and sweaty.

Taking his hand, Sal resolved to change all that. And she might have gotten a start if the med student hadn’t stuck his head out the door.

“Dr. Manning’s asking where the blood is.”

Damn it. What was taking Maria so long? Had the head nurse suddenly lost her mojo? Sal glanced around the dim ER and found an intern heading her way. “Clipsham, could you go down to the blood bank?”

His cheeks blotched as he stammered, “Sorry. I’ve got to get Manning.”

“You can get the blood first.”

He shook his head almost violently. “You don’t understand. That patient is throwing a tantrum. He’s going to sue me!”

“You’re going to hear that ten times a shift around here.”

“I’m calling my lawyer!” Kasza shouted loud enough to be heard all the way across the ER.

Sal looked over her shoulder. Stacy had stepped to the back of the trauma bay, glowering like a master puppeteer controlling her marionettes. So in control. So cool. So aloof. Then Sal glanced at the irate patient.

“Yeah, you go get Manning,” Sal encouraged. “I’ll get the blood.”

The intern looked relieved, clearly unaware that not only did Stacy hate her dog-and-pony show interruptions, but absolutely despised whiny, difficult patients. If he thought Kasza could throw a tantrum, just wait.

Feeling more satisfied than she should, Sal turned to Richard. “I’ll be right back.”

“Sal…”

She squeezed his hand. “It’ll be a hell of a lot quicker to help Maria at the blood bank than to talk that patient down.”

They looked over at Kasza, who yelled into his cell phone. Oh yeah, tonight was going to be quite the show.

CHAPTER 7

Trotting down the darkened steps, Sal had to admit that she had an ulterior motive for fetching Maria. Only her best friend could truly commiserate over Stacy’s antics. After having the required conniption fit, Maria would utter some wicked comeback that Sal could use later.