Trauma Plan (4 page)

Jack glanced at the monitor, satisfied that the heart rhythm hadn’t changed. “I’m going to need that EKG, folks. And then the brain scan. Did we get a temp yet?” He stroked a gloved fingertip across Vesta’s cheek, brushing away a fine sprinkle of millet seed. “Can you hear me, ma’am? Feeling better?”

The patient opened her eyes and nodded, mumbled beneath the fogged oxygen mask, then closed her eyes again. But her fingers curled around his and stayed there. She smiled very slightly, and he was reminded of Gilbert’s face in the parking lot this morning, when he realized Jack was there to help him. Nothing—
nothing
—felt better than that. And it was worth any bureaucratic battle he had to wage.

Jack glanced at the clerk entering information into the bedside computer. “Have you located any past medical records?”

“Yes, sir.” The diminutive woman tapped the keys. “It looks like Mrs. Calder changed addresses four times in the past fifteen years but fortunately remained local. And within the Grace Hospital system. She’s been hospitalized twice for diabetes problems.” The clerk scanned the screen. “Let me make sure I’ve got the most recent records. Yes, this one has her listed under her current Bluffs address.”

Jack raised his brows. “The Bluffs?”

“That snooty community off San Antonio Street.” Her eyes widened. “Oops. If you live there, Dr. Travis, I’m sorry.”

“If I lived there,
I’d
be sorry.”

“Anyway,” she continued, “I recognize the street name. My hubby and I took that Street of Dreams tour. Amazing homes. Some folks gotta have the whole enchilada, you know?”

Jack knew all too well. The action committee represented The Bluffs. And its members lived there. Not all of the residents were opposed to what the clinic was doing; a few had even inquired about volunteering. Unfortunately, they tended to be less vocal. He glanced down at the woman still holding on to his hand, wondering—

“Dr. Travis? Excuse me, but may I slide this machine in there?”

Jack stepped aside so the tech could set up the EKG equipment. Then he scanned the department’s assignment board on his way back to the physicians’ desk: orthopedic patient with a too-tight cast, asthmatic on a breathing treatment, lawn mower versus toe needing sutures, and that psychiatric patient waiting for his injection to kick in. Typical day, no surprises. Except for the birdseed . . . and his being mistaken for a drug addict, that is.

Jack settled into his chair and began to review Vesta Calder’s history and current medications. Afterward, he’d do a complete physical exam.

He shook his head. Vesta Calder lived in The Bluffs. Which side was she on?

Jack reached for a pen, and his knee bumped into the side of the desk. He was glad he’d covered the sutured wound with a thick padding of roller gauze. Glad, too, that he escaped his makeshift treatment room before that hospital chaplain called for his arrest. From what he’d seen, the woman was attractive, maybe even beautiful. An intriguing possibility. Eclipsed, of course, by the way she’d pointed her cell phone like it was an M16. And by the stubborn jut of her chin as she dismissed him as unsafe before striding away. A gutsy woman. Who’d left no doubt at all which side she was on: any side but his.

* * *

Riley settled onto a cedar bench, hearing the grackles’ raucous squawking from the parking lot trees. She was grateful for the shade provided by the hospital’s limestone gazebo; early April and already San Antonio temperatures were approaching eighty, with humidity moving toward sticky as a gecko. She smiled, remembering her favorite nanny’s colorful saying.
“Sit awhile, child. And have mercy, I’m already sticky as a gecko from chasin’ you around your daddy’s big yard.”

Of course, Riley never did sit still. Or have mercy, apparently, because as far back as she could remember, she’d tried her best to pierce the protective insulation that came with being an only child. And a Hale—a family that had known unspeakable tragedy at the hands of a kidnapper. Though her sister’s death happened long before she was born, it shaped Riley’s life. While other kids worried about the bogeyman under their beds, Riley was cautioned endlessly about abduction. Taught that there were godless, greedy people who would do anything to get what her family was blessed to have.

Everything was centered on keeping Riley safe. And it was the reason she launched a quiet, well-mannered, polite rebellion. Not rowdy enough to truly frighten her parents; she loved them too much for that. But just enough to
breathe
. She needed to feel that if any of the truly horrible things she’d been warned about really did happen, she could stand on her own. Survive them.

So Riley tested the boundaries of her privileged and protective world, even if it only meant climbing to the highest branch of the lightning-struck pecan tree at her grandfather’s summer home. Or switching names with her best friend during vacation Bible school; writing private, childish poems about Alejandro, the dark-eyed gardener’s son; and becoming a nurse.

Riley touched her hospital badge. Being a nurse was her adult act of rebellion, or at least it began that way. Her parents had expected something far different from their only child.

“Watch out! I’m gonna get you!”

A little girl raced toward the gazebo, letting out a howl that was half shriek, half giggle. She wore a yellow tutu, striped tights, and a rainbow-hued wreath of paper flowers in her hair, its ribbons trailing down her back—and snatched at by a boy running close behind. He caught her inches from where Riley sat, crowed with delight, and then cracked a purple egg over the little girl’s head. Confetti spewed from inside it, sprinkling the children like ground pepper on a grilled rib eye. They giggled and took off running again.

A woman, heavily pregnant, hurried behind, murmuring a breathless apology to Riley. “My kids haven’t stopped squealing since we got back from the field trip to the River Walk. I shouldn’t have scheduled my doctor’s appointment during Fiesta.” She glanced at Riley’s hospital badge. “Can you please tell me where the lab is?”

Riley gave the mother directions, then checked her watch. Time to get back; there was paperwork to finish. She stood and brushed confetti from her jacket, along with a bit of broken purple eggshell.
Cascarones
. Fiesta eggs. Lovely, traditional—and great, silly weapons. She’d made them at her Christian grade school in Houston. Poked holes in the egg, blew out the slippery insides. Then decorated the shell with Easter dyes, glitter, crayon, and filled it with colored bits of confetti, sealing the hole with tissue paper. The toughest part was trying to do all of that without breaking the shell.

No
 . . . the hardest part was finding out she was the only one in the class who’d never been to San Antonio Fiesta.
“Too far, too crowded, not safe,”
her mother had said, dismissing the idea. It didn’t take long for Riley to figure out that most truly fun things fell into those categories.

She shook her head at the ugly irony. Despite all her parents’ efforts to protect her, keep her close, she’d been viciously attacked and nearly killed in a parking garage barely five miles from her home. The assault that rocked the Houston hospital, validated her parents’ fears, and put Riley in the situation she was in now. She crushed the shard of
cascarón
between her fingertips and let the tiny bits fall. She’d been treated as carefully as a fragile eggshell and had been broken anyway. Now her parents wanted her back in Houston. More than that, they wanted her to give up nursing completely, take a position on the board of the Hale Foundation.

Riley couldn’t do that. Being part of the trauma team had been the first time in her life that she felt competent and valued. Worthy in her own right. She had to have that back. She’d make it happen. Even if . . .

She raised her eyes toward the ceiling of the gazebo, pressed her palms together, strong against numb.
You know that I need this. You know how hard I’ve tried. Why aren’t you helping me? Please—

Her prayer was interrupted by a buzzing from her jacket pocket. A text message requesting a chaplain in the ER.

Riley pocketed the phone, checked her watch. It was an hour past change of shift for the emergency department physicians.

Ugh.
Jack Travis would be there. The last thing a department steeped in chaos should welcome was a reckless physician. Any more than Riley should be expected to tolerate another arrogant smirk.

Where was a crate of
cascarones
when you needed one?

* * *

“What was that last glucose reading?” Jack swiveled the chair enough to watch through the exam room door as yet another staffer tried to calm Vesta Calder. Without success, it seemed. The woman had started to pick at the tape on her IV. Yanking the needle out was probably part of her current plan. That and climbing over the gurney rail. Why was she so agitated?

“Her blood sugar is normal at 97. I had the tech check it twice to be sure.” Kate glanced down at the CT report on the nursing station desk. “We can’t blame this new behavior on her brain, either. Completely normal too.”

Jack frowned. “So are the labs, except for that first glucose. And her gases and EKG are excellent for her age. I’d wonder about early onset dementia, except that there’s no mention of it in her records, and . . .”

“She’s not the least bit confused,” Kate said, finishing his thought. “She recited her name, address, the current date, and the name of the president. She even told me the breeds of the last five First Dogs—she loves dogs. No, Vesta’s not confused. Unless wanting to get out of
here
counts as that.” Kate’s nose wrinkled. “I can’t really blame her. Seven o’clock can’t come soon enough for me.” She reached up to push back an unruly lock of her short, dark hair. Then her eyes widened as Jack caught hold of her arm. “What?”

“That’s what I was going to ask,” he answered, pointing at her forearm. “Why are you so bruised?”

“Oh. It’s nothing. I let one of the nurses practice IVs on me.”

He shot her a look. “Our nurses need practice? Don’t tell me that.”

Kate started to speak, then hesitated. Jack got the feeling she was being protective. “She’s been out of clinical practice for a while, recovering from a work injury.”

“What sort of injury?” he asked.

“Cervical fracture with spinal cord involvement—her dominant arm.” Kate looked down, and Jack was even more certain she was cautious about this nurse’s privacy. He respected that. Jack hated people poking around in his past.

Kate met his gaze again. “But she’s doing pretty well.”

He peered at her bruises. “Not that well.”

Kate nodded reluctantly. “The tough thing is that she was an ER nurse. You know how we are. Just try and make us work anywhere else; not gonna happen. I can relate to how she feels. She’s hoping that administration will let her work here in the department as a triage nurse. Get a toe in there to start. But . . .”

“But what?”

“I can’t count the number of times I’ve manned a desk in triage and ended up doing CPR on that floor. Or had a panicked mother come running into the waiting room carrying a child in a blanket, scream that he’s not breathing, and shove him into my arms.” She swallowed. “What if that happened to her? What if she had to run to the resuscitation room carrying an unconscious toddler? She can’t lift her right arm higher than halfway, and it’s weak and numb even after a solid year of therapy. I’m afraid she’d . . .” Kate bit her lower lip.

Drop that kid on his head.
“And I’m guessing this injured nurse wants you to be a reference when she applies for a job at Alamo Grace.”

“She’s already working here. As a trauma chaplain and—”

Jack smothered a groan. “Let me guess: safety officer.”

Before Kate could answer, a tech interrupted. “Excuse me, but Mr. Farrell—that patient from the mental health facility—is awake again and asking for more medication. He took his gown off and stuffed it into the toilet. I talked him down, but it’s not going to last.” The tech raised his voice as the sharp whine of a cast cutter rose from the ortho room. “And Mrs. Calder’s asking for her clothes. She says she can’t stay here any longer.”

Jack shook his head. “Tell Mr. Farrell I’ll be there in a few minutes.” He turned to Kate. “Vesta needs insulin dosages adjusted and a consult with the dietician, probably overnight observation. See if the clerk can get her doctor on the line. I’ll go in and explain things to her one more time.”

“Wait.” Kate plucked at his sleeve. “Let Riley talk with Vesta. I asked her to come by and help.”

“Riley?”

Kate nodded. “The chaplain I was telling you about.” She glanced toward the department doors. “Ah, here she is.”

Jack turned to look.

The Alamo Grace trauma chaplain strode toward the nurses’ desk, dark-blonde hair brushing her shoulders, chin held high—tall, confident, and looking anything but sadly impaired. Her dark-lashed blue eyes scanned the room before settling directly on Jack.

“She’ll get through to Mrs. Calder,” Kate assured. “Riley has a real knack for connecting with people. I’ve never seen anybody quite like her.”