Maverick In The Er

His grin was boyishly wicked. “I’m good at other things, too.”

The sudden flare of heat in his eyes spoke of more physical activities—activities that her imagination so unhelpfully supplied in vivid, living color.

If she was going to work with the delectable Dr. D. so closely over the next few months, she really would have to get more sleep. Exhaustion didn’t give her the mental fortitude to rein in her wayward thoughts.

“I’m sure you are,” she said lightly.

Inside the room, Sierra saw the dark-haired woman curled into a fetal position on the bed. Another nurse, Billie, was taking her vital signs.

“Hi, Franny,” Trey said as he approached the bed and immediately took her pulse. “I hear you’re not feeling well today.”

Frances opened her eyes and offered a weak smile. “Hi Dr. D.,” she said in a singsong voice. “My stomach really, really hurts bad. Can you fix it? “

Her childlike question made Sierra wish for the several-hundredth time that medicine could solve the problem of a child’s mind trapped inside an adult body. Not many people could deal effectively with people with learning disabilities, and she carefully watched Trey’s demeanor. She didn’t know what she was expecting, but she was pleasantly surprised to watch him smile benevolently at Frances while he patted her arm and questioned her about her diet.

As he talked, she herself focused on his sinfully thick dark hair, dark eyes and long eyelashes. She’d never studied him up close and personal before, but she understood how he’d developed his reputation of a dreamboat.

Thank goodness she wasn’t taken in by appealing packages.

“I think I was poisoned,” Frances moaned.

“Her temp is one-oh-two,” Billie interjected.

Trey glanced at Sierra, his humor evident in his eyes. “I don’t think you have food poisoning, Frances. But you are sick, which makes me glad I brought our very best doctor to see you. This is Dr. McAllaster.”

Sierra took her cue to come forward. “Hi, Frances.”

Frances gazed at Trey. “She can’t be the best ‘cause you are.”

He chuckled. “Thanks, Franny, but stomachaches are Dr. McAllaster’s specialty. Will you let her examine you?”

Frances apparently was convinced because she slowly nodded. “If you say so.”

Sierra immediately took over, not surprised by Trey’s ability to gain Frances’s cooperation. He’d obviously been dealing with this woman for quite a while.

“Okay, Frances,” she said softly. “I need you to stretch out for me.”

“But it hurts when I do,” she wailed.

“I know, but I really need you to lie flat.” After much maneuvering and moaning, Sierra gently prodded Frances’s abdomen. It didn’t take long to decide that her problem didn’t have a simple solution.

She turned to Trey. “Do you remember the paperwork you said you didn’t initiate? You’d better start it now.”

Over the next hour, Sierra realized she couldn’t have done her job without Trey. While Frances’s problem had been fairly straightforward, it had taken longer to arrive at the diagnosis because she hadn’t been particularly cooperative. Thank goodness Trey was a salesman at heart. He explained, gave guarantees and promised her everything from watching television to an ice cream if she’d allow them to do one more test.

He saw Frances through the pain of bloodwork and he did so with patience she hadn’t expected—patience that wasn’t contrived.

Neither did he express any great relief to relinquish his task when Frances’s mother arrived. Instead, he simply changed gears from moral-support agent to physician as easily as he flashed his handsome smile.

“Appendicitis?” he asked as soon as he cornered Sierra at the nurses’ station.

“I’m impressed,” she said, amazed at how he’d pinpointed her diagnosis before they’d received any reports. “You really can walk and chew gum at the same time.”

“What can I say? I’m a man of many talents. Plus, it didn’t take too much effort to add lower-right-quadrant pain and rebound tenderness with a fever to come up with appendicitis. I assume her white count is elevated?”

“According to the report that came through a minute ago, it’s eighteen point four. I’ve already called Vijay. He said because it’s such a clear-cut case to save him a trip and send her upstairs to surgery.”

Vijay Gupta was a fourth-year surgical resident assigned to Emergency. Sierra had consulted with him on several patients prior to her current E.R. stint and thought highly of him. After he completed his training, he planned to return to his native India and Sierra would be sorry to see him go.

“Sounds good to me.”

Sierra always took pride in making accurate and timely diagnoses, but none more so than when Trey stopped her a few hours later, not long before their shift ended.

“Vijay called,” he said without preamble. “Frances’s appendix was the worst he’s seen in a long time. You’ll be pleased to know he was glad you’d sent her up when you did, otherwise there would have been dire consequences.”

Gracious, but she was blushing again. “It was a team effort,” she said lightly.

“That may be, but I think we should celebrate with a cup of coffee.”

“Coffee sounds good, but I’m not sure the occasion calls for a celebration,” she said. “I was only doing my job.”

The second those words came out of her mouth she realized how much she’d sounded like Professor “Grumpy” Gunderson. After she’d pored over a patient’s medical file for clues about his illness, she’d discovered an obscure fact which had led to a confirmatory test. Her fellow students had been impressed and she’d been proud, but “Grumpy” had raised one eyebrow and sniffed.

“You’re expected to make proper diagnoses, McAllaster,” he’d said in his most condescending voice. “Every patient deserves your best. It’s your job to provide it.”

Now, a question begged to be asked. When had she become so cynical and turned into Grumpy Gunderson?

“Working down here…” Trey interrupted her bleak thoughts as he herded her into the lounge “…we take our victories when we find them. Too many cases don’t have happy endings.”

As if she’d needed a reminder, she reflected wryly as he began pouring two mugs of the strong coffee.

“Black or white?” he asked.

“White.” She fished among the containers for a packet of sweetener and dumped in a moderate amount of powdered creamer.

He leaned against the counter, mug in hand. “Just so you know, our real partying takes place on Fridays, after work. You’ll have to join us. No excuses allowed.”

She thought about the days when she’d ended the work week with the rest of her ED team at a nearby watering hole. Their tradition had been for the most senior member to make two toasts—one to the staff for jobs well done and one to pay tribute to the people they’d lost.

Her finances could surely stretch far enough for her to resume the tradition, even if she honored it only during her temporary tenure in Emergency. While she took pride in her efforts when she’d discharged a patient from the fifth floor, drinking a glass of wine alone in her apartment didn’t generate the same emotional satisfaction as being surrounded by people who’d shared in the experience.

Until Trey had dangled the notion of a celebration in front of her, she hadn’t realized how much she missed the camaraderie associated with a group of her colleagues. Trey had inadvertently reminded her of another part of her life that David had stolen.

Well, no more. She’d come to Pittsburgh to start over, and creating a new routine was part of that. She may not be able to afford more than a glass of tea or a soft drink, but drinking wasn’t the issue. Being with friends and colleagues was.

“I didn’t realize I’d touched on such a deep subject,” he joked. “You looked like you were a hundred miles away.”

“Sorry,” she said, embarrassed at being caught woolgathering. “I was, but you’re right. We should rejoice in our success stories when we can.”

His smile nearly blinded her. “Then you’ll join us on Friday night?”

“Sure, why not?”

“Great,” he said with such enthusiasm that she knew he’d hold her to her decision, no matter what. “We’ll—”

Their pagers went off simultaneously. Sierra abandoned her mug and followed Trey out of the door.

A scuffle at the far end of the hall near the ambulance entrance doors caught her attention. Two police officers were escorting two punks in low-slung jeans and ripped T-shirts, but for every step forward they sidestepped two more in an effort to keep the two street hoods apart. Obscenities flew, along with several wild punches, but it was obvious that not long ago those punches had been landing.

One young man had a swollen, bloody nose and a bloodstained bandana wrapped around his right biceps. The other had one eye completely swollen shut as he limped forward.

Trey sighed. “Looks like the natives are restless.”

“No kidding. I thought they saved their fighting for Saturday nights,” she remarked.

“Around here, any time is a good time,” he answered. “I’ll take one and you can take the other so we can get them both out of here faster.”

“Okay.”

She started forward, but he pulled her behind him. “Stay out of the way until they’re stashed in separate corners.”

Stay out of the way? For a few seconds she stood in amazement at his high-handedness. Did he really think she couldn’t hold her own? She’d gone nose to nose with men who were far more belligerent than these two. Of course, she hadn’t been wearing a dress and heels at the time, but sometimes looking feminine gave her an advantage. Goons like these were often busy ogling her legs and forgot their reason for fighting.

She hurried to catch up, but Trey’s long-legged stride had already put him at the scene. Although she was still half a hallway away, she heard and saw everything.

“Take him…” Trey pointed to the one sporting a bloody nose “…to Trauma One and the other to Room Two.”

“Move it, buddy.” Officer Wright gave his prisoner a not-so-gentle nudge in the appropriate direction. “You heard the doc.”

“Hey, man, don’t tell me what to do.” The guy immediately began swinging.

Instinctively, Sierra knew this wasn’t going to end well. She watched in horror as the situation deteriorated, taking Trey with it.

CHAPTER THREE

TREY saw the man’s arm move out of the corner of his eye. He tried to duck as he watched a beefy fist come toward him, but his body didn’t respond to his brain’s command. His instincts warned him of the impending blow, but before he had a chance to brace himself for impact, his ears rang and his vision blurred.

He heard shouts and curses as if they were coming from a distance, but he concentrated on trying to protect himself. Before his scrambled brain could convince him to duck, a body plowed into his midsection and he lost his balance. His fall inevitable, he twisted to minimize the damage, but five hundred pounds of angry males landed on top of him, effectively causing him to kiss the floor.

The bruise on his chin and the weight on his back seemed minor in comparison to the excruciating pain that he felt in his right knee.

Damn! This wasn’t how this was supposed to play out, he thought, before everything faded to black.

Before Sierra could yell at Trey to watch out for the guy on his right, she heard the distinctive sound of flesh striking bone. For a split second, he stood upright, frozen in place, until the other man shoved Trey in his apparent haste to reach his enemy. Immediately, Trey crumpled like a broken toy and disappeared under the bodies of punks and police officers.

“Call Security,” she yelled over her shoulder as she hurried forward. She certainly couldn’t fight this battle if she relied on muscle because she was definitely outgunned. However, she could win through chemistry.

“Lorazepam,” she called out, already calculating an appropriate dose of tranquilizer to use. “Hand me lorazepam!”

Suddenly, what seemed like the entire emergency department materialized around them. By the time someone had slapped the medication in her hand, there were too many arms and legs to identify the owners. She could accidentally sedate a staff member, which would definitely not be the best thing to do.

To her great frustration, she simply had to wait for stronger backs to peel back the pile, layer by layer. Finally, only Trey was lying facedown on the floor.

Sierra knelt beside him, half-afraid of what she might find. “Trey,” she said urgently as she frantically ran her fingers over his head to check for injuries. “Can you hear me?”

She found a goose egg on his forehead, presumably caused by his bounce against the linoleum. “Trey?” she asked again.

This time, he groaned. “Must you scream in my ear?” he complained.

He’d answered. What a relief. “I’m not screaming. Can you move?”

“Barely.” He grimaced as he tried to roll over and only got as far as his side. “Damn. My knee.”

She placed a hand on his shoulder to steady him. “Anything else?”

“You mean, other than the fact that my lungs will never be the same after being squashed within an inch of my life?”

She smiled at his affronted tone. If he could be sarcastic, his injuries probably weren’t as bad as she’d feared. His skin color was on the pasty side, but he didn’t sound wheezy or raspy, which was good because she felt guilty enough for not wading into the fray with him. “Yeah, other than that.”

“You’re the doc. You tell me.”

She paused to study him with her practiced eye. “We’ll need X-rays to check for hairline skull fractures or broken ribs, but as a purely preliminary opinion I’d cancel any photo ops if I were you.”

He swiped at the blood running down his chin. “That bad, eh?”

“It could be worse,” she said, taking a gauze pad someone had handed her to hold against his chin. “Besides the goose egg that’s probably giving you a headache and the gash you’re already well acquainted with, you’re developing quite a shiner. Don’t worry, though. You’ll be back to your handsome self in no time.”

“My handsome self, eh?” He tried to grin, but it came out as a grimace. With shaky fingers, he gently probed his cheekbone. “Oh, that hurts.”

“I’m sure. Pain is a common side effect of having your face meet a fist, but ice will help. What about your chest? Can you breathe in and out easily?”

He huffed first, then took a deep breath and let it out. “Yeah.” He rubbed the side of his chest. “My ribs are sore, though. How do football players handle this day after day?”

“Conditioning and extra padding,” she answered. “Let’s get you to a room so I can look at your knee. Ready?”

He winced. “I’ll have to be.”

Immediately, multiple hands pulled him upright. “Any dizziness?” she asked.

“Not really,” he muttered as he sank heavily into a waiting wheelchair, his face white with pain.

“Who’s on call for Orthopedics?” Sierra asked Roma.

“Abernathy. I’ll page him,” the nurse said.

She turned back to Trey. “Ready for your ride down the hall?”

“No. I want to go home instead.”

“Don’t be a baby,” she scolded lightly as she pushed his wheelchair alongside a bevy of worried-looking staff.

“Did anyone ever tell you your bedside manner lacks a little something?” he grumbled. “Like compassion?”

“Would you rather I stand here and gush all over you?” she wanted to know. “If so, I could hand you to another doctor, but I don’t think Lamont or Ben are likely to treat you like spun glass either. Marissa might, but you’re older than her usual clientele, so who knows?”

Lamont Stedman and Benjamin Kryszka, both men pushing forty, were the other two ED physicians on duty. Marissa Landower, an attractive woman about ten years older, was the resident pediatrician. While any of them would fuss a bit over him, none would fall apart like a dewy-eyed debutante.

He peered at her, looking like a lopsided raccoon. “I should get hazardous-duty pay.”

“If it will make you feel better, I’ll give you one of the kids’ sugar-free lollipops. Cherry or grape?”

“Can you lace it with a painkiller?” he asked, his voice hopeful.

“Sorry.”

“Then I’ll pass.”

Sierra braked the wheelchair beside the bed. “Do you want to hop up here or stay where you are?”

“I’ll stay right here, thank you very much. It’ll save on wear and tear when you send me to my car. So I can go home,” he finished pointedly.

“What? And miss a trip to Radiology?” She tutted. “Now, Dr. Donovan—”

“This is so unnecessary,” he grumbled. “I have a minor bump on my head, my chin’s not bleeding nearly as badly as it was and I wrenched my knee. Nothing that a few ice packs and a bandage won’t cure.”

She leaned over to study the gash, fully aware of how wonderful he smelled. “You’re right about your chin. A butterfly bandage should take care of it. As for the rest of your aches, we need X-rays.”

“No, we don’t.”

His expression reminded her of a little boy whose wishes were being thwarted. If he crossed his arms and stuck out his lower lip, the picture would be complete.

The diagnosis was in and it was definite—Dr. Donovan was a lousy patient.

“Yes, we do,” she said, hiding her amusement. “How would it look if I sent you home with a subdural hematoma, a concussion or a torn ACL?”

“I didn’t tear my ACL,” he said. “Anterior cruciate ligament tears would be more painful and I would have heard a distinct pop, which I didn’t. I also didn’t fracture my skull and I absolutely, positively, do not have a concussion.”

“Here’s your ice pack, Doctor.” A nurse thrust the cold bag at him and he placed it on his face with heartfelt thanks.

“You know your brain wasn’t scrambled because…?” She waited for his response.

“I’ve had a concussion before and my current headache doesn’t come close.”

“That’s good to hear, but while you may have Superman’s X-ray vision, I, as your physician, do not.” She motioned to one of the nurses to begin taking his vital signs. “So your opinion is overruled. We might even spring for an MRI of your knee.”

“You’re making far too much of this.”

“Risk Management and Workman’s Comp all require a thorough exam, which is what I’m trying to do. As one of the hospital’s finest and most illustrious staff members, you should sit back and enjoy the attention.”

“I’d rather be at home, licking my wounds in private.”

While his injuries were obviously painful, she suspected they were strictly of the minor variety. “You’ll get there soon enough,” she predicted. “Meanwhile, let’s slip you into a hospital gown so we can take a look at—”

“Not a chance.”

“It’s either that or cut off your pants leg,” she warned. “I can’t see through fabric either.”

“Grab your scissors,” he said firmly. “Losing a pair of pants is not worth the indignity.”

“Okay, but it’s a waste of a perfectly good garment.”

“They’re mine to waste. Cut.”

With an order like that, she couldn’t refuse. She began snipping through the cotton, careful to avoid puncturing his skin. Each slice revealed more of his muscular leg and caused her mouth to suddenly go dry.

To make matters worse, she was oddly unsettled by her task, which was ridiculous because she’d cut off clothing before without a second thought, and on a number of men more handsome than Trey. If she wasn’t almost finished, she would have turned over the job to one of the hovering nurses, who clearly would have been thrilled at the honor.

“Do you run?” she asked, trying to deal with her view of his leg clinically.

“Yeah.”

His knee was too swollen for her to pull the free leg off, so she sliced the fabric lengthwise and laid it open. “You’ll have to postpone your daily jogs for a while.”

“You think?”

She smiled at his sarcasm. “You really are holding true to the stereotype about doctors being lousy patients.”

“I’m entitled. This whole thing was so stupid! It should never have happened.”

The guilt she’d been holding at bay reappeared. “Maybe next time you’ll let me handle it.”

His battered face didn’t hide his skepticism. “And what would you have done? Ended up at the bottom of the pile with me? Or, worse yet, instead of me?”

His outrage was obvious and she understood why. Men hated appearing weak. Being caught off guard and injured because of a misplaced punch would, in their opinion, epitomize the very trait they hated. Now, if he’d earned his wounds because he’d thrown a few blows of his own, they would have become badges of honor.

“Maybe you’re right,” she conceded, “but you shouldn’t feel embarrassed either. In fact, once news gets out, you’ll become more popular than you already are.”

“I guess.” He didn’t sound too happy about his new status, which surprised her. David had always preened under extra attention and she’d expected Trey to do the same.

“Can I have some ibuprofen and ice for my knee now?” he complained.

“The ice is coming right up,” she said. “We’ll save the pain reliever until after your CT scan.”

“BP is one forty-five over eighty,” the nurse broke in to report. “Pulse is sixty-eight.”

“Your blood pressure is a little high—”

“Of course it is,” he snapped. “Getting caught in the middle of a fight will do that.”

Sierra exchanged a wry glance with Roma. Clearly the charge nurse held Sierra’s opinion about Trey’s attitude. She looked as if she was ready to comment when another nurse brought a fresh ice pack, breaking the moment.

Sierra secured the bag to his knee with elastic wrap. “This’ll hold it in place while you’re visiting Radiology. After you’re back and Dr. Abernathy sees you, we’ll wrap your knee more securely.”

“What? No Lachman’s? No pivot shift test?”

She smiled as he referred to the two tests performed to diagnose an ACL injury. “Knowing an orthopedist will do those himself, do you really want me to manipulate your knee and leg just to prove I know how? “

“True. Good idea to wait.”

Sierra stepped aside. “I’ll see you when you get back.”

For the next hour, past the time Sierra’s shift should have ended, a steady stream of staff members approached her to ask how Trey was doing. Even the people who were just reporting for duty had heard of the mishap and begged for details.

The two prisoners stopped her in the hallway to gruffly pass on their apologies to Trey before their caretakers herded them to jail.

“What was all that about?” she asked Ben and Lamont, who acted rather pleased with themselves as they perched on the counter beside her.

“We let it be known they’d better be on their best behavior if they ever come here again because we don’t take kindly to our staff getting hurt,” Lamont replied. “The next time they lose their cool and need something more than a few stitches, we’ll use drugs that produce some unpleasant side effects.”

“Like impotence, incontinence, hair loss, skin blemishes, boils, diarrhea and blurred vision,” Ben chimed in.

“Not to mention anal leakage and flatulence.”

Sierra looked at her two colleagues in amazement. “You didn’t.”

“We did,” Lamont assured her, before he exchanged a wide grin with his partner-in-crime.

She laughed. “You guys are awful. You both look so meek and mild-mannered, but underneath you have an evil streak.”

“Hey,” Lamont protested without heat, “we protect our own. Now that we’ve done our good deed for the day, we’re going home. Are you sticking around?”

“Only until Radiology turns Trey loose.”

While she waited, she impatiently checked the computer for his test results. One by one, the reports filtered in.

Normal chest film. No skull fracture. No concussion.

All she needed now was Dr. Abernathy’s recommendation and she could grant Trey his wish. Of course, she could have granted it sooner if she hadn’t gone overboard with the X-ray requests, but she wasn’t going to risk overlooking anything. There would be hell to pay if she did, not only from her boss and Trey’s, too, but also from Trey’s adoring public.