Following the Doctor's Orders. Caro Carson
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Brooke was in charge once she entered a treatment room, so she focused on the elderly man on the gurney.
“Good afternoon. I’m Dr. Brown. You’re Harold Allman, is that correct?”
The man looked frail despite being heavyset. His white face and the stiff way he was holding himself meant he was in pain, but he still chuckled and looked up at Zach.
“Boy, times have changed,” he said conversationally, ignoring Brooke’s question. “Not only do we have lady doctors, but good-looking ones, too. This one’s a real looker.”
“That she is,” Zach said.
Brooke neither frowned nor smiled. She was accustomed to hearing this kind of tedious “lady doctor” comment from men of a certain generation. Beyond the patient’s bed, Loretta rolled her eyes and shook her head. Obviously, she was tired of the same old comments herself.
“Harold, how did you break your leg?” Brooke stepped forward to start the hands-on part of her exam, but Zach didn’t move out of her way as he normally would. At this point, with responsibility for the patient turned over from the paramedic to the hospital staff, he’d usually tell the patient goodbye and leave. But Harold, she realized, was clinging to Zach’s gloved hand with a white-knuckled grip at odds with his chuckle.
As Brooke pulled on her own latex gloves, she walked to the far side of the bed. Far be it from her to deny the old man comfort. If hanging on to a strong man like Zach gave Harold a little courage, that was fine with her.
Harold spoke with a noticeable hitch in his breath. “I’d like to tell you I did something that would impress you, young lady. I could’ve broken my leg sky diving. That would’ve been something, wouldn’t it? But the truth is, I just fell down my own porch stairs.”
“Were you dizzy before you fell?” Brooke asked.
“No, I’m just—I’m just turning into a clumsy old man.” He sounded sad.
“Nah, anyone can trip,” Zach said, and Brooke saw him give the old man’s hand a quick squeeze. “Happens to the best of us.”
“I’m going to look for other injuries. If anything is tender, let me know.” She checked Harold’s scalp, turned his head from side to side, pressed on his ribs and palpated his arm from shoulder to wrist. Judging by how tightly he gripped Zach’s hand, Harold’s other arm wasn’t injured, so Brooke decided to forgo that part of the exam.
She lifted one edge of the paper tent that was hiding the patient’s broken leg from his own view. The bone was protruding from the skin. Just seeing this type of injury could send patients into shock, so she kept the paper in place.
Pain also contributed to shock. Harold was being brave in his benignly chauvinistic way, but he was clearly suffering.
Brooke addressed Zach. “What have you given for pain, Mr. Bishop?”
“Morphine, two milligrams.”
She raised a brow at him. That dose was low. “Only once?”
Zach shrugged a bit. “Didn’t want to mask any chest pain.” His tone said it was no big deal, nothing to worry about.
“I see,” Brooke said, and she did. Zach suspected severe heart disease in this patient. A more potent dose of morphine could have meant the man would have a heart attack without feeling it. The attack would have to reach great severity before symptoms would be noticeable in a morphine-drugged, pain-free man.
The patient was already anxious and his body was under significant stress. Brooke knew Zach’s shrug and easy tone of voice were meant to keep the patient’s anxiety levels from skyrocketing. She envied Zach’s bedside manner.
“Nitroglycerin at the scene, Mr. Bishop?” Brooke could never match Zach’s life is good approach, but she did her part to keep the patient calm by continuing her methodical exam, palpating his undamaged leg as if she weren’t discussing a potentially life-threatening event with Zach.
Anticipating Brooke’s next order, Loretta opened a drawer and pulled out a pack of ECG leads, ready to place the little sticky circles on Harold’s chest so they could monitor his heart, although that wasn’t a typical part of treating a fracture. As if they’d choreographed it, Brooke moved to the foot of the bed as Loretta took her place.
While Loretta unbuttoned Harold’s shirt and attached the leads, Brooke pressed her fingertips to the ankle of Harold’s broken leg. She took his pulse without jostling the injury, needing to confirm that blood was still circulating past the fracture to reach his extremities.
The patient looked up at Zach and scolded him. “Now, don’t go embarrassing me in front of these pretty ladies. That chest pain comes and goes, I told you. I just take one of those tiny white pills, and I’m fine. Fit as a fiddle, except for my leg.” But his chuckle was forced and he rubbed at the center of his chest with his free hand.
No sooner had the nurse turned on the television-like monitor over the bed than Harold’s worried rubbing motion changed. He clutched at the open edge of his shirt. “Maybe...one of my pills?” he gasped.
Brooke read the jagged line of his ECG in a glance. A myocardial infarction—a heart attack—was underway. “I’m going to take good care of your heart, Harold. Let’s do something about that pain, too.”
From that moment, time slowed down and sped by simultaneously. It was always that way for Brooke while she led her team through an emergency. When she had to function at a high level of complex decision-making, everything seemed paradoxically simple.
At her word, the crash cart was called. Extra personnel filled the room. Decisions had to be made, one after the other, in a logical order. As a nurse tied a yellow disposable gown over Brooke’s white coat, Brooke called for the right drugs at the right doses. Once morphine had eased the panicked and pained patient into unconsciousness, she quickly dressed the broken leg as a stopgap measure before the cardiac cath team arrived to rush the patient to their artery-opening, lifesaving theater.
After the patient and his bed had been rolled away to the cardiology floor, there was a moment of silence, of inactivity. As if the bed were still there, no one walked through the empty center of the room as they snapped off their gloves and discarded protective gear.
Brooke was the first to use the sink as she scrubbed her hands for the millionth time that day, the smell of the soap and the sound of the water bringing her back from that intense state of mind. She thanked her team for their work, making eye contact and nodding at each person, the equivalent of a handshake in an environment where hygiene procedures made real handshakes problematic.
Zach was not in the room. Brooke had been so very alert through it all. How had she missed his exit?
The image of Harold clinging to Zach’s hand was vivid in Brooke’s mind. When Harold had lost consciousness, his hand had slipped from Zach’s. Brooke could remember thinking, Now Zach can administer the oxygen. Brooke had ordered him to do just that, and he had, of course.
When had he left the room? It was curious, how moments that were crystal-clear became hazy. As more and more of her regular team had entered the room, Zach must have stepped out, no longer needed and making room for those who were. He was a good paramedic that way.
He was a good paramedic in every way. Sharp and smart in matters of medicine. Comforting in his cocky way. Patients loved him. Her staff loved him. And Brooke—well, she needed to at least thank him as she had the others.
He was probably out by the nurses’ station, filling out his own paperwork. Brooke would go out there to dictate this patient’s chart. She’d ignore Zach, he’d ignore her and just before he left, he’d lean in, ready to murmur some outrageous line in her ear. But this time, she would speak first.
She would thank him for a job well done. Even if he did leave a disturbing wake of feminine fluttering everywhere he went, it was a pleasure to work with someone as good at his job as he was. After eight months