Love On Call

“You know,” Glenn said, impressed as always by Cindy’s clinical sense, “there’s an opening in the rotation for first-year PAs. You might consider—”

“No way. I’m done with school, even if I do have an in with the new program director.”

The title still felt like a too-tight shoe, and Glenn shrugged aside thoughts of her new job. “Where are the X-rays?”

“I put them on a box outside her room.”

“Okay, I’ll check her out. Let me know as soon as you get her labs back.”

“I’ll call now.” Just as Cindy reached for the phone, the red triage phone rang. Cindy gave a little shrug and picked that one up instead. “ACH—go ahead.”

Glenn walked down to cubicle seven and announced herself as she pulled the curtain aside. “Ms. Purcell? I’m Glenn Archer, one of the surgical PAs.”

Naomi Purcell sat propped up on several pillows, her eyes fever bright in a pale white face. Lank strands of medium brown hair framed her face. Sweat beaded on her forehead, and her chest beneath the shapeless cotton hospital gown fluttered with quick, shallow breaths. A tall, husky man in a faded T-shirt hanging over the top of baggy blue jeans stood to the left side of the bed, his hand on her shoulder and terror in his eyes.

“She seems to be getting sicker really fast, Doc,” he said in a low, tight voice.

“I’m fine, Todd.” Naomi Purcell’s voice was wispy and faint but she mustered a smile. “My leg feels like a nest of fire ants are having a picnic on it, though.”

“Let me take a look.” Glenn snapped on gloves and drew back the sheet, expecting to see the angry laceration Cindy had noted on the chart along with the bright red sheen of a superficial infection surrounding it. All the expected signs of infection were there, but nothing about Naomi Purcell’s leg was typical. An irregular inch-long gash just above her left ankle gaped open, and a thin milky fluid oozed from its edges, slowly trickling down onto the sheet. Her foot was swollen to twice its size, the skin thin and tight as if trying to prevent the flesh and fluid beneath from bursting out and close to losing the battle. She checked for the dorsal pulse and couldn’t find it. “Can you feel me touch you?”

“Yes, a little. My toes are numb, though.”

“Do they feel cold?”

“No. More like they’re just not there.”

The inflammation extended up her calf following the path of lymphatic drainage, spidery fingers spreading toxins and whatever bacteria had invaded the deeper tissues. Glenn felt for the artery behind Naomi’s knee and found the rapid beat that signaled Naomi’s system was working hard to combat the infection. “This might hurt a little bit.”

“Don’t worry about me,” Naomi said, as if Glenn had anything else to worry about.

Right now, Naomi Purcell was the only thing that mattered in her life. She gently probed at a distance from the laceration, and a faint crackle, like air popping in the plastic bubble things they wrapped around packages that come in the mail, crinkled beneath her fingertips. Her belly tightened and she straightened up. “I want to check your X-rays. I’ll be right back.”

“She should get some antibiotics, right, Doc?” Naomi’s husband Todd said.

“Yes, and we’ll get on that in just a minute.”

His eyes followed her out of the room. Eyes that said, Don’t leave us. Help us. Eyes she’d seen hundreds of times before. Three X-rays hung on the light box next to the curtained cubicle. The bones of the lower leg stood out like bleached driftwood, balloon-shaped shadows marking the surrounding muscles and fat. And there in the depths of the tissue, clear streaks like icing in a layer cake extended from the edges of the laceration. Air where there shouldn’t be any. She found Cindy drinking a cup of coffee and making notes in a stack of charts in the tiny staff lounge. “We need to start her on antibiotics—I’ll get cultures and call Flann.”

“It’s bad, isn’t it?”

“It’s necrotizing fasciitis, and she needs to go to the OR, right now. I should call Williams, but Flann’s upstairs—”

“God, don’t call Williams. If you do, she’ll be sitting down here until after he’s had his morning coffee.”

“You did good calling me.”

“I knew you’d come. You always do.”

Of course she did, what else would she be doing. She scribbled an order for an antibiotic cocktail and called up to the OR. Dave Pearson, an OR tech, answered. “Hey, Dave, it’s Glenn. Can you patch me into Flann’s room?”

“Sure, hold on. You got something?”

“Yeah—do you have another team?”

“We can put something together if it can’t wait until Flann is done.”

“Let’s see what she says.”

A second later the line buzzed and a woman answered. “OR seven.”

“Fay, it’s Glenn Archer. Can Flann talk?”

“Hold on a second…Flann, it’s Glenn. Can you talk?”

“Glenn?” Flann said. “What are you doing? I thought you’d moved on to greener pastures.”

“Not until seven a.m. I’m down in the ER. Cindy called me. There’s a thirty-five-year-old woman here with necrotizing fasciitis of her left lower extremity. Right now it’s in the midcalf, but the wound is less than twenty-four hours old, and she looks toxic. She needs to come up.”

“Damn it,” Flann muttered. “We’ve got another half an hour before we can test the shunt. Pete can close after that. If they can set up another room, you can get started.”

“Dave says they can. I’ll get her upstairs.”

“You started her on bug killers?”

“As we speak.”

“Let me know as soon as she’s asleep, and I’ll put my head in if I’m not free yet.”

“Okay, no problem.”

Husband and wife fixed Glenn with anxious gazes as soon as she stepped through the curtain. “You’ve got an infection in your leg, you know that. The X-rays show air inside your tissues where it shouldn’t be. That indicates a certain kind of infection from strains of bacteria that can be harder to treat than the ordinary kind. It’s probably caused by whatever was on the old wire that you got tangled up in.”

“But you can treat it, right? With the antibiotics?” Todd’s voice was an octave higher than it had been and his face had gone from ruddy to gray. He swayed just a little.

“Sit down right there, Mr. Purcell, and I’ll finish telling you what we’re going to do.” Glenn pointed to the plastic chair next to the bed and Todd Purcell dropped into it with a thud.

Todd repeated, “You can treat it—”

“Todd,” Naomi said with gentle firmness, “let the doctor talk.”

Glenn didn’t bother correcting them. Almost everyone she took care of in the ER called her Doc. Everyone in Iraq had too. “We are going to treat you with antibiotics, and Cindy, the nurse you met earlier, will be starting them any minute. But that’s not going to be enough. We need to take you up to the operating room—”

Naomi’s husband gave a little groan. Glenn walked closer to the bed and gripped his shoulder, her gaze still fixed on Naomi, who held hers unwaveringly.

“You’re not going to have to amputate my leg, are you?” Naomi Purcell asked.

“No. We’re going to make an incision and wash out the deeper tissues to help stop the spread of infection. We might have to make several four-or five-inch incisions, but they’ll heal. You’ll have some scars, but it’s early yet, and chances are good your leg will be fine except for that.”

“All right,” Naomi said instantly. “When?”

“Right now. As soon as we can get the antibiotic started, we’ll take you upstairs to the OR.”

“Are you sure you have to do this?” her husband asked, looking like a frightened deer trapped in a thicket of briars.

“I’m sure. I talked to Dr. Rivers about it, and she—”

“Harper Rivers?”

“No, Flannery.”

“Harper takes care of our kids,” he said, some of the color coming back to his face. “Her sister—that’s the surgeon, right?”

“That’s right. She’ll be in charge upstairs.”

“But you’ll be with her, right?” Naomi said.

“Yeah, I will be,” Glenn said, thinking this would probably be her last case with Flannery Rivers.

Chapter Two

Mari had never lived anywhere without bus service. She’d never lived anywhere without malls and movie theaters and takeout. When she was thirteen, she’d gone to one of the big agricultural centers in LA County on a school-sponsored trip, but the miles and miles of row after row of green things had seemed foreign and boring at the time. Looking back, it had probably only been a few hundred acres of lettuce, but she’d been happy to get back to the concrete and city smells she’d grown up with. No buses meant driving, which she could do but had rarely needed to undertake back home when everything was a stop away on the subway, light rail, or bus. Who would drive in the insanity if they didn’t need to?

When she’d arrived at the Albany Airport lugging everything she planned to start a new life with in two suitcases and a taped-up carton of books, she’d rented a car and, following a printout from Google Maps, driven on increasingly narrow, twisting roads through countryside vaguely reminiscent of the fields and green valleys beyond the sprawl of Los Angeles. The farms she passed here, though, were so much smaller and the land so much hillier and the air so much cleaner. Maybe the East Coast seemed so alien because she’d never known anything other than LA. She’d rarely spent much time outside the city, because why would she? Everything that had seemed important growing up was there in the teeming streets—entertainment, shopping, school. Her parents almost never took a vacation—her father was always working in the store, her mother often joining him during the welcome busy stretches, and on the rare times when they weren’t both busy, there was always something going on with one or the other of Mari’s siblings. With barely a year and a half between them all, the after-school sports, clubs, and social events were a never-ending cycle that repeated year after year. Dances and finals and sports practice occupied everyone’s time, and when her mother was too busy with the younger ones, the older ones—the girls at least—stood in for her. Mari’s life had been the family, and she’d never imagined it any differently until everything had changed.

She’d dropped the rental off at the nearest return site as soon as she’d unloaded her belongings and the household essentials she’d picked up at a Target before leaving the city. She couldn’t afford to lease or buy a car, and so she would walk. She didn’t mind walking and it wasn’t very far from her studio apartment to the hospital. Or to anywhere else in the little village, either. Everything she needed in terms of food and necessities she could get at the grocery store she’d discovered just at the opposite end of town, its parking lot filled with pickup trucks and Subarus. She’d wondered on her first exploration of the village four days before if people drove anything else at all. Since then she’d found a surprisingly big pharmacy at the intersection of Main Street and the county road that ran through the center of town, a diner, a bakery that also served decent coffee and beyond-describable muffins and pastries, a pizza place, and a number of other shops. She could survive without a car, and walking felt good. Using her body felt good, and even after a week, her muscles seemed stronger.

And she’d better get her butt in gear now with just over an hour before she needed to start her new job. Her stomach squirmed with nerves. This wasn’t at all how she’d imagined her first day as a newly minted physician assistant. The silence of her tiny apartment reminded her every minute of all the voices that weren’t there, encouraging her, teasing her, quietly supporting her. Now there was only the voice in her own head telling her she could do this. She’d done much harder things. And she wanted to do it, needed to do it. Work gave her a reason to get out of bed in the morning, that and her stubborn refusal to be defeated.

She showered in the miniscule pocket bathroom, barely able to dry off without bumping her hip on the corner of the sink. She blow-dried her hair, thankful again for the natural waves that required little more than a decent cut to look acceptably stylish, and put on the minimum of makeup to cover the smudges beneath her eyes. Sleep was sporadic still, and she hadn’t quite gotten over the jet lag. She’d never been very good at traveling on the few occasions she’d visited her father’s distant relatives in Mexico or interviewed for PA-training positions. She always missed her pillow. The one she’d slept with forever, it seemed, shaped to her arms and the curve of her cheek.

She smiled at her weary image in the mirror and admitted what she really missed. The smell of coffee floating up from the kitchen in the morning along with her mother’s voice reminding Joseph of some errand he had to do after work or calling to Raymond to get out of bed before he missed the bus or singing snatches of some old song as she fixed breakfast and packed lunches. Even with four of the kids gone, the house had still felt full with her and the two boys and Selena still living at home. The house always felt full of life.

Her tiny apartment was neat and airy and sunny, but oddly sterile, as if the silence scoured it clean. Getting to work and occupying her mind was exactly what she needed to remember she was damn lucky to be able to complain about anything—including a nice, clean, quiet place to live and a job she’d wanted all her life. Self-pity was an unbecoming pastime, and she needed to be done with it.

Feeling better for the mental scolding, she dressed in tan pants, brown flats, and a dark green cotton polo shirt, gathered the necessities into her favorite buttery soft leather shoulder bag, the one Selena had given her for Christmas two years before, and made sure to lock the door on the way out. The hospital was at the other end of town up a hill, a twenty-minute walk from the short street a few blocks off Main where she’d found an apartment in what had once been a grand mansion but was now carved up into small odd-shaped apartments. Hers was on the second floor in the back, overlooking a plain fenced yard shaded in one corner by a big tree she thought was a maple, but wasn’t sure. No one seemed to use the yard, although someone cut the grass.

Traffic was heavier than she expected at a little after six, mostly those pickup trucks again, almost all filled with men and carrying logos on the side saying floor repair, general contractor, plumbing, or some other trade. The café was open, and she treated herself to a scone and a cup of very good espresso and still approached the hospital twenty-five minutes before she needed to be there. The hospital was the only building on the wooded hillside, and as she passed through the stone pillars flanking the entrance to the winding, crushed-gravel road and climbed past tall cast-iron lampposts and taller pines, she felt as if she was walking back in time.

At the top of the approach road, Mari stopped. She’d only had glimpses of the hospital through the trees that surrounded it on her walks through the village, although she’d been aware of its presence, perched above the fray like a watchful bird. It even looked a little like a bird, with its wings stretching out to either side. She’d seen pictures of it online and even found an old historical society talk about it that someone had posted along with photos, some of them decades old. She tried to imagine, looking at the faded sepia images of young women in long dresses with white aprons and frilly caps, and stern-faced men in high-collared white shirts and tailored coats with narrow lapels and high-waisted pants, what it had been like practicing medicine before the modern era had brought such astounding progress and devastating commercialization. Before the days of vast medical consortia and insurance companies and all of the other agencies that had crowded in and relegated so many of the hospitals like this to memory.

This hospital was undergoing a major transition, adding an Emergency Medicine residency program and joining with the regional medical school’s PA training program. She was about to become one of the faculty of that new program. A year ago she thought she’d never have the chance to treat a single patient, and now this. Everything had happened so quickly. A job and a new life.

No one had congratulated her and no one had tried to stop her from leaving. Of course, in so many ways, she’d already been gone.

A siren wailed, drowning out her thoughts, and she jumped onto the green grassy shoulder well to the side of the curving road as an EMS van rolled around a corner and swept past. Perhaps whoever rode inside would be her first patient. Fifteen minutes from now, she’d know.

From the turnaround in front of the hospital, she took one more second to appreciate the soaring majesty of her new home—as she somehow thought of it. A fountain centered the grassy expanse in the middle of the circular drive, clear water draped in rainbows gushing into a scalloped cast-iron basin from beneath the feet of a life-sized metal sculpture of a woman with a child by her side, their hands clasped together. The hospital itself was anchored by the central structure, a brick edifice six stories high, ornate white columns surrounding the broad entrance, and wings extending from either side like arms clasping the forested hills towering behind it. She turned and looked at the village down below, dappled in sunlight and shrouded by tree branches—seeming so peaceful, as if nothing could ever disturb its tranquility. She knew she was only wishing such a place existed, a foolish wish. The past could not be undone or relived. Harsh words could only be forgiven and someday, she hoped, forgotten.

And none of that mattered now. She turned back to the hospital and took a deep breath of the cleanest air she thought she’d ever experienced. So fresh her lungs actually tingled. Smiling at the thought, she followed the drive in the direction she’d seen the ambulance take and found the emergency room entrance without any trouble. At six forty-five in the morning, it was already busy. Several people stood in line at reception, waiting to sign in with the woman sitting at the counter. A line of gurneys waited along the wall on either side of big double doors that stood open at the entrance to the treatment area. An orderly pushed a woman in a wheelchair around a corner, and an elevator dinged. The murmur of voices drew her down a short hall to the nurses’ station. She stopped by the desk and waited until a middle-aged man with thinning brown hair wearing khaki pants and a camo scrub shirt adorned with Snoopy looked up at her and smiled.

“Can I help you? Are you here with one of the patients?” he asked in a surprising lilting tenor.

She held out her hand. “No, I am Mari Mateo. A new PA. I was wondering—”

“Oh, right. That’s today—welcome. Glenn’s not here, but come with me.”

Mari hesitated as he swept around from behind the counter. “If you could just point me to the conference room—”

“I’m Bruce Endie—one of the nurses. This way,” he said over his shoulder as he hurried along. Mari followed down the hall and around the corner before he disappeared completely.

He stopped in front of an open door, rapped quickly, and said, “Dr. Remy. New troops.”

Mari halted abruptly beside him and glanced into a small office where a woman sat behind the desk. She felt her face color when she recognized the head of the ER. They’d only talked via Skype, but Dr. Remy wasn’t someone she would easily forget. “Oh, Dr. Remy! I’m really sorry. I think I was supposed to be in the conference room.”

The blonde with the emerald green eyes, sculpted cheekbones, and warm smile motioned her in. “That’s okay. Mari, isn’t it? Call me Abby. Have a seat.”

“Thanks.” Mari sat in one of the two chairs in front of the ER chief’s desk. “I’m afraid I’m early.”

Abby grinned. “You’ll never hear complaints about that. I’m sorry Glenn isn’t here to—”

“Am I late?” a low, smooth voice inquired from the direction of the open door.

“Not at all,” Abby said. “This is Mari Mateo, our new PA. Glenn Archer is our program director, Mari.”

Mari turned in her seat, her gaze falling on a slightly taller than average woman with shaggy dusky blond hair, a lean face with slate-blue eyes, and a wide sensuous mouth above a square chin with a shadow of a cleft. The expression in those intense eyes was appraising and cautious. No quick smile and friendly welcome here. Not unfriendly, just remote.

“Good to meet you,” Glenn said in a slow, sensuous drawl. A smile flickered and was gone.

“Glenn will take care of getting you settled,” Abby said.

Mari rose, wondering just how settled she’d be when just the slow sweep of Glenn Archer’s gaze over her face made her pulse quicken.

Chapter Three

Glenn strode silently down the hall toward the main area of the ER with the new PA keeping pace. Why the hell had she let Abigail Remy talk her into giving up her position as Flann Rivers’s surgical first assistant to head up this new training program? Abby hadn’t even had to work hard to convince her. It hadn’t been flattery, she wasn’t susceptible to that. Sure, Abby had said she’d needed her, needed someone with experience who was used to leading a team to be sure the PA training program got off the ground and running without any hitches. The new cooperative programs between ACH and the area medical centers were vital to keeping the hospital healthy. The ER, hell, the whole hospital had been in trouble not long before, and there’d been talk of the place being bought out and closed. Everyone thought Presley Worth, the new CEO, had come here to do exactly that. Maybe she had. But not now. Presley, medical staff president Edward Rivers, and every member of the staff were united in turning the place around. So how could she have said no—when had she ever said no when she believed in something and duty called? She’d been happy working as Flann’s second, satisfied with her solo responsibilities. Comfortable. Safe. Hell. She knew what the problem was. She didn’t want to be a team leader, didn’t want to be responsible for success or failure. Didn’t want to be anyone’s go-to. Not again. But she’d signed up for it, hadn’t she? Reenlisted just as automatically as she had the last two times. So here she was, the PA director, with a new staff PA, and she still hadn’t said anything more to Mari Mateo than “Come on, I’ll show you where your locker is.”

Glenn stopped so abruptly Mari took a step past her, then turned back and stared at her with a question in her eyes.

“You drink coffee, don’t you?” Glenn said.

Surprise registered in the deepest, darkest, richest brown eyes Glenn had ever seen. Streaks of gold splintered through the chocolate, making Glenn think of sunrise over the desert, of the piercing shock of unexpected splendor in a desolate landscape. A smile rode the sunrise, cresting on Mari’s wide, full rosy lips, and Mari went from pleasantly attractive to knockout beautiful in a millisecond.

“No, I don’t think much of coffee.”

Still caught in the storm of sudden beauty, Glenn wordlessly shot a raised eyebrow. She frantically tried to envision getting through morning report without coffee. Some people drank tea, sure. On occasion she had done that herself. But coffee was tradition, and for most medical people as precious as blood. But she could deal with a tea drinker. Somehow. “Oh. Okay. Well, uh, then…how about—”

“On the other hand,” Mari smoothly went on, an amused glint in her eyes, “I particularly enjoy an espresso—especially when it’s made from a good Mexican bean.”