Nightwatch

Internal Memo: Courage Bay Hospital E.R.

From: Dr. Guy Giroux

To: E.R. personnel

After reviewing patient reports from Thursday night, I would like to commend all of you for your hard work and professional expertise during what’s now being billed as the Storm of the Century. Although I was unable to be here because of the storm, I have received nothing but praise and gratitude from the fire and police departments, as well as civilians, on the performance of Courage Bay Hospital’s emergency room staff.

As many of you know by now, one of the patients admitted was my stepdaughter. Heather was given excellent care by the admitting staff, and I know that all of you who dealt with her, especially Dr. Rachel Browne, worked tirelessly on her behalf.

I also want to thank you for the concern you’ve shown me during this time. Because of the extra work due to the storm, as well as my personal situation, schedules will be less flexible and some of you will be asked to cover extra shifts. I appreciate your willingness to do this, and suggest that anyone who finds the commitment onerous should address their concerns directly to me.

As I have always known, our E.R. staff is one of the best in the country.

JO LEIGH

Jo Leigh has written more than forty novels for Harlequin and Silhouette Books since 1994. A triple RITA® Award finalist, she has contributed to many series, most recently Harlequin Blaze.

Jo lives in Utah, where she’s hard at work on her next book. You can chat with her at her Web site, www.joleigh.com. And don’t forget to check out her daily blog!

Nightwatch

Jo Leigh

www.millsandboon.co.uk

Dear Reader,

Welcome to the next adventure in the Code Red series. I had a fascinating time with this book, diving deep into the world of medicine and emergency rooms, which was a blast! I talked to a lot of nurses, particularly the terrific Tammy Strickland and Myrna Temte, who made sure I wouldn’t make a fool of myself. Then I got to work with the other authors of the series, which made it too fun. As for the romance, well, let’s just say I was able to use some of my own experience to make it all come alive.

Let me know what you think. I promise I’ll get back to you!

www.joleigh.com

Best,

Jo

To Marsha. Thank you. Again.

CONTENTS

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

CHAPTER ELEVEN

CHAPTER TWELVE

CHAPTER THIRTEEN

CHAPTER FOURTEEN

CHAPTER FIFTEEN

CHAPTER SIXTEEN

CHAPTER SEVENTEEN

CHAPTER EIGHTEEN

CHAPTER NINETEEN

CHAPTER ONE

THE MOMENT Dr. Rachel Browne stepped outside to the emergency bay, the wind and rain slapped her in the face. So hard, in fact, that she had to hold on to the door to keep her balance.

The ambulance had slogged through what was already being called the storm of the century by the media, taking almost fifty minutes for what should have been an eight-minute ride.

The EMTs pushed open the doors, and John Wilkins, one of the E.R. orderlies, ran up to help them pull out the gurney.

Rachel, inadequately dressed in her lab coat, waited just under the overhang, but even so, she was soaked by the time the patient got to her.

“Julie Bell,” the paramedic closest to her shouted over the wind. “Found on her bathroom floor, presumed overdose. No suicide note, but a lot of empty bottles.”

“Any narcotics?” Rachel asked as they hurried into Courage Bay Hospital.

“Not that we saw. She’s lethargic, but arousable. BP’s 110 over 65, pulse 80.”

“Julie,” Rachel said, trying to get a response. “Can you hear me?” She looked back at the paramedic. “How long?”

“Maybe an hour. A friend found her.”

“Where is she?”

“A tree fell on her car—she couldn’t get out.”

Rachel turned back to her patient as they hit trauma two. “Julie, what did you take? What kind of drugs?”

“I picked up everything I could find on the floor,” the paramedic said, handing the bag to John.

They moved her parallel to the E.R. bed, and Amy Sherwood, a first-year resident, and two nurses, Katya and Karen, spaced themselves to make the transfer.

“On three,” Rachel instructed, and they lifted the young woman with practiced ease.

“We’re out of here,” the paramedic said. “It’s a nightmare out there. I wouldn’t be surprised to see Noah building the ark. Man, I’ve never seen anything like this.”

Rachel nodded at the man, then turned back to her patient, who’d roused enough to try to sit up.

“Leave me alone,” she said, her voice slurred and wet.

“Lie back, Julie. We’re going to help you, but you need to help us. What kind of drugs did you take?”

“Nothing, let me go.”

“CBC, chem panel, blood and urine tox screen,” Rachel instructed Katya. “We’re going to have to pump her stomach.”

“I’ll get a tube.”

“Wait.” Rachel raised her hand, stopping Katya. “What were the drugs?”

The nurse opened the bag the EMTs had left. “Diazepam, doxepin, amaryl, aspirin.”

“Pulse ox is 96 on 2 liters. I’ll run an EKG. It could be tricyclics.”

“She’s tachy at 120,” Katya said.

Rachel bent over the girl. “Julie!”

“Sats down to 81.”

“Okay,” Amy said, “She’s lost her gag reflex.”

“Let’s intubate.” Rachel grabbed the tube and got it into position. “Push flumazenil, .2 mil.” Just as she prepared to open the girl’s mouth, Julie stirred, then sat up.

Rachel took a quick step back. “All right, then. That’s good.”

“What’s going on?” Julie asked.

“Do you remember taking pills?”

“What?”

“Let’s give her charcoal and get her something dry to wear, please. Amy, you take it from here.” Rachel walked out of the trauma room, shedding her gown and gloves. It had been like this for almost ten hours now, only most of the patients had storm-related injuries. Blunt trauma, electrical shock, traffic accidents. Which wouldn’t have been so bad if any of the damn medical staff were here.

She wasn’t completely alone, but every doctor who had made it in had been pushed to the limits of endurance, literally running from patient to patient, and there was no end in sight.

“Incoming!” John Wilkins yelled as he stepped on the floor pad, activating the automatic door. A man in a uniform stumbled in carrying a drenched woman. She had passed out or was dead.

Rachel ran to the woman while Wilkins and two others got a gurney. “What happened?”

“She’s pregnant,” the man said, gasping for air. “She was in my cab and she started having seizures. She passed out about ten minutes ago. Before that, she said her head was killing her.”

“Thank you,” Rachel said, shoving the Good Samaritan aside. She’d immediately recognized the symptoms of preeclampsia.

Katya came running to help, and as they pushed the gurney, Rachel told her to get a CBC and do a chemstrip. “And get me an OB.”

Thunder rumbled as they headed toward Trauma 3. The girl, name unknown, roused when they transferred her from the gurney. She looked very young, pasty and full-term. She opened her eyes briefly, then shut them tightly as if the lights were terribly painful.

Rachel moved to the bedside. “What’s your name?”

The girl mumbled incoherently.

“That’s okay. We’re going to take care of you and your baby.”

The ghost of a smile flickered briefly as the nurses, Lydia and Katya, got busy with her vitals.

“BP is 250 over 70, and oh—”

The girl went into a seizure, her body spasming as if she’d been hit by a live wire.

“Give her 5 milligrams Dilantin. And get respiratory down here. We have a precipitous delivery, people, so let’s get the kit and the crash cart. Where is my OB?”

“There is no OB.”

Rachel looked up to see her resident, Amy Sherwood, at the door, donning her gown. “They have no one to send. We have to do it here.”

Rachel held back her curse. She could do this. She would do this.

Lydia, one of the best E.R. nurses Rachel had ever worked with, moved in close, preparing the woman for a C-section.

“Amy, work on her BP,” Rachel said, as she picked up the scalpel. “Where’s anesthesia?”

“Right here, Dr. Browne.”

Rachel didn’t even look up. She knew it was Dr. Reid, and he could handle the next step. She pushed a stray hair from her young patient’s face. “You’re going to be okay, honey. What’s your name?”

“Heather. Heather Corrigan.” Even those few words seemed an appalling effort for her and Rachel had to lean close to hear.

“Hello, Heather. I’m Dr. Browne.”

Heather’s lips curled in a faint smile and she half nodded before her teeth clamped again as another labor pain hit.

Rachel swabbed her forehead while Lydia prepped her belly. “Who’s your doctor, Heather? Do you have an OB? An obstetrician?”

Heather rolled her head back and forth in a negative response that obviously cost her. “Haven’t seen a—a doctor. I need to see…” Her already weak voice faded into nothingness as another wave of pain swept her body.

Katya raced into the cubicle carrying the FHD–100—a portable fetal monitor that ran on batteries. “I’ve got another orderly coming down,” she said. Then Reid covered Heather’s mouth with the mask.

“All right then,” Rachel said, putting on rubber gloves. “Let’s be on top of this, people. Everything’s going to be fine.”

ONLY, EVERYTHING WASN’T fine.

Rachel peeled off her paper scrubs and threw them furiously into the trash. She never got used to losing a patient. At least the baby would live, although his heartbeat was irregular and his jaundice was advanced. If only Heather had seen an obstetrician when she’d first gotten pregnant. Or even come to the hospital a few hours earlier.

Desperate for some coffee, Rachel headed toward the call room, but John Wilkins flagged her down from the other side of the hall. She stopped wearily and waited for him to reach her.

“Sorry, Doc. EMTs are bringing in a guy who had a roof cave in on him in the storm. They’ll be here in five.”

“Oh, Lord. Okay, when he gets here, can you get him cleaned up and into X ray and then come get me?”

“Sure, Doctor.” He paused midturn. “You okay?”

She looked at her watch. Almost 3:00 a.m. She’d been on duty for nearly seventeen hours. “I have to be, John. There’s nobody else.”

He nodded sympathetically. “I’ll take care of it.” He turned and hustled down the hall.

This time, Rachel made it to the coffee machine. She practically guzzled the first cup and was halfway through the second when John returned.

“He’s in X ray, Doctor. Whoa. They need you, stat.”

“That bad, huh?”

The orderly nodded.

Rachel slugged back the remainder of the coffee. “Well, let’s hit it.”

As she and John reached the X-ray room, the technician was just wrapping up. Rachel nodded and smiled at her, then approached the body lying on the gurney.

She noted approvingly that John had installed a saline drip and oxygen feed on the patient. She understood the orderly’s reaction. The face of the man on the gurney was in worse shape than many of the traffic accidents she’d seen—a palette of cuts, bruises and swelling distorting the features beyond recognition. “What’s his name?”

“Bruce Nepom.”

The man’s salt-and-pepper hair was matted with blood and he showed no signs of consciousness.

“Let’s get him in one,” Rachel said. As they walked, she pulled a small flashlight from her pocket and gently pried the man’s eyelids open, one at a time. She flashed the light across his eyes, but the pupils were blown—dilated and unresponsive to the light. “Bruce—Mr. Nepom. Can you hear me?” As expected, there was no reaction.

Rachel examined the man’s mouth. Three of his front teeth were broken, but he hadn’t bitten his tongue.

Once they were in the exam room, she pulled the sheet back to expose a well-developed chest with a smattering of graying hair, and a massive bruise along the ribs.

She noted John had already put in a catheter, and that most of the man’s injuries were upper body. She ran a finger along a tattoo on the man’s left shoulder—two dragons entwined around a Celtic cross. The tattoo had once been colorful, but the tints had faded and darkened.

“According to the EMTs, the whole roof fell on him,” John repeated.

She pulled on a fresh pair of rubber gloves. “Let’s see what we can do to help Mr. Nepom.”

RACHEL HANDED HER NOTES to the admitting nurse in the E.R. “Hang on to these for me, will you, Karen?”

“Sure, Doctor.” She gave Rachel a quick once-over. “You look beat. About time you went home.”

Rachel glanced at the half-filled seats in admitting. Aside from the two serious operations, she and Amy had treated dozens of broken limbs, stitched up God knows how many cuts, and even treated a man whose foot had been caught under a falling tree by poking through his toenail with a red-hot paper clip to relieve the pressure. She smiled at that one. “That’s my plan, Karen. I’m hoping to sleep uninterrupted for a good twenty-four hours.”

“Good night, Doctor. Or rather, good morning.”

“See you later.” Rachel headed out the double doors to the parking lot, still worried about Nepom. The surgery had been a success, but that didn’t mean the patient would live. Even if he did, his head wounds were so severe she doubted he’d regain anything like normal consciousness.

Although the sun was actually rising behind her, she felt as if she were coming out of a movie matinee. It was as though she’d forgotten what natural sunlight was like. Standing on the steps a moment, she took a deep breath. Clean air, sunlight.

Great time to go to bed.

With leaden feet and a killer backache, she made her way across the debris-strewn lot to her car. It would take her ten minutes to get home. Twelve minutes to be in bed.

DR. GUY GIROUX CLIMBED over a fallen palm tree then up the rise at the edge of his property. From there he could see the road and, thankfully, the city maintenance crew hard at work disentangling the trees and cars that had prevented him from getting to the hospital the previous night.

The last he’d heard from the E.R., before his cell had gone dead, was that they were critically understaffed. As head of the E.R., he should have been there. Thank God Rachel had made it in, but with this kind of storm, the injured would be more than any one doctor could handle.

They should have been better prepared, given the run of bad weather they’d been having. It was only a couple of months ago that the last severe storm had come through, causing major mudslides that had washed away houses. Now this.

He headed back to his house, which mercifully had been spared the worst of last night’s storm. His neighbor’s ground floor had been flooded, and Mrs. Allen had come to him for help, but all he’d managed to do was get her and her three annoying Pomeranians into the warmth of his spare room.

It was the only thing that had gone right. Without television reception or phone service, he’d relied on his radio for any word of relief, but it hadn’t come till about an hour ago.

The storm was the worst recorded in the history of Courage Bay, California, and he knew firsthand how far back that history went. His great-great-great-grandfather, Pierre Giroux, had been the captain of an American twenty-one-gun sloop of war, the Ranger, which had blown off course during the U.S.–Mexican War and been shipwrecked in Courage Bay. Perhaps in a storm like this.

Guy heard the dogs yapping before he crossed his threshold. He liked dogs and ordinarily wouldn’t have minded their incessant barking, but not today when he was suffering from lack of sleep and a rare feeling of helplessness.

“Dr. Guy?”

He inhaled deeply and let the air out slowly, trying to ease the headache that had been building steadily from four this morning. “Yes, Mrs. Allen?”

“The babies are hungry. Do you think it’s possible to get into my house and get some food for them?”

“No, I don’t believe it is. But I have some ground beef in the freezer.” He closed the door behind him and headed for the kitchen, avoiding the small woman still dressed in her housecoat and curlers.

“They’d like that very much,” she said.

As he got the beef out, he turned to her. “I’m going to have to leave. The road is open, and I’m needed at the hospital. The power’s back on, and I’m sure they’ll have the phone service turned on shortly and you can call your sister.”

Mrs. Allen nodded. She was eighty if she was a day, and her sister was only a few years younger.

“Then you call your insurance agent. He’ll help you with the house.”

The woman sat down at the dining room table, and the dogs, none of them puppies, swirled around her legs, panting heavily. “Thank you for last night. I don’t know what we would have done without you.”

“It was my pleasure.” He put the beef in the microwave, hit defrost, then excused himself with a reassuring smile to get ready for work.

His shower, although too brief, revived him somewhat, and the three aspirin would help even more. By the time he’d dressed and returned to the kitchen, the dogs were gobbling up their breakfast, eating out of his cereal bowls. Mrs. Allen stood watching them, and he was glad that she had them. Everyone needed someone to care for.

She looked up at him with a coy grin. “Have I told you about my great-niece, Lilly?”

He nodded. “You have.”

“She’s a very beautiful girl, Doctor. And she can cook like a dream.”

He grabbed his coat from the back of his dining-room chair and slipped it on. “I’m sure she can, but I’m already married—to my work.”

“Oh, I’m sure—”

“If you don’t believe me,” he said, “you can ask my ex-wife. Turns out I don’t share well with others. So save your niece the grief.”

Mrs. Allen sighed. “It’s such a shame. You’re so very handsome, and especially nice.”

He touched the older woman on the shoulder. “Thank you. You have my phone number if you need anything, right?”

She nodded.

“Please let me know when you reach your sister. If I’m not available, you can tell my secretary, Connie.”

Mrs. Allen went back to the pleasure of watching her “babies” as Guy headed toward the garage. He pressed the door opener as he stepped inside. The garage was neat as an operating room, which was the only way he’d have it. Inside, his baby, a 1958 Corvette, sat shiny and polished as the day she was born. But he wouldn’t take her out today. Not with the roads so torn up. Instead he climbed into his Range Rover and prepared for a slow twenty miles to the Courage Bay E.R.

When he arrived at the hospital, his headache returned full force. He went to his office first, but the usual piles of reports were missing. As was Connie. He played back the messages on his private line, and after two calls from a pharmaceutical house in Boston asking him to speak at a symposium next spring, Connie’s voice came on, letting him know that she’d been stranded and would get in as soon as the streets were cleared.

Guy sighed as he went to make coffee. His office wasn’t large but it had its pluses, the main one being the private call room. He busied himself with coffee grounds while he thought about the missing reports.

He’d have to give the staff the benefit of the doubt. Considering the conditions last night, reports weren’t the top priority. Saving lives was.

Which meant that he would take his coffee to go. He’d do rounds, assess the situation in the E.R. But first, more aspirin.

The scent of his Kona coffee made him feel better as he went back to his desk. He kept meaning to replace the old thing, with its battered sides and stiff top drawer, but whenever he had any time off, he made his way to the boat.

Just thinking of the Caduceus relaxed him more than anything else in the world. His ’44 sloop was everything a man could want in a boat, and his only regret was that he had so little time to sail her.

Thank God she’d been in dry dock during the storm. She was getting a new mast, aluminum. He was to have taken her out next week, but with this damn storm…

He’d call. After rounds.

Coffee cup in hand, Guy walked toward the admitting desk, all thoughts of sailing firmly stowed away. Before he reached his destination he was stopped twice, once by Karen, the admitting nurse, then by Mike Trailer, the head of maintenance, both of whom had tales of woe. Karen was concerned that the computers had been down for two hours during the night, and Mike told him about some window blowouts on the third floor. He listened patiently, although he was sure the information had already been given to Callie Baker, the chief of staff. He was more concerned with what was happening now in his domain.

Surprisingly, there were only four people in the admitting area, none of whom presented serious problems. Two of the E.R. bays were occupied, one with a woman who had broken her left hip when she fell on a toppled tree, and the other with a heart-attack victim, who was now stabilized.

He went back to admitting, and when Karen gave him the charts, he flipped quickly through the various cuts, bruises and breaks. He stopped when he got to Bruce Nepom. After reading the chart, Guy put the stack back and headed for the ICU.

He found the man in room C. There wasn’t much to see. Nepom was hooked up to a heart monitor, IV, respirator. Bandages covered his face and head, and his ribs had been taped.

There wasn’t much hope, but he was glad to see Rachel had been so thorough. Everything that could have been done had been done. What he didn’t see on the chart was that Nepom’s family had been contacted.

After putting the chart back, Guy returned to admitting one more.

Karen gave him the rest of the night’s paperwork, and he headed for his office and another cup of coffee.

He flipped through more notes. Damn. Rachel and Amy must have stitched, sewn, patched, splinted and put casts on nearly a hundred people since the storm started.

The name on the next report stopped him cold. Heather Corrigan. He did a quick check on her vital statistics: age eighteen, blond hair, no wedding ring. It was the Heather he knew. His stepdaughter. And she was dead.

Guy put the papers down on his desk and closed his eyes. Heather was supposed to be in Europe with his ex-wife. What was she doing here? Pregnant?

He focused his gaze with some difficulty, but as he read, the words became horrifyingly clear. Preeclampsia. Heather was healthy, strong. For God’s sake, she was only eighteen. And she’d died in his E.R. What the hell had Rachel done?

He picked up the phone with shaking fingers and dialed.

“Hi. You’ve reached Dr. Rachel Browne. Leave your number at the beep.”

“Dr. Browne, this is Guy Giroux. Pick up the phone. Right now.” He sat stiffly, a well of anger making it difficult to breathe, then slammed the receiver down when she didn’t answer. He stared blankly at his desk for a moment, then pounded his fist on it so hard his pen holder fell over.