Urgent Care Read online

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  ONE - Thursday, 6:42 A.M.

  TWO - Thursday, 7:32 A.M.

  THREE - Thursday, 7:48 A.M.

  FOUR - Thursday, 8:21 A.M.

  FIVE - Thursday, 11:02 A.M.

  SIX - Thursday, 12:17 P.M.

  SEVEN - Thursday, 12:34 P.M.

  EIGHT - Thursday, 12:41 P.M.

  NINE - Thursday, 1:22 P.M.

  TEN - Thursday, 6:42 P.M.

  ELEVEN - Thursday, 7:37 P.M.

  TWELVE - Thursday, 8:13 P.M.

  THIRTEEN - Friday, 6:32 A.M.

  FOURTEEN - Friday, 6:53 A.M.

  FIFTEEN - Friday, 7:22 A.M.

  SIXTEEN - Friday, 8:02 A.M.

  SEVENTEEN - Friday, 9:03 A.M.

  EIGHTEEN - Friday, 9:42 A.M.

  NINETEEN - Friday, 10:17 A.M.

  TWENTY - Friday, 11:01 A.M.

  TWENTY-ONE - Friday, 11:23 A.M.

  TWENTY-TWO - Friday, 1:31 P.M.

  TWENTY-THREE - Friday, 2:02 P.M.

  TWENTY-FOUR - Friday, 2:13 P.M.

  TWENTY-FIVE - Friday, 7:26 P.M.

  TWENTY-SIX - Friday, 8:53 P.M.

  TWENTY-SEVEN - Friday, 9:13 P.M.

  TWENTY-EIGHT - Saturday, 5:32 A.M.

  TWENTY-NINE - Saturday, 8:54 A.M.

  THIRTY - Saturday, 10:11 A.M.

  THIRTY-ONE - Saturday, 12:49 P.M.

  THIRTY-TWO - Saturday, 1:47 P.M.

  THIRTY-THREE - Saturday, 2:42 P.M.

  THIRTY-FOUR - Saturday, 5:17 P.M.

  THIRTY-FIVE - Saturday, 5:28 P.M.

  THIRTY-SIX - Saturday, 5:34 P.M.

  THIRTY-SEVEN - Saturday, 5:44 P.M.

  THIRTY-EIGHT - Saturday, 5:54 P.M.

  THIRTY-NINE - Saturday, 10:47 P.M.

  NOTE TO READERS

  WARNING SIGNS

  PRAISE FOR WARNING SIGNS

  “This page-turning medical mystery will keep readers captivated.”

  —Romantic Times (4 stars)

  “This exhilarating medical thriller gets the blood pumping . . . A terrific thriller . . . fans of Michael Palmer will enjoy this fine tale of a brave but scared medical student in trouble.”

  —Genre Go Round

  “A good writer can make you feel that you aren’t missing anything even when you haven’t studied the right subjects—and CJ Lyons achieves that in Warning Signs . . . [It] delivered a tight mystery and a good dose of action, along with strong, individualistic characters. I highly enjoyed it.”—Errant Dreams Reviews

  PRAISE FOR THE NATIONAL BESTSELLER

  LIFELINES

  “[A] spot-on debut . . . a breathtakingly fast-paced medical thriller.”

  —Publishers Weekly

  “Forget about your plans for the day and prepare to be swept away on a pulse-pounding adventure. This is my favorite kind of medical thriller—harrowing, emotional, action-packed, and brilliantly realized. CJ Lyons writes with the authority only a trained physician can bring to a story, blending suspense, passion, and friendship into an irresistible read.”

  —New York Times bestselling author Susan Wiggs

  “A pulse-pounding adrenaline rush! . . . Reminds me of ER back in the days of George Clooney and Julianna Margulies.”

  —New York Times bestselling author Lisa Gardner

  “Have we got a prescription for you . . . a tense thrill ride that feels like all the best episodes of ER and Grey’s Anatomy squeezed into one breathtaking novel . . . [an] impressive debut.”

  —Hilton Head Monthly

  “CJ Lyons writes with both authority on her subject and a down-to-earth reality for her characters . . . Engrossing, intriguing.”

  —New York Times bestselling author Heather Graham

  “CJ Lyons’ debut medical thriller is a fantastic and wild journey through the fast-paced world of a big-city ER. With rich, fascinating, and complex characters and a thoroughly compelling mystery, Lifelines is an adrenaline rush and an all-around great read.”

  —New York Times bestselling author Allison Brennan

  “Lyons captures the frenetic setting of the ER with a smooth style that demands the reader move forward to keep up with the piece, but she also creates winning portraits of the supporting players set to anchor the series . . . Sets the table well for the next adventure at Angels of Mercy.”

  —Newsday

  “If this debut novel is any indication, [Lyons’] decision [to write books] could be a gift to readers of multiple genres . . . Lydia is a well-drawn heroine, the writing is strong, and the plot could have been taken out of today’s headlines.”

  —Pittsburgh Post-Gazette

  “Lyons’ first book is a winner . . . giving us terrific characters and a compelling plot. An excellent book for fans of the medical thriller.”

  —Fresh Fiction

  “It takes a real emergency physician to write this excitingly about an emergency ward. CJ Lyons has been there and done it. The pages are packed with adrenaline. I can’t recall a hospital novel that so thrilled me.”

  —New York Times bestselling author David Morrell

  Titles by CJ Lyons

  LIFELINES

  WARNING SIGNS

  URGENT CARE

  THE BERKLEY PUBLISHING GROUP

  Published by the Penguin Group

  Penguin Group (USA) Inc.

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  Penguin Books Ltd., Registered Offices: 80 Strand, London WC2R 0RL, England

  This is a work of fiction. Names, characters, places, and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or dead, business establishments, events, or locales is entirely coincidental. The publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

  URGENT CARE

  A Jove Book / published by arrangement with the author

  PRINTING HISTORY

  Jove mass-market edition / November 2009

  Copyright © 2009 by CJ Lyons.

  All rights reserved.

  No part of this book may be reproduced, scanned, or distributed in any printed or electronic form

  without permission. Please do not participate in or encourage piracy of copyrighted materials in

  violation of the author’s rights. Purchase only authorized editions.

  For information, address: The Berkley Publishing Group,

  a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  eISBN : 978-1-101-14898-3

  JOVE®

  Jove Books are published by The Berkley Publishing Group,

  a division of Penguin Group (USA) Inc.,

  375 Hudson Street, New York, New York 10014.

  JOVE® is a registered trademark o
f Penguin Group (USA) Inc.

  The “J” design is a trademark of Penguin Group (USA) Inc.

  http://us.penguingroup.com

  This book is dedicated to all the nurses I have been

  privileged to work with during my seventeen years of

  practicing pediatrics.

  You all have taught me more about the true art of

  medicine than any school could. You have inspired me,

  grieved with me, and made me laugh.

  Thanks for all the lives you save!

  ONE

  Thursday, 6:42 A.M.

  NORA HALLORAN HURRIED THROUGH THE HOSPITAL’S parking garage, shoulders back, pepper spray clenched in shaking hands. She struggled to control her fear, lock it away, but the more she denied it, the worse it got.

  Every morning for two years, she’d fought her panic, bat tling fear to work her shift as a charge nurse in the ER. It was her daily, dreaded ritual. A battle she never lost.

  She couldn’t lose. Her patients depended on her—and she needed them as much as they needed her.

  On high alert, Nora scanned the shadows. No one. Not many cars in the employee garage this early. Fewer places someone could hide.

  She entered the stairwell, heart stuttering in time with her steps. Twelve down, three steps around the landing, twelve more. She counted the familiar cadence, holding her breath as long as possible as she sprinted for the door.

  One of the lights on the final landing was burned out. Can’t stop. She raced through the darkness. Slamming through the exit, gulping in the frigid December air, she propelled herself outside.

  Her feet hit the sidewalk. Inhaling deeply, she straightened her posture, mastering her stride and with it, her emotions.

  Tomorrow she’d do better. Tomorrow would be different.

  The sun streaking the eastern horizon surprised her, a slit of gold-rimmed crimson, blinding in intensity as it reflected from the pavement slick with melted frost. She’d sat in her car, psyching herself up for the walk, long enough for the morning light to edge through the indigo darkness.

  Despite the fact that it meant she was running late, Nora welcomed the light. As she walked beside the wrought-iron fence surrounding the cemetery across from Angels of Mercy Medical Center, a splash of unnatural color caught her eye.

  It was inside the cemetery fence, filtered through a snag gle of barren forsythia. Too large to be trash blown in through the fence, too gaudy to be a memorial. Nora stopped, grabbed the fence post, and stepped up onto the lowest rung, trying to make sense of the bright splashes crowding the shadows.

  Pushing aside the forsythia branches, she could finally see where the color originated. The marble statue of a weeping angel had been defiled by vile, hateful curses streaked across it in neon spray paint.

  Face down in the frost-speckled grass below the angel lay a naked woman, more graffiti scrawled across her body.

  Primal instincts screamed at Nora to run. To hide. Save herself.

  Shoving her fear aside, she grabbed her cell phone and sprinted toward the cemetery entrance, wishing for longer legs as she ran. She didn’t bother calling 911, not with Pittsburgh’s busiest trauma center right across the street.

  “Angels of Mercy, Emergency Department,” came the clerk’s chipper voice.

  “Jason, it’s Nora. There’s a woman down in the cemetery. Get me a trauma team over here, fast.”

  “Hang on, here’s Dr. Fiore.”

  Nora raced into the cemetery, crossing over graves, the slick grass threatening to send her sprawling. Her bag smacked against her hip as she dodged headstones. Her breath came in short bursts, fogging the air.

  No other sounds disturbed the cemetery’s peace. Long shadows stretched across the grass, but they couldn’t obscure the freshly painted graffiti that stood out sharply from the somber grays and whites surrounding the woman’s body.

  Nora reached her just as Lydia Fiore, the ER attending, came on the line. “What’s up?”

  “There’s a woman down. In the cemetery. Unconscious.” Nora’s voice sounded surprisingly normal, but after all, she was a charge nurse and this was what she did best—taking control of chaos, including the chaos of her own emotions.

  She knelt in the grass, snow melting into her jeans. Yanking her gloves off, she felt the woman’s pulse. Not all of the color came from spray paint, she realized. “Bleeding—looks like she was stabbed. She’s breathing on her own, but her pulse is fast, poor capillary refill.”

  “Hang on. Help’s coming.”

  Through the fence, Nora saw the ER’s doors open across the street, releasing two figures pushing a gurney laden with equipment. A man dressed in surgical scrubs sprinted past them, a blue blur as he bolted across Mathilda Street, almost getting hit by a car. Seth Cochran. Lord, couldn’t it have been anyone else?

  “You’d better call the police,” Nora told Lydia, wrapping her free hand around the woman’s wrist—the only comfort she could offer until help arrived.

  “Already on it. We’ll have Trauma One ready and waiting for you.”

  Nora squeezed her cell phone so hard it almost slipped away. Before hanging up, she added, “Lydia. She’s going to need a rape kit.”

  “Nora!” Seth called from five graves away, startling a solitary bird from the holly bushes. He was too loud for this place. That was Seth, always somehow larger than life—too alive, too vibrant, too . . . much. “Are you all right?”

  Of course she was all right. She was always all right. Even as she knelt in wet grass, hands covered in sticky neon paint and another woman’s blood, her insides churning, bile clawing its way up her throat, Nora was all right. She had to be. It was her job.

  “Multiple stab wounds, she’s shocky, blunt trauma.” Nora reported as she concentrated on the woman’s pulse fluttering beneath her fingertips.

  “What the hell?” He skidded to a stop beside her, kneel ing at the woman’s head. “Help me turn her over. Watch her c-spine.”

  Elise Avery, one of the flight nurses, ran to join them, bringing with her a paramedic, a stretcher, and a backboard. Seth cradled the woman’s head in his large hands, supporting her cervical spine as they rolled her onto the backboard. The woman now lay face up, the extent of her injuries revealed.

  “My God,” Elise said as she fastened the c-collar. “It’s Karen Chisholm.”

  Seth’s face blanched the same chalky white as the tombstone beside him. Karen was a nurse anesthetist at Angels. She was also the reason Nora and Seth had split up five months ago, after Nora discovered Karen and Seth naked together in a hospital call room.

  But she couldn’t think of any of that now. Now Karen was a patient. Her patient. Nora’s fists tightened with the effort as she clamped down on her emotions.

  “Get the O2 on her,” she ordered.

  Seth listened with his stethoscope. His hands shook. Anyone except Nora would think it was from the cold.

  “Left lung is down, heart sounds distant,” Seth pronounced, his voice grim as he palpated Karen’s naked torso, ignoring the graffiti and blood. “I need to crack her chest.”

  They maneuvered the backboard onto the stretcher. “I lost her pulse,” Nora announced, starting CPR. Elise grabbed a bag to force oxygen into Karen’s lungs.

  “Call the ER,” Seth ordered the EMT as they pushed the gurney over the grave sites and bounced back onto the pavement. “We’re going to flash and crash. Tell them to get the OR ready.”

  “Room thirteen?” Elise asked, now jogging beside the gurney as traffic stopped to let them cross the street. “Not upstairs?”

  Seth was shaking his head. “She won’t make it upstairs alive. Room thirteen is our only choice.”

  “Not much of a choice,” Nora replied. The small but well-stocked operating room behind the ER was used only for patients too unstable to survive the short elevator ride upstairs to the main operating rooms on the fourth floor. Most OR 13 patients died.

  They pushed past the ER’s doors and raced
down the hallway. Ahead of them two night-shift nurses were scrambling, getting the lights on in Room 13 and unpacking sterile instrument trays.

  “Anesthesia and the trauma team are paged,” Lydia Fiore, the ER attending on duty, said when they banged through the operating room’s doors.

  Nora continued CPR. Elise prepped the patient, throwing some drapes over Nora’s hands and splashing her with Betadine, while Lydia intubated and hooked up a ventilator and monitor.

  “C’mon, people, let’s hustle.” Seth snapped on gloves, not bothering with a gown or mask as he grabbed a ten blade and sliced open the left side of Karen’s chest. Dark maroon blood splashed him, puddling at his feet.

  Golden-brown Betadine soap swirled around the neon glare of the spray paint, not hiding the hateful words so much as highlighting them. Nora threw on gloves, their bright purple color clashing with the graffiti punctuated by dozens of stab wounds across Karen’s chest and abdomen. Nora slid into position beside Seth, grabbing a sponge and a Satinsky clamp.

  “IV’s in, blood on the rapid infuser,” Elise announced.

  “Clamp,” Seth said, holding his hand out blindly. Nora slapped the Satinsky into his palm as she reached in to clear the field with the sponge. “Aorta cross clamped. Someone mark the time.”

  “Five hundred cc’s out of the chest tube already,” Lydia told him. “And her belly’s distended.”

  “One thing at a time,” Seth muttered as he delicately snipped a hole in the bulging membrane surrounding the heart. A gush of blood poured out.

  “I’ve got a pulse.”

  “Good.” Seth straightened, a smile of satisfaction flickering across his face. Two surgical nurses rushed in, gowned and scrubbed and looking askance at Nora in her civilian clothing. She stepped aside as Seth dumped more Betadine over Karen’s abdomen. “Okay, let’s get to work on that belly. Knife.”