Warning Signs Page 8

  “Not only was she cute, she was smart. Helped me pass, then inspired me to go on and get my Pharm.D. as well as my medical degree. Wouldn’t be where I was without my Faith.” His voice trailed away. “Let’s try that again.” She felt the dull thud of the reflex hammer against her elbows, then her knees. “Hmm …”

  Amanda opened her eyes. “What’s wrong?”

  “Hang on a second.” He opened the door and called for Faith. She joined them almost immediately. “Faith, would you be a dear and check Amanda’s status for me?”

  “You mean break the double-blind code? Norman, if I do that—”

  “She’s out of the study, I know.” He glanced at Amanda. “It’s for the best, Amanda. I want to put all your fears to rest.”

  Amanda gulped. Suddenly she was less afraid about some vague dizzy spells than she was of losing two hundred dollars a month. That money was her food budget. “Really, it’s not necessary.”

  “I think it is.” He nodded to Faith, who disappeared out the door with her usual efficient stride.

  “Your reflexes are abnormal,” he explained to Amanda once they were alone. “Hyperactive in your triceps and absent in your patella and Achilles. And you’ve some areas of decreased sensation, along the soles and sides of your left foot. Have you noticed any clumsiness, difficulty with balance lately?”

  “A little—but nothing consistent,” she was quick to add. A shiver crawled down her spine as the air conditioner blew onto her bare back. She hugged the gown tighter around her, but the cold feeling didn’t go away. “Just when I’m rushed, or nervous.”

  “Hmmm. Might be nothing but a little electrolyte imbalance.” He looked up as the door opened again and Faith returned. “What did you find, Faith?”

  “Amanda is in the placebo group.” Concern for Amanda was etched on her face. “I hope that helps.”

  “Well, at least we don’t have to worry about any of the supplements being the cause of these symptoms. I still want to do some tests.”

  “Norman, if she’s out of the study, you can’t continue as her physician,” Faith quietly protested. “I’m sorry, Amanda. But we have to follow the rules—”

  “I can ask Lucas,” Amanda said, although she dreaded the thought of admitting that there might actually be something wrong with her. Especially to Lucas Stone. “Or one of the other neurology attendings.”

  Dr. Nelson hesitated. “Let me at least get the basics,” he said. “I’m sure I have a much better handle on these things than Lucas Stone. Besides, who’s going to tell me who I can see as my patient and who I can’t, right?” He grinned and patted Amanda’s arm reassuringly. “Don’t worry, Amanda. We’ll get everything sorted out and it will be fine.”

  TEN

  Thursday, 12:27 P.M.

  LYDIA WAS STAPLING A SCALP LACERATION WHEN alarms sounded from the bed space across the hall. She quickly placed the last two staples, leaving the dressing for a nurse to take care of as the sounds of a woman shouting propelled her from the suture room and into Emma Grey’s bed space.

  “What’s going on here?” she asked, raising her voice to be heard over the blaring alarm.

  Emma had removed her oxygen and climbed out of bed. Across from her, Nora held Deon, her arms wrapped around his chest. A man, a stranger to Lydia, stood beside the bed. He had dark, wavy hair, rugged Eastern European good looks, and a wide mouth stretched into an “aw shucks” grin.

  “You must be Dr. Fiore,” he said, his smile never losing any wattage when she didn’t shake his hand, although his face blushed beet red. More than just a blush, he had a bad case of rosacea marring his otherwise good looks. “I’m Tommy Zwyczaje. Sorry we have to meet under such circumstances. Don’t worry about trying to pronounce my name, everyone just calls me Tommy Z.”

  “You’re not taking my Deon.” Emma’s voice sliced through the air with the strength of an ax swing. In contrast, her body quivered with rage and fatigue. “Let him go. We’re leaving this place.”

  “Calm down. No one’s going anywhere. You’re both still my patients; no one has the right to take Deon from you.” Lydia reached past Emma to silence the alarm.

  Emma’s heart rate was slow—too slow, given her agitation, and there were a few irregular beats. Exactly the kind of rhythm that could trigger the Brugada syndrome. “Please Emma, lie back down.”

  “No. Not until he leaves. You promised, Dr. Lydia, you said you’d see to Deon.”

  “I will.”

  “I’m afraid Dr. Fiore is in no position to make any promises of that nature,” the man, Tommy Z, said.

  “Who the hell are you to tell me how to run my ER?” Lydia snapped at him.

  Nora came to his defense. “Lydia, Tommy’s from social services.”

  “I didn’t call social services.”

  “Any staff member can consult social services,” Tommy said. “If they feel their patient’s needs aren’t being adequately addressed.”

  “I’m addressing these patients’ needs just fine.”

  “Lydia,” Nora protested, “you can’t keep Deon registered as a patient when there’s nothing wrong with him. And he can’t stay here while his grandmother is admitted.”

  Nora was right. Lydia had no idea how she could keep Emma and Deon together if Emma needed surgery, but she would figure something out. Without the meddling of an overzealous Good Samaritan like Tommy Z.

  “Cardiology is on their way; we’ll come up with a game plan for everyone after they make their assessment.”

  She turned her back on Nora and Tommy. Emma was barely standing, both hands now grasping the IV pole like a lifeline. “Emma, I promise, I’ll take care of this. Please get back into bed.”

  Lydia reached an arm around Emma to guide her back to the bed. Suddenly, the older woman’s entire weight fell on her. The monitor screeched. Lydia was barely able to protect Emma’s head as they both slid to the floor.

  “Get me the crash cart. Now.” She glanced up at the monitor. Emma’s heart was beating in an erratic fashion, torsades de pointes—a lethal rhythm. “No pulse.”

  “Gram!” Deon cried out, trying to crawl over the bed to reach his grandmother. “What’s wrong with her?”

  “She’ll be all right, Deon. But you need to leave.” Shit, shit, shit. She was not going to lose this woman, not in front of her grandkid, not lying here on the floor.

  Deon cried out and struggled as someone pulled him away, Lydia didn’t see who—maybe Tommy Z had finally made himself useful. Running footsteps and the rumble of the crash cart coming down the hall sounded behind her.

  She couldn’t wait for the cart. Lydia raised a fist high in the air and struck Emma midsternum. The thump was audible even over the roar of the dueling monitor alarms.

  She felt for a pulse, her gaze fixed on the monitor as the jagged lines went flat and then slowly reassembled into a slow but regular rhythm.

  Emma’s pulse echoed the beats on the monitor and her eyes fluttered open. “Deon,” she gasped, her fingers scratching at Lydia’s wrist.

  “He’s fine. Let’s get you back into bed now.”

  Several people had gathered by now, providing enough muscle to lift Emma back into the bed. Lydia put an oxygen mask back on her while Nora took a complete set of vitals.

  “Did that ACS patient go up to the cath lab?” Lydia asked.

  “A few minutes ago.”

  “Good. Move Mrs. Grey into the telemetry room. I’ll call cardiology again and get their butts down here.”

  Emma gasped in the oxygen and wrapped a hand around Lydia’s. “What happened?”

  “It was your heart. It began to beat erratically and couldn’t get enough oxygen to your brain. But the cardiologists can fix it—it takes a simple operation. They implant a pacemaker that can keep your heart beating regularly.”

  “Operation?” Emma’s eyes closed for a moment as she shook her head so vigorously the oxygen mask almost flew off. “I can’t. What about Deon?”

  Lydia squeezed her
hand and looked around. Tommy was holding Deon back beyond the curtain as everyone milled around Emma. Lydia gestured to him to let Deon go. The boy ran the few steps to Emma’s bedside but stopped short of touching her.

  “Is she okay? I’m not going to hurt her, am I?” he asked in an earnest quaver. Tears streaked his face.

  “She’s going to be fine. And you didn’t do anything to hurt her.” Lydia crouched so that she was at eye level with Deon. She wiped his tears with the side of her thumb. “You saved her life by making her come in today, Deon.”

  He nodded slowly, as if reluctant to believe her words. Poor kid. She wondered what had happened in his life to make him feel responsible for the adults around him.

  She hoped it was nothing like what had happened when she was a kid, but odds were it was probably something just as bad.

  Lydia couldn’t resist the urge to wrap her arms around him in a tight bear hug. Then she lifted him up to sit beside Emma on the bed, ignoring Nora’s frown of disapproval as the movement jostled the monitor leads, triggering a bleep from the alarm.

  “Emma, we’re moving you to a room across the hall. It’s a private room with special heart monitors. If this happens again, we’ll have the equipment to fix things. The heart doctors will be down soon to talk to you.”

  “Deon can stay with me?”

  Both Emma and Deon stared at her with matching dark brown eyes and fearful expressions.

  “Yes. For now, he can stay with you in the telemetry room. I’ll try to figure out what to do after that; just give me time, all right?”

  Emma lay back against the pillows, drained of color and the energy to fight. Deon stroked her hair, taking care not to disturb her oxygen mask.

  “All right,” she said in a tone of surrender.

  Lydia left her and Deon only to be ambushed by Tommy Z in the hallway and Nora from behind as the charge nurse followed her.

  “Lydia, you can’t—”

  “Dr. Fiore, I have to call Children and Youth—”

  Lydia whirled on them both. “Don’t spout the rules and regulations to me, either of you. They’re my patients and I’ll deal with the situation. We’re short on telemetry beds upstairs, so I’m sure cardiology won’t mind if we keep Mrs. Grey down here tonight. Deon can stay with her.”

  “It’s against policy to board admitted patients down here in the ER,” Nora said. “What if we need that bed for someone else?”

  “You don’t even have documentation that she’s the boy’s legal custodian,” Tommy put in. “Even if she is, CYS needs to be involved. That boy can’t keep living out on the street, with or without Emma Grey.”

  “All I know is that if you separate those two now, the stress will probably kill her. I for one am not willing to risk that. So to hell with the rules.”

  They both opened their mouths to protest, but Lydia silenced them by raising her palm. “Don’t say it, I don’t want to hear another word. Write me up, fill out a complaint, do what you need to do, but Deon and Emma are staying together.”

  She whirled on her heel and strode to the nurses’ station to call cardiology and convince them to agree to her plan. It wouldn’t be hard; the CCU was short staffed and short on beds, and they’d love to let the ER do their work for them.

  Which would take care of the problem tonight. But if they took Emma to surgery tomorrow, what was she going to do with Deon then?

  ELEVEN

  Thursday, 12:52 P.M.

  “HEY, NORA, HOW MUCH YOU WANT TO BET Lydia gets another rip?” Jason the desk clerk asked once Nora had finished moving Emma Grey to the telemetry room and Tommy Z had left a terse and disgruntled note on Deon’s chart. “Tommy Z’s sure to write her up.”

  “Don’t you have work to do?” she asked as Jason simultaneously played a handheld video game, rocked to whatever music was being drilled into his skull by his iPod, and meddled in things that didn’t concern him.

  “No, but you do.” He nodded to the ambulance bay where medics appeared, wheeling in a teenaged girl, bundled in a blanket despite the heat, her face bruised and swollen.

  “Trauma Two,” Nora directed the medics. She was surprised to see Trey Garrison, the district chief for EMS, and Jerry Boyle, a detective with the Major Crimes Squad, accompanying the girl. “VIP?”

  “Yes,” Jerry said.

  “Not her,” Trey answered. He jerked his head at Jerry. “Him.”

  Jerry ignored him and followed the girl into the trauma room. Trey leaned over the counter at the nurses’ station. “Lydia around? Damn fool got cut and wouldn’t let me do more than dress it at the scene. If it wasn’t for department regs and his partner, he would have refused treatment entirely. But I’m worried about a tendon laceration.”

  “I’ll call her,” Jason said with a knowing grin. Although they seldom engaged in public displays of affection, it was common knowledge that Trey and Lydia were involved.

  “Thanks.”

  Trey joined the others in the trauma room, standing in the doorway—to prevent Jerry from leaving without treatment, Nora guessed. Both men were about the same height—a little over six feet—but Trey definitely had a weight advantage, and it was all muscle.

  “Dr. Fiore, Trauma Two.” The overhead page went out and she wasn’t too surprised to see Lydia emerge from Emma Grey’s room to answer it. Lydia was guarding Emma and Deon as if she had to protect them from the rest of the ER staff. Nora had hoped that Tommy Z could persuade her to see the wisdom of the rules about minors and protective services, but apparently Lydia was the one person in Pittsburgh on whom Tommy’s charms failed to work.

  Which also wasn’t endearing Lydia to the rest of the staff. She shook her head; Lydia would just have to learn the hard way, as so many other new attendings did.

  Trey moved aside to let Nora enter the trauma room, his broad face lighting up in a smile when he looked past her and saw Lydia.

  Now that Nora was closer, she could see that the sleeve of Jerry’s dark gray suit jacket was saturated with what looked like blood. He held his arm snugged close to his chest but otherwise ignored it, his focus on the girl on the stretcher.

  “Tanesha, it’s going to be all right,” Jerry was telling the frightened and battered teen.

  He had crouched down to meet her at eye level but looked a bit wobbly. Nora steered a wheeled stool up behind him. He sank down onto it. “Yancy is not going to hurt you. Never again.”

  “You don’t know him,” the girl wailed, tears streaking her glittered blue and black mascaraed eyes, leaving a glistening path through layers of rouge. “He’s going to kill me.”

  “What happened?” Lydia took charge of the situation, reaching for Jerry’s arm.

  “Take care of her first,” he insisted. “Bastard beat her pretty good before we got there.”

  “You mean before you charged in like a fullback in a ’roid rage. I told you to wait for backup.” Janet Kwon, Jerry’s partner, stood in the doorway. She was a petite woman but intimidating—even if she weren’t carrying a gun on her hip. She nodded to Lydia. “He gonna be okay?”

  “We’ll see.” Lydia finished her examination of Tanesha. “Nora, why don’t you take Tanesha down to radiology? We’ll need a full facial series and a Panorex.”

  “Janet, you go with her,” Jerry said even as the teen began to panic and grabbed his arm. It was the wrong arm; he went pale with pain and swayed. Trey stepped forward and caught him, supporting him as Lydia took his good arm, and between the two of them they led him to the other gurney.

  “I want to stay with him,” Tanesha complained. “Yancy’s gonna come after me, he’s gonna kill me.”

  “Not while I’m around,” Janet said, but her attention was on Jerry, not their witness.

  “Tanesha, let’s get you into a wheelchair.” Nora tried to distract the girl.

  Ignoring trauma protocol, Lydia hadn’t cut away Tanesha’s clothing. Nora could forgive her that infraction; it had allowed Tanesha to retain a small amount of dignity. No
t that there was much clothing to get in the way of the exam: a Lycra micro-miniskirt and a metallic fringed crop top that barely qualified as a bra, much less a shirt.

  Nora hoped that during the trip to radiology she might get a moment to ask the girl about possible sexual assault as well as her physical injuries—at the very least, she would need STD screening.

  “It’s okay, Tanesha,” Jerry said from where he sat on the gurney opposite. “I’ll be here when you get back.”

  “EVERYTHING WILL BE FINE,” DR. NELSON HAD said. His words rang through Amanda’s brain as she walked down the steps in the secluded and empty stairwell of the research tower. How many times over the past few months had she told herself the same thing?

  She hated it when her mother pasted on a sugary smile and denied anything was wrong with the world. Like when her father had had his stroke. Now it looked like Amanda had inherited at least one thing besides Amelia Mason’s blond hair and blue eyes . . . the art of denial.

  Amanda stopped, clutched the handrail, and banged her left foot against the side of the step below. Dr. Nelson was right. She could barely feel it. How could she have missed that?

  Of course, how often does anyone go around sticking pins in the bottom of their feet to see if they can feel? She sank down to sit on the steps, not caring if her lab coat got dirty or how unladylike it looked. What if there really was something wrong with her? What if she had the same thing that had killed Becky and left Tracey paralyzed?

  Stop it! Her mother’s voice rang through her, more real than the sound of her own breathing echoing against the cement walls of the stairwell. Mama was known for her hypochondriasis—always had to be the center of attention—but she also had a steel-willed resistance to anything intruding into her reality. In the best Scarlett O’Hara tradition, Mama would think about anything bad tomorrow.

  Amanda stood up, brushing off the back of her lab coat. This time Mama was right. No sense worrying when she’d have to wait to get the lab results back.