Critical Care (2 page)

She whirled to catch a glimpse of a man barreling toward her
with his gaze on the ambulance entrance some dozen yards away.
He looked a few years older than she was, maybe thirty-five, tall
and wide shouldered, with curly dark hair and faded blue scrubs.
He leveled a forbidding scowl at Claire like a weapon and slowed
to a jog before stopping a few paces from her.

"What are you doing?" he asked, grabbing his stethoscope
before it could slide from his neck.

"I'm ... waiting," Claire explained, awkwardly defensive. "I
was paged to the ER."

"Good. Then don't just stand there holding up the wall. Let's
go. The charge nurse will show you where to start."

"But I-," she choked, her confusion complete.

"But what?" He glanced toward sounds at the ambulance bay
and then back at her.

Claire cleared her throat. "I don't know why I'm here."

He shook his head, his low groan sounding far too much like a
smothered curse. "If that question's existential, I don't have time
for it. But if you're here to work, follow me. Erin Quinn will tell you
everything you need to know." He pointed at a crew of paramedics
racing through the ambulance doors with a stretcher. A toddler, his
tiny, terrified face raw and blistered behind an oxygen mask, sat
bolt upright partially covered by a layer of sterile sheets. "See that
boy? That's why I'm here. So either help me or get out of the way."
He turned and began jogging.

Speechless, Claire stared at the man's retreating back and the
nightmarish scene beyond: burned child, hustling medics, a flurry
of scrubs, and a hysterically screaming parent. Help or get out of the
way? What was she supposed to do with that ultimatum? And what
gave this rude man the right to issue it?

Then, with a rush of relief, Claire spotted the Jamaican nursing director striding toward her. This awful mistake was about to
be cleared up.

"I'm sorry for the delay," Merlene Hibbert said, her molassesrich voice breathless. "As you can imagine, there have been many
things to attend to." She slid her tortoiseshell glasses low on her nose, squinting down the corridor. "I see you already met our Dr.
Caldwell."

Claire's eyes widened. Logan Caldwell? Sierra Mercy Hospital's
ER director?

Merlene sighed. "I'd planned to introduce you myself. I hope
he wasn't ... difficult."

"No, not exactly," she hedged, refusing to imagine a reason
she'd need an introduction. "But I think there's been a mistake.
He thought I'd been sent down here to work in the ER." Tell me
he's mistaken.

"Of course. A natural mistake. He's expecting two more agency
nurses."

Claire's knees nearly buckled with relief. "Thank goodness.
They need help. I can see that from here." She glanced at the ER,
where patients on gurneys overflowed into the hallway. A nurse's
aide held a sobbing woman in her arms, her face etched with
fatigue. Styrofoam coffee cups, discarded cardboard splints, and
scraps of cut-away clothing littered the floor. All the while, the
distant cries of that poor child continued relentlessly.

"Yes, they do," Merlene agreed. "And that's exactly why I
called you."

"But I've been at Sierra Mercy only a few months, and my hours
are promised to the education department-to train the students,
write policies, and demonstrate new equipment." Claire floundered ahead as if grasping for a life preserver. "I've interviewed to
replace Renee Baxter as clinical educator. And I haven't done any
critical care nursing in two years, so working in the ER would be
out of the-"

"That's not why you're here," Merlene said. Her dark eyes
pinned Claire like a butterfly specimen on corkboard. "I need you to assess my staff to see how they're coping emotionally. I don't
have to tell you this has been one miserable morning." She studied
Claire's face and then raised her brows. "You listed that in your
resume. That you've been recently trained in Critical Incident
Stress Management?"

CISM? Oh no. She'd forgotten. Why on earth had she included
that? "Yes, I'm certified, but ..." How could she explain? Merlene
had no clue that Claire's entire future-maybe even her sanitydepended on never setting foot in an ER again. It was the only
answer to the single prayer she'd clung to since her firefighter
brother's death in a Sacramento trauma room two years ago. Being
helpless to save him left her with crippling doubts, sleep-stealing
nightmares, and ... She'd mapped her future out meticulously. The
move to Placerville, a new hospital, a new career path, no going
back. Everything depended on her plan.

Claire brushed away a long strand of her dark hair and forced
herself to stand tall, squaring her shoulders. "I understand what
you're asking. But you should know that I haven't done any disaster counseling beyond classroom practice. I'm familiar with the
principles, but . . ." What could she possibly offer these people?
"Wouldn't the chaplain be a better choice?"

"He's going to be delayed for several hours. Erin Quinn's my
strongest charge nurse, so if she tells me her ER team is at risk, I
believe it. They received six children from that explosion at the
day care. Four are in serious condition, and a two-year-old died."
Merlene touched the amber and silver cross resting at the neckline
of her uniform. She continued, frowning. "Dr. Caldwell's working
them ragged. An agency nurse threatened to walk out. Security's
got their hands full with the media.... You're all I can offer them
right now."

Claire's heart pounded in her throat. With every fiber of her
being, she wanted to sprint into the northern California sunshine;
fill her lungs with mountain air; cleanse away the suffocating
scents of fear, pain, and death; keep on running and not look back.
It would be so easy. Except that these were fellow nurses in that
ER; she'd walked in their shoes. More than most people, Claire
understood the awful toll this work could take. The staff needed
help. How could she refuse? She took a breath and let it out slowly.
"Okay. I'll do it."

"Good." Relief flooded into Merlene's eyes. She handed Claire
a dog-eared sheaf of papers. "Here's our hospital policy for staff
support interventions. Probably nothing new there." She gestured
toward her office a few yards away. "Why don't you sit down and
review it for a few minutes before you go in? You can report to me
later after I make my rounds."

Before Claire could respond, the ambulance bay doors slammed
open at the far end of the corridor. There was an answering thunder of footsteps, rubber-soled shoes squeaking across the faded
vinyl flooring.

Logan Caldwell reappeared, shoving past a clutch of reporters
to direct incoming paramedics. He raked his fingers through his
hair and bellowed orders. "Faster! Get that stretcher moving. Give
me something to work with, guys. And you-yeah, you, buddyget the camera out of my face! Who let you in here?" The ER director whirled, stethoscope swinging across his broad chest, to shout
at a tall nurse who'd appeared at the entrance to the ER. "Where are
those extra nurses, Erin? Call the evening crew in early; a double
shift won't kill anyone. We're working a disaster case here. Get me
some decent staff!"

Claire gritted her teeth. Though she still hadn't officially met him, there was no doubt in her mind that Logan Caldwell deserved
his notorious reputation. Dr. McSnarly. The nickname fit like a
surgical glove. Thank heaven she didn't have to actually work with
him-the man looked like he ate chaos for breakfast.

Claire turned to Merlene. "I'll do the best I can," she said, then
drew a self-protective line. "But only for today. Just until the chaplain comes."

"Of course. Very short-term." Merlene began walking away,
then stopped to glance over her shoulder. "Oh, a word of caution:
Dr. Caldwell hates the idea of counseling. I'd watch my back if I
were you."

Claire hesitated outside the doors to the emergency department.
She'd reviewed the summary of steps for an initial critical stress
intervention and was as ready as she'd ever be. Considering she'd
never done any peer counseling before. I'm a fraud. Why am
I here?

She shut her eyes for a moment, hearing the din of the department beyond. It had been stupid to put the CISM training on her
resume. She'd taken the course last fall and participated reluctantly in the mock crisis situations, mostly because it would look
impressive on her application for the clinical educator position.
But afterward Claire knew that she could never volunteer as a peer
counselor. Never. It felt too personal, too painful.

Healing the healers, they called it, the basis for the work of volunteer teams that waded into horror zones after events like 9/11,
the killer tsunami in Indonesia, and the devastating aftermath of
Hurricane Katrina. And a Sacramento, California, trauma room after
a warehouse fire that killed seven firefighters.

Claire fought the memories. Yes, the counseling teams made sure that caregivers took care of themselves too, assessing them
for burnout and signs of post-traumatic stress. Like difficulty making decisions, sleeplessness, nightmares, and relationship failures.
Claire knew the symptoms only too well. She'd struggled with
most of them herself these past two years, exactly the reason she'd
run away from that Sacramento hospital-after refusing its offer of
stress counseling-and never looked back.

But here she was at another ER door, peeking inside through
a narrow panel of bulletproof glass. And now she was responsible
for helping these people deal with everything she was trying so
hard to forget and expected to offer the kind of counseling she'd
never accepted herself. Beyond ironic-impossible and completely
at odds with her plan.

Claire raised her palm and pushed the door inward.

Heal my heart and move me forward. She'd prayed it every
single day.

So why was her life slamming into reverse?

The essence of Sierra Mercy ER hit Claire's senses like an assault.
Sounds: anxious chatter, a burst from the overhead PA speakers,
beeping of electronic monitors, inconsolable crying, and painful
screams. Smells: nervous perspiration, stale coffee, surgical soap,
bandaging adhesive, the scorched scent of sterile surgical packs ...
and of burned hair and flesh.

No, no. Claire's stomach lurched as she clutched her briefcase
like a shield and scanned the crowded room for the charge nurse.
Find Erin Quinn. Concentrate on that.

She took a slow breath and walked farther into the room,
searching among the eddy of staff in multicolored scrubs-technicians, nurses, and registration clerks. She forced herself to note
the glassed-in code room, a small central nurses' station and its large dry-erase assignment board, the semicircular arrangement of
curtained exam cubicles with wall-mounted equipment at the head
of each gurney, and the huge surgical exam lights overhead.

Claire tried to avoid the anxious faces of the family members
huddled close to the tiny victims. Because she knew intimately
how much they were suffering. No, much worse than that. I feel
it. I still feel it.

When she'd agreed to do this for Merlene, she'd hoped
this smaller ER-miles from the Sacramento trauma center and
two years later-would be somehow different, but nothing had
changed. Especially how it made Claire feel, the same way it had
in those weeks after Kevin's death. Unsure of herself for the first
time in her nursing career, she'd been antsy, queasy, and clammy
with doubt. Dreading the wail of approaching sirens and jumping
at each squawk of the emergency radio. No matter how hard she
tried, she couldn't shake the irrational certainty that the very next
ambulance stretcher would be carrying someone she loved, someone she'd be unable to save, and ...

A cry in the distance made Claire turn. Her breath caught as the
young charge nurse opened a curtain shielding a gurney.

A child, maybe three years old, rested upright in a nest of blue
sterile sheets, tufts of his wispy blond hair blackened at the tipssome missing in spots-reddened scalp glistening with blisters.
One eye had swollen closed, and his nose was skewed a little to one
side by the clear plastic tape securing a bandage to his cheek. The
other blue eye blinked slowly as if mesmerized by the drip chamber of the IV setup taped to his arm. An oxygen cannula stretched
across his puffy, tear-streaked face.

Beside him, a stainless steel basin, bottles of sterile saline, and
stacks of gauze squares sat assembled on a draped table. Burn care: control pain, cool the burn to stop it from going deeper, monitor
for dehydration, and prevent tetanus and infection. All the bases
covered. Unless the burns are horrific and complicated, like Kevin's.
Unless there is profound shock, heart failure, and ... No, don't think
of it.

Claire exhaled, watching as Erin Quinn pressed the button on a
blood pressure monitor and efficiently readjusted the finger probe
measuring the child's lung status. She made a note on a chart and
moved back to the bedside as the child stirred and cried out.

"Mommy?"

"Mom's getting a bandage on her leg, Jamie, remember?" she
explained gently, then caught sight of Claire and acknowledged her
with a wave. She called to another nurse across the room. "Sarah,
can you finish the ointment on Jamie's scalp? watch him for a few
minutes?" After giving a brief report to the petite blonde nurse, she
crossed to where Claire stood.

"Good, you found me," Erin said, noting Claire's name badge
and offering a firm handshake. Strands of coppery hair had escaped
from her ponytail, and her blue scrubs were splotched with snowy
white burn ointment. She nodded as Claire glanced once more
at the injured boy. "Second-degree burns. No explosion trauma,
otherwise he'd be on a chopper ride to Sacramento. But Jamie's got
asthma, and the smoke stirred things up. So ..."

"He needs close observation," Claire finished. "I understand."