Nerves of Steel (8 page)

The man was on something.  It was just a hunch.  Drake had no reasonable--or even unreasonable, as Miller would tell him--grounds for suspicion. 

King patted his patient's hand and looked up.  His confident grin didn't falter when he saw Drake staring at him.  "Mrs. Kertesz will be needing a bed pan," he told Drake, brushing past him.

"I'll send someone right in," Drake assured the woman.  He followed King out to the empty corridor.

"Didn't catch your name earlier," King said, his speech slow, unhurried.  He slouched against the wall as if they were waiting to tee off on the back nine.

"It's Drake, Mickey Drake."  He mimicked the surgeon's posture, giving the man one of his best eat-shit-and-die smiles.

"You're new here, Mickey.  So let me fill you in on the situation.  Dr. Hart is my wife, my business.  Understand?"  The surgeon's gray eyes tried to issue a challenge, but it was lost on Drake.  King turned on his Italian leather clad heel and stalked away without waiting for a reply. 

Leaving Drake more curious than ever about the conversation he'd interrupted.  And Dr. Cassandra Hart.

CHAPTER 13

It was five till seven and the ER was empty.  Knowing Ed Castro would be there any minute to relieve her, Cassie erased the last patient's name from the board at the nurses' station with satisfaction.  Nothing like a clean board at the end of a shift.

"Med Five rolling up with a MVA," the dispatcher's voice sounded from her radio.  "Fifty year old male, unrestrained driver, T-bone collision, they just lost vitals."

"Level One Trauma, room one," Cassie told her.  The trauma alert began to sound on pagers throughout the ER.  Cassie grabbed her Tyvek gown, mask, and goggles, and raced out to the ambulance bay to meet the medics.  Med Five backed in with a squeal.  She opened the door as soon as it braked to a stop.

"Fifty year old male, closed head injury, left pneumo needled in the field, dislocated right hip, compound fracture right radius and ulna with arterial bleeding.  No BP in the field, lost his pulse about two minutes ago," the paramedic told her as he performed chest compressions. 

Cassie and his partner wrestled the gurney out of the ambulance, and together they rushed down the hall to the trauma bay.

"Get him on the monitor, someone take over CPR, push epi," she called out her orders as she assessed her patient.  "Get me a chest tube tray.  And four units Oneg."  She nodded to the senior resident who quickly placed a chest tube.  Blood poured out of the man's chest and into the waiting pleurovac.  Cassie finished inserting an IV into the man's subclavian vein, and the nurse hooked up the blood. 

"Pulse is back.  We've got a pressure."

"Score one for the home team.  Let's get another gas and crit and start our secondary survey."  Cassie began addressing her patient's less life-threatening injuries.  She looked up to find Richard smiling at her from across the man's body. 

"I forgot how good you are at this," he told her as he examined their patient's open fracture. 

He reached a hemostat into a pool of blood and deftly snagged a gushing artery.  Cassie wasn't the only one good at her job.

Once she had the man stabilized, Richard moved to tackle the dislocated hip.  He nodded at her.  "You mind?"

She hated dislocations, that clunk the bone made when you popped it back into the joint, a feeling that echoed through your body.  It was a two-person job, and in such a critical patient, she didn't want to delegate it to someone else, like Richard's linebacker-sized resident who might cause more harm than good.

Cassie climbed onto the gurney beside the man's hips and wrapped her hands around his pelvis to stabilize it.  She leaned her weight into the maneuver, bearing down while Richard pulled against her.  Then he flexed the leg, easing the head of the femur back into place.  She gritted her teeth against the clunk, tried to suppress her shudder.  Richard offered her his hand as she scrambled back down.

"Nice job," he said, his hand squeezing hers.  "I'll meet you up in the OR," he told the trauma surgeons as they wheeled the patient out.  His eyes went wide, and he smiled.  "God, I forgot what a rush this is!"

It had been a long, long time since she'd seen Richard genuinely excited about anything--her or his work.  Sometimes, she could almost understand why he had turned to drugs and alcohol for stimulation, to escape the life he felt was smothering him.  Almost.

He grabbed her other hand and pulled her close, waltzing her through the debris scattered on the floor.  "You were amazing." He beamed down at her.  "You saved that man's life, Ella."

Sickened by his touch, she pushed him away, escaping from his embrace.  "Just because we have to work together, don't get any ideas." 

Richard stood in the center of the room, the overhead surgical lights glinting from his perfect white teeth.  "I made a promise to myself when I left that clinic.  I vowed I'd get my life back.  All of it.  And this," he gestured to the trauma room with its resuscitation equipment, "is the first part."  He stepped to her, took her hand once more, his finger caressing the space where her wedding ring used to rest.  "The first part, but not the most important part."

She yanked her hand free.  "Richard, you can't--"  

His beeper went off, and he released her before she could finish.

"Got to go, they're ready up in the OR."  He sped from the room, his trauma gown flying behind him like a superhero's cape, and Cassie lost her chance to set him straight.

She frowned.  Words would never dissuade Richard.  When they first met, he'd coaxed and cajoled, charmed her with surprise gifts, beguiled her with thoughtful acts, until she finally relented and agreed to go out with him. 

And what a first date.  A cruise past the Point on a chartered yacht, caviar and champagne, he'd even bought her a ball gown, and they danced on the deck for hours.  Cinderella had finally met her Prince Charming.

She squeezed her eyes shut against the memory of that night.  Waltzing under the stars, how could she not fall in love with the man who had offered her that?

The familiar smells of Betadine and cautery smoke--sharp, acrid odors that belonged in no fairy tale--jarred her back into reality.  Cassie opened her eyes and surveyed her kingdom.  Here, surrounded by blood and pain, there was no playacting, no fairytale dreams.  Here she made a difference, here she was the one in control.

Right, she was in control.  Just had to figure out how to convince Richard of that.  She stripped off her trauma gown, wadded it up and threw it into the trash.

CHAPTER 14

Cassie stepped out into the hallway, her nerves still jangling with adrenalin from the trauma.  Not to mention Richard showing up with no warning.

Ed Castro had some explaining to do about that.  As department head, he sat on the Executive Committee, the group who would have granted Richard permission to return to Three Rivers.  Cassie gritted her teeth, pacing through the nurses' station to the chart rack where her bantamweight boss waited.

"You could've told me Richard got his privileges back." 

"Good morning," he said, keeping his voice bright, ignoring her accusatory tone.  "How was your night?" 

"How do you think my night was?" she demanded.  "Richard ambushed me, and we had another kid overdose, almost lost him."

Ed stroked his perpetual five o'clock shadow.  "FX?"

"Combined with MDMA.  Together they have some kind of synergistic effect.  Kid had a temp of 106, chest wall rigidity, laryngospasm.  The worst of both drugs, multiplied."

"How'd you stabilize him?"

"Tried Valium, got nowhere.  So I put him in a pentobarbital coma and paralyzed him.  That worked, but I almost lost him first.  Might still, I don't think there's much left upstairs."  She tapped the side of her head.

"Do the police know about this new combo?"

Her face grew warm, and she turned to the board.  "I'm sure their hotshot detective passed the word by now.  I don't like him skulking around down here."

"So you met Detective Drake.  He comes highly recommended.  Was part of the task force that broke up the drug dealers and gangs that were turning Ruby Avenue into a war zone."

"The FX was stolen upstairs.  Why is he wasting his time down here?"

"I just do what I'm told." 

"When I went to the police yesterday, they acted like I was a suspect.  Was he down here to spy on me?"  If he was, he'd gotten an eyeful, walking in on her and Richard.  She rapped her pen against the chart rack in irritation.  "I didn't do anything wrong.  I was just trying to help."

"By breaking hospital protocol?" 

"If I have to."  She leveled a stare on him.  Ed returned it full force--no surprise, it was hard to intimidate the man who'd helped change your diapers when you were a baby.

But, as usual, he gave in.  "I'll see what I can do to keep the police off your back.  And the Executive Committee."

She sniffed at the mention of the governing board of the hospital.  "They're too busy recruiting drug addicts to the medical staff to worry about doctors actually trying to make a difference."

"I'm sorry about Richard.  I argued with the Committee, but he threatened a lawsuit if they didn't let him back.  And you know how powerful his family is."

"Not to mention his father being on the Committee, himself."  Richard's father was head of orthopedic surgery, his uncle the senior partner and his brother the managing partner of the largest law firm in Pittsburgh.

"If he becomes disruptive in any way," Ed continued, "tell me so I can bring him before the disciplinary board."

"Why?  So they can feed him coffee and doughnuts while they lecture him?"

"My hands are tied."

   She realized he was sorry about more than just Richard.  She regretted shutting Ed out of her life, but all she could think of when she saw him was Ed proudly leading her down the aisle on the happiest day of her life.  The day when she'd made the biggest mistake of her life.  

"Have a good shift."  She left to change and get breakfast. 

Cassie walked into the "dirty" room of the temporary pharmacy and found Drake already there, head to head with Fran, the glow of the computer screen bathing their faces in blue.  Fran laughed charmingly over some shared joke, then looked up to greet her.  "Food.  You're an angel." 

Cassie deposited two cheese Danish and a blueberry muffin on the desk.  Drake snagged the muffin for himself before Cassie could make a grab for it.  Another strike against him.  He was making it damn hard to pretend he didn't exist.  She saw the gleam in his eye as he bit into the muffin and wondered if that was the point.  To annoy her into acknowledging his presence.

She glanced around.  Drake perched on the corner of the desk, looking over Fran's shoulder.  There were no other chairs available.  She settled for the safety of the lab bench behind Fran's computer station.  As far away from Drake as she could get and still see the monitor.

"I rechecked our stock of fentephex."  Fran typed one-handed as she nibbled on a Danish.  "Every pill is accounted for.  But what if someone were replacing it with look-a-likes?  It wouldn't take a lot.  One legitimate pill to duplicate, anyone could do it."

"FX is kept locked up, right?" Drake asked.  "How would they make the switch?"

Cassie fielded that one.  "Think of how many are dispensed a day.  Almost every post-op patient, a lot of the cancer patients, even ob-gyn uses FX.  That's hundreds of patients every day, which translates into hundreds of times someone familiar with the hospital and how the wards are run could have opportunity to sneak a few here or there."

"So you think that's what they did?  Stole FX and replaced it with sugar pills?"

"I'm sure of it," Fran said.  "Instead of trying to track the fentephex and where they all went, I did a search of medication failures, times when nurses had to give more sooner than expected or gave a different drug because the fentephex didn't work."

"Because it was a placebo."  Cassie filled in the blanks. 

"How many?" Drake asked.

"I only went back a month, but I found over two hundred.  Way above average.  And that was just inpatient.  I didn't have time to check the outpatient stock."

"Two hundred?"  Drake pursed his lips in a silent whistle.  "That's about ten thousand dollars on the street.  Can you get me dates and times?  Anything we can use to narrow down who'd have opportunity."

"Sure."  Fran saved her data to a disk and handed it to him.

"Thanks, Fran.  It was wonderful meeting you."  He gave the pharmacist a quick salute and was gone.

Fran was blushing from Drake's attentions.  Cassie rolled her eyes.  The detective appeared to be in his mid thirties, but acted like a hormone-driven school boy.

"We need to find those placebos and get them off the floors," she told Fran.  "Is there a way you can tell the difference?  Maybe we could have them analyzed--"  She stopped as Neil Sinderson appeared in the doorway, carrying a small box of medication.

"Here's the extra pentobarbital you wanted, Fran."  His smile was directed at Cassie.  "It's nice to see you again, Cassie.  What time do you want me to pick you up on Saturday?"

She stared at Fran who grinned in delight, mouthing the words, "Pay back," behind her hand, out of sight of Neil.  Cassie groaned.

  "Eight works for me and Mike," Fran answered.

"Sounds good."  Neil cleared his throat and stood in embarrassed silence, looking at Cassie with an expectant expression. 

Fran elbowed Cassie in the ribs, nodding at the pharmacist.  "Eight's fine," Cassie said, grudgingly, plastering a saccharine smile on her face.

"Good.  See you then.  I'll go restock the chemo."  Neil walked past them to the rear of the pharmacy and the "clean" room with its laminar flow hoods.

"What's going on?" Cassie asked.

"Yesterday after you left, he asked about you—"

"No, you didn't!"

"Oh yes, I did.  C'mon, where's the problem?  He's cute, the nicest guy ever, and you'll be doubling with me and Mike.  It's bowling, what could go wrong?"

"Fran I can't—"  The excuse stalled.  She couldn't say no—who could when Fran truly had her best interests at heart?  But Fran's constant attempts to help her "get over" her divorce were misguided at best.  She'd never told anyone the real reason she and Richard split up.  Or the real reason Cassie couldn't let anyone into her life again—she couldn't trust herself not to make the same mistake.