Patient Nurse (5 page)

He didn't want to leave. He was genuinely worried about her. “Get a checkup, at least,” he said.

“I'll gladly do that, but not tonight. Now, can I please go to bed…?”

He made a rough sound and turned on his heel. “If you don't feel better in the morning, stay home,” he said gruffly.

“Don't presume to give me orders,” she said calmly. “I'll do what I please.”

He glanced over his shoulder at her. She'd blended into the woodwork for most of the time he'd known her. But nothing could disguise the fact that she was a woman, with spirit and independence and intelligence. Isadora had yielded to his will, flattered his ego, stroked his passions at first until she obsessed him. But she hadn't been intelligent and she never fought face-to-face. She was given to pouting and self-inflicted illnesses to gain sympathy. And she would never have soiled her hands with a wet kitten… His own thoughts shocked him. How could he be so disloyal to the only woman he'd ever loved?

“Good night,” he said tersely. He went out the door and paused just for an instant. “Lock this behind me.”

She glared at his retreating back. She slammed the door and then locked it. She leaned against the wall, barely able to get her breath. Her knees were weak. Why had he come to see her? Was it really a guilty conscience that had prompted his visit? She couldn't imagine what would have brought him to her door. He hated her so much that she'd never expected him to come to her home. He never had before.

 

On his way home again, Ramon was wondering about his motives, too. He kept seeing the spartan way she lived, the lack of frills, the frugal furnishings. She was obviously living on her salary, without any help at all from her aunt and uncle. Was that by choice, or did they simply ignore her now that Isadora was gone? He couldn't forget that they'd blamed her as much as he had for his wife's fatal illness.

He worried the question so much that the next time he saw the Kensingtons, at a business dinner, he asked them point-blank about the way Noreen lived.

“She earns a good living,” Mary Kensington said haughtily. “Besides, we don't owe Noreen a thing. She's responsible for Isadora's death. How can you care how she lives?”

“She had a stray kitten in the apartment.”

Mary waved a hand. “Noreen and those filthy animals! She was forever bringing things home to us. I can't even remember how many trips we made to the local veterinarian.”

“She was always too softhearted,” Hal Kensington agreed. “She got that from my brother,” he reminisced sadly. “He was softhearted, too.”

Ramon's dark eyes narrowed. “Then why would
such a softhearted woman deliberately leave a sick cousin to die?”

They both looked stunned.

“You hadn't thought about that, had you?” he asked them quietly. “Now ask yourselves one more question. Is Noreen, a qualified nurse, callous enough to let any human being die, much less one she cared about?”

The couple only looked back at him, without speaking. Two years after the fact, they were finally able to think rationally. Perhaps just after Isadora's death, they hadn't really thought at all.

“Have you seen her lately?” he asked them.

“We invited her over for coffee the week before my husband's birthday,” Mary admitted. “People were beginning to talk… Why?” she asked abruptly.

“I think she's ill,” Ramon said. “Her color is bad, and she seems to become breathless at the least exertion. Do you know if she has a family physician?”

“She hasn't lived at home for a long time,” Mary said, “so we don't know much about her private life.”

“Has she ever had a complete physical?”

They both looked blank. “Well, she was always so healthy, there never seemed any need to go to the bother,” Mary replied, sounding almost defensive.

He didn't question them further. But he wondered, and that prompted him to go to a friend in the insurance office at the hospital and ask if a complete physical had been required of Noreen when she was accepted by the hospital's nursing department.

“Well, yes, she was supposed to,” the officer agreed, “but I don't see it here.” He frowned over the computer screen. “Maybe it's somewhere else…”

“Never mind,” he said, giving up. “I don't suppose there was anything there.”

“If there was, the new laws wouldn't permit us to exclude her on the basis of a preexisting condition” he was reminded.

“Yes, of course.”

He thanked the man and left, silently promising himself that he was going to get to the bottom of Noreen's odd behavior and any health secrets she might be harboring.

 

He couldn't examine her forcibly, but he could observe her. He spent more time at O'Keefe during the next week. He could do it without attracting undue attention because he had several recovering patients there.

He managed to stand close to Noreen while they were going over Mrs. Charles's chart. He could hear the breathless sound of her voice, see the flutter of her pulse against the collar of her blouse. Her pallor was evident now, along with the dark circles under her eyes and the weakness that manifested itself in her lack of animation.

But despite his noble motives, it slowly dawned on him that Noreen was excited by his proximity. He remembered the teasing statement she'd once made about his closeness being the reason for her fast heartbeat. He hadn't taken it seriously. But it seemed to be the truth. She reacted visibly to him, and not only because of whatever illness was beginning to show in her.

It disturbed him because he seemed as vulnerable as she did. He found himself noticing the elegance of her long-fingered hands, the blemishless skin on her oval face, the delicate shape of her mouth. He'd forced
himself to never pay attention to her while Isadora was alive, but slowly he began to remember things about Noreen. How she'd blushed when he looked at her, even indifferently. How she avoided him when she was living with Isadora's parents. How she never seemed able to speak to him except on the job. She'd betrayed her feelings for him in a hundred ways over the years, and he'd deliberately avoided noticing.

Until now.

He met her eyes, unblinking, and watched the pupils dilate. She was vulnerable and he wanted to protect her. He hadn't felt that way with Isadora. He'd wanted his wife obsessively, loved her, but she wasn't the woman she'd pretended to be while he was courting her. After they'd married they'd argued incessantly about her need for company, for parties and social gatherings. She'd refused to even discuss Ramon's hunger for a child. Isadora hadn't wanted the responsibility of children. He scowled as he remembered these things.

“You needn't glower at me,” Noreen muttered, averting her gaze protectively to the chart she was holding. “I haven't been late on any more medications.”

“It wasn't that,” he said slowly. His eyes fell to the unsteady rhythm of her jacket, mirroring her heavy heartbeat.

She stepped a little away from him, because the contact with his tall, elegant body disturbed her so. “Were there any other charts you wanted to go over?” she asked unsteadily.

He stuck his hands into the pockets of his lab coat and stared at her without smiling. “I want you to see your family physician and have a complete physical,” he said suddenly, bringing her shocked eyes up to meet
his. “You're ill and trying to hide it. But it won't work. You can't possibly go on like this.”

She was all but speechless as she gaped at him. “I…I've had a checkup,” she stammered, floored by his interest in her state of health.

“And…?” he prompted.

“My doctor said that I needed more B-12 in my diet and he gave me a bottle of iron pills,” she lied.

He scowled. “That doesn't explain this.” He touched her throat lightly, where the pulse jumped erratically.

She jerked back from him, so disturbed by his touch that she flushed red. “Dr. Cortero.” She choked out his name. “I'm not obliged to share my physical condition with you. You're not my doctor!”

“No, but I am on staff here,” he replied shortly. “I'm ordering you to have another checkup, and I warn you that I'm going to request a copy of the report. You're jeopardizing not only the patients in your care, but your own health by putting this off.”

She wished that she had a comeback. He was much too perceptive. She knew that it wasn't on her account that he was concerned. He didn't want anything to happen to his patients. How amusing, to let herself think for an instant that Dr. Cortero would ever look at her with the tenderness and concern he'd shown to his beloved wife.

She stared down at her white lace-up shoes. “All right,” she said wearily, tired of fighting the inevitable. “You win.”

“This isn't a contest,” he said solemnly.

“Isn't it?” she asked, her tone weary with pain and defeat. “I'll get in touch with my doctor.”

“I'm glad you're willing to see reason.”

“Don't worry,” she said, looking up at him. “I won't deliberately jeopardize your patients.”

He scowled. “That isn't why…”

“Please excuse me,” she said formally. “I have a lot to do before I can go off duty.”

She took the chart and walked to the nurses' station, without looking back.

Ramon watched her go with mixed feelings. He was more confused than he'd ever been before.

Noreen didn't allow herself to watch him leave the ward. She'd spent so many years eating her heart out for him that she took his contempt for her as a matter of course. If he was concerned for her health, it was only because of his patients, and she'd better remember it. She was far too old for pipe dreams.

On the other hand, he was right about her condition. She was only delaying the inevitable. She went home and phoned her surgeon in Macon. She arranged to go into the hospital the following week for the surgery.

N
oreen had a cup of black coffee for breakfast. She had to go to work, but she didn't know how she was going to make it through another day. She went to the bathroom mirror and looked at her pale, pinched face. The irregular heartbeat was much worse today. Her breath rattled when she breathed, and it was hard to get a decent breath. It was probably just as well that she'd given in on the subject of the valve replacement. She glanced down at the kitten following her and remembered that she was going to have to find someone to keep him while she was away. That would be her first priority today. She refused to think about her finances for the moment.

She leaned against the sink and lowered her head. It was hard to think straight when she could hear her own heartbeat in her ears, erratic and a little frightening.

Her surgeon had assured her that it was a fairly simple operation these days, that people had it all the time. She was in good health and a fighter, he knew she'd come through it just fine.

Of course she would, she told herself. She certainly would. In the back of her mind, she wished that she could have asked Ramon to do it. He was the very best in his field. But she didn't think he'd consent even if she asked him. He hated her far too much.

 

She went out the door and everything started going wrong at once. Her car wouldn't start, not for the first time in memory. She heard the sickening sound of the battery going completely dead, and remembered that the mechanic who'd jumped the car to start it just recently had warned her to replace it. She'd been saving up to do that, hoping it would last just a bit longer. She groaned, checking her watch. She'd have to run to catch the bus and she was already late.

She locked the car door and slammed it shut angrily, forgetting in her haste that she'd left the keys in it, and her purse. She stared at her bag through the glass with a sense of despair. Her wallet, her credit cards, her apartment keys, everything she had was in there.

Well, first things first, she decided. This was a good neighborhood and the owners of the apartment house where she lived looked out for her car and the medical student's. She'd worry about her car and purse later.

She had on her raincoat, which contained all the money she would need for bus fare on MARTA and snacks at work. She could do without her makeup, or borrow some at the hospital when she needed it. She wouldn't need her keys until she got back home, and
anyway, the owner had a passkey and he and his wife lived downstairs.

She trudged out to the street, made it breathlessly to the crowded bus stop on the corner and climbed aboard the bus that would take her right past the hospital where she worked.

It was another cold and rainy morning. With her mind on getting to work on time, she hadn't noticed that the breathlessness, which usually passed, hadn't. She could barely breathe. Her heartbeat felt different. Strange. Frightening.

She saw the people around her as a blur that became brighter and brighter and then, suddenly, vanished.

 

Ramon was already scrubbed at St. Mary's when they brought the emergency patient into the operating room. A Jane Doe, he thought irritably, on whom he'd have no background information whatsoever. One of his colleagues had already done a catherization. That had indicated a leaky heart valve, which had, over time, deteriorated past saving. He would have to replace it with a prosthetic valve and hope that the unknown woman had no medical conditions that would complicate his surgery. He had no idea of her medications or her state of physical health beyond the heart problems he could see for himself. It was always a risk to operate on a stranger, he thought, but he had no choice.

The oxygen mask was already over her face when his team was assembled and he was ready to begin. Her skin was creamy, very pink and soft, and he regretted the long scar this surgery would leave after he opened and closed the chest cavity.

The surgery took almost four hours. Ramon straight
ened his back with a grunt at the end of it, satisfied not only with the surgery, but with the closure of the incision he'd made. She'd only have a slight scar. Later, he could recommend a good plastic surgeon, if she could afford it. He knew nothing about her circumstances. She might be a street person, for all he knew. The only part of her he saw was her creamy, soft skin. She had a strong heart and her lungs were in excellent condition, except for a mild bronchitis. She seemed in good health otherwise.

She was taken away to the intensive care unit and he went on to the next case, without giving the identity of his patient another thought for the moment.

Hours later, still in his surgical greens, he went to ICU to have a look at the young woman his skill had saved. She was hooked up to the usual machines and the huge breathing tube of the heart-lung machine was still in her mouth. But when he paused at the side of the bed, his own heart almost stopped. He choked on his own breath. A technician was staring at him with open curiosity. He knew the blood had drained out of his face. That was Noreen. And she'd collapsed with a damaged heart valve. She had a bad heart, and he hadn't known. Nobody had known!

Shaken out of his normal calm, he motioned for the floor nurse to join him. “I was told that this woman's identity was unknown!” he said harshly.

“She had no identification on her at all,” the nurse began.

“She's my late wife's cousin!” he raged, his fist clenched at his side. “I would never have performed surgery on her if I'd had any idea in the world who she was!”

She felt the whip of his anger and winced. “I'm sure if anyone had known… We thought she was an indigent—”

“She's a nurse.” He interrupted irritably. “She works at O'Keefe's in the cardiac care unit.” Even while he spoke the words, he was remembering his own unjust treatment of her when she'd been desperately ill and hiding it. He hated remembering how unfair he'd been to her. She might have died…

“But how did she get here?” the nurse was asking. “And without any identification on her? Surely she had a wallet?”

“I don't know.” He stared down at her white, drawn face, expressionless from the anesthesia. He glanced at her small hand, from which tubes rose above the shunts. The nails were short, rounded, unvarnished. She had elegant, but capable hands. She had a bad heart, a damaged valve. She hadn't told him. Why? Had she truly been afraid to let him operate on her, afraid that in his contempt and dislike, he might fail her? It was sheer torture to think about it!

“I'll see if I can find out how she came to be here,” the nurse assured him.

“Never mind,” he said shortly, turning on his heel impatiently. “I'll find out myself. Let me know if there's any change, any change at all.”

“Yes, sir.”

He paused to check another of his surgical patients and then, with a last worried glance toward Noreen, went down to the emergency room.

It took several minutes to discover that Noreen had collapsed on a MARTA bus and had been brought to
the emergency room by ambulance without a scrap of identification on her. Possibly when she'd passed out, someone had taken her purse, he surmised.

The clothes she'd been wearing were in a plastic bag. He took them out to his car when he went, with plans to return them to her apartment. He didn't have a key, so he found the owner of the apartment house instead.

“Locked her keys in her car this morning, I noticed,” the man said dryly. “Purse and all. I saw her take off after that MARTA bus. She had to run to catch up with it. I expect she's upset.”

“She had a close call,” Ramon said curtly. “She had heart surgery this morning. She won't be home for several days.”

The owner was shocked. “Such a quiet, nice young woman,” he remarked. “Always had a kind word for everyone, and a smile. She'll be missed. Please tell her that my wife and I wish her the best, and we'll look after the apartment until she gets back. Anything you want from her apartment?”

“Later, perhaps. I'll be back to get anything she needs after I've spoken to her.” He'd not only have to do that, but he'd have to do something about that kitten, too. It would die if he left it. Besides, she hadn't wanted the apartment owner to know she had it. Pets were against the rules.

“I'll be around, if I'm needed. You a relative?” he asked.

“Yes,” Ramon said without explanation.

He left, with the intention of driving himself home for dinner. But he couldn't. Involuntarily he turned back in the direction of the hospital.

 

She hadn't regained consciousness. It wasn't unusual, but it worried Ramon. He checked her carefully with the stethoscope, noting the steady rhythm of her brand-new metal valve, which made a soft
chink-chink
sound as it opened and closed. The valve would last for many years, and her quality of life would be enhanced by it. No more breathlessness at the slightest exertion, no more erratic heart rhythms, no more fatigue.

He frowned, wondering when she'd first known about it. Surely she'd had some sort of warning and had seen a doctor when she started having trouble. Judging from the condition the valve was in, she had to have noticed that something was wrong. Her bad color alone had alerted him to a physical problem.

That line of curiosity led him further along. He sat in the cafeteria, eating without tasting his food, and his mind continued its meandering. Why had she never told anyone of her condition? Had she had some violent episode with it? Did her aunt and uncle know anything was wrong? Did they care?

He couldn't help noticing the difference in the way the Kensingtons had treated Noreen since Isadora's death. Like himself, they'd blamed her for that. None of them had ever considered anything save neglect as the cause of Isadora's untimely passing. But Noreen's present condition opened the whole subject up again.

He finished his meal and got up to take his tray to the moving belt assembly in the canteen, frowning thoughtfully. He put it down and then checked his watch. It was going on eight hours since he'd operated on Noreen.

He went back up on the staff elevator to the ICU, and moved right along past the automatic door to the cubicle where Noreen was settled.

With a rough sigh, he went into her small cubicle and checked the many monitors to which she was connected. She seemed to be in acceptable ranges on all of them. But why hadn't she regained consciousness?

He leaned over her. “Noreen,” he called abruptly.

And all at once, her eyes flew open.

His heart jumped at the unexpected but welcome response. Her eyes followed his dark face curiously, as if she wasn't quite conscious even now. Probably she wasn't. The effects of anesthesia lingered.

He checked her pupils, borrowed a stethoscope from one of the nurses and listened, nodding, to the steady rhythm of her heart. Her lungs sounded clearer.

He lifted his head and searched her eyes, noting that they'd removed the breathing tube from her mouth.

She tried to swallow. “So…dry.” Her voice sounded weak and shaky.

He found one of the swabs kept for moistening the lips, drew it out of a sterile package and applied it to the inside of her mouth.

“It's the anesthetic we use,” he explained. “It leaves a bad taste in the mouth and some dryness. It will pass.”

She seemed to relax. “What are…you doing here?” she managed drowsily.

“No one knew who you were when you were brought into surgery,” he explained. “I operated.”

She frowned. “Unethical,” she whispered.

He shrugged. “Yes. But I didn't see your face. I had no idea it was you.”

She was having a hard time keeping her eyes open. “Dr. Myers will…be…upset.”

“Myers?” he asked.

“In…Macon. County General. He was…supposed to operate…next week.”

She lapsed into sleep again, weary from the surgery and the exertion of talking. She was in pain, too, from the surgery. The nurses had given her the painkiller he'd already ordered.

He moved away from the bed with a quiet sigh, pausing since he was in the unit to check on his other patient.

 

She'd sleep the rest of the night; he was fairly sure of that. He went home and, on an impulse, sought a telephone number for a cardiac surgeon in Macon named Myers.

He found the man without too much difficulty. When Dr. Myers knew to whom he was speaking, he was stunned.

“I've heard of you,” he told Ramon on the telephone. “You're quite well-known.” He paused. “Is this about a patient of mine?”

“My late wife's cousin, Noreen Kensington,” Ramon began.

“Ah, Norie,” he replied, a smile in his voice. “Hard girl to get on the table, if you know what I mean. I happened to be visiting an old friend in an exclusive Atlanta apartment house two years ago when the superintendent found a young woman collapsed on the staircase and asked for my help after he'd phoned for an ambulance. I checked her over and went with her to a local hospital and conferred with the emergency room doctor about
her. He ordered X-rays and we saw immediately that something was wrong. He admitted her, barely conscious and confused, and we did an echocardiogram.” He sighed. “The valve was leaking a little, and I recommended surgery, but she was lucid enough to refuse. She kept mumbling something about her cousin, who was apparently under the weather, and how she needed to get back there. I thought her own condition merited more concern, so I had her sedated and kept her overnight, until she was stabilized.”

While Isadora died. Ramon's eyes closed. So it hadn't been negligence at all. Noreen had collapsed.

“Was it a heart attack?” he asked.

“I think it might have been a very mild one, although nothing showed up on the EKG or the echocardiogram. She recovered and refused surgery, but I insisted on keeping a watchful eye on her. I had her come to see me every three months. About a month ago, the leaking began to increase and I insisted that she arrange to have surgery before the situation became critical. She was already showing symptoms…” There was a pause, as if Ramon's very silence communicated something to him. “How is she?”