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She thought it was going to be a good evening. Finally.
Kristin Tate, known to family and friends as Krissie, stood at the nurses' station and looked out the window across the corridor at a view of purpling Wyoming mountains to the west as the sun settled for the night. It was, she told herself, good to be home in Conard County.
Six years in the navy followed by eighteen months at the VA hospital in Denver had thoroughly killed any taste she had for the so-called excitement of trauma care. If she lived the rest of her life without ever seeing another human being in that kind of condition, it wouldn't be long enough.
But tonight, her first night on her new job at Conard County's community hospital, it felt good to be in scrubs and facing a patient load of ordinary illnesses, and taking care of people who would recover.
A review of the charts assured her she would face no major difficulties: a kid with a broken leg in traction by himself in a room. An older man with phlebitis receiving anticoagulants. She'd need to check him frequently. A woman with congestive heart failure who seemed to be recovering nicely as her fluid retention diminished. A gastritis that should be ready to go home in the morning, along with a dehydration case and a man with diverticulitis on IV antibiotics.
Straightforward, likely totally uncomplicated. An easy night of checking up on patients who were getting better. God, what a relief that was going to be.
Julie and Nancy, the two licensed practical nurses sharing her shift, were off down the corridor, beginning to usher visitors out for the night. Both LPNs seemed nice, if terribly young, and she wondered if they were new to the area, or if shehad somehow just forgotten them. It was possible. They would have still been kids when she left for nursing school, well beneath her radar.
And all these thoughts, she realized as she looked at the mountains, were thoughts designed to distract her from the familiar antiseptic smells that could so easily cause her to regurgitate memories of horrors best forgotten.
The sound of rapid footsteps drew her attention down the hall.
A man bore down on the nurses' station looking a bit like a thundercloud. Dark-haired, dark-eyed, a bit rough around the edges, as if he were too busy to worry about things like haircuts and five o'clock shadow. He wore blue scrubs beneath a white coat. As she watched him approach, she saw her two LPNs glance at each other and dart into separate patient rooms. One of those, she thought, somewhere between amusement and impatience.
"Ms. Tate," he said peremptorily.
She stiffened a bit at his tone, and scanned his name plate: Dr. David Marcus. She'd heard a new doctor had started since her last visit home, and this must be him. She forced herself to reply pleasantly, "Yes, doctor?"
"Before we begin, I'd like a few words with you."
Okay, Kristin thought, as she followed him to an empty patient room. One of those. Big ego, martinet, wanting everyone to kowtow just so to him. Well, she'd dealt with that kind before. If he was the only thorn on the rose of this new job, she could handle it.
In the patient room, he tossed down a chart he was carrying on the bed and faced her from the far side. His brows lowered, making him appear angry.
"Close the door," he said. No please or thank you. Forcing her face to remain empty of expression, she gave the door a quick tug. On its pneumatics, it swung slowly closed behind her.
Then, as a result of years of long training in the navy, she assumed the at-ease position: feet spread, hands clasped behind her back. That was the most she would give him.
"I read your jacket," he said.
Kristin stared at him, wondering where the devil this was going? She had ample training and experience as a nurse and excellent recommendations. Did he have something against the navy? "Yes, sir?"
"I know about your experience. I know the conditions you practiced under, because I practiced under similar conditions years ago, with the army."
And this meant?
"I want to make it very clear that this is a different kind of medicine we practice here."
"That's what I was hoping." She tried to smile, but her dislike for him was rapidly growing. Kind of sad, because he was actually an attractive man. Not that she wanted to be attracted to any man right now.
"The thing is, Ms. Tate, on severe emergencies, we stabilize and transport. The cases we have here are uncomplicated. They don't require any extraordinary measures, as a rule, and they don't require any creative treatment. I know what it's like in a field hospital and in a trauma center, and I'm telling you right now, you will follow proper protocols at all times, and you will not step outside your legal responsibilities as a nurse."
That's when she began to simmer. Really simmer. Part of her wanted to take him on and ask what kind of yahoo he thought she was, what kind of nurse? Instead she kept her voice level. "Nurse practitioner," she corrected.
"Nurse whatever, I don't care. Your experience is all wrong for this kind of hospital, and I want you to be aware of it before you make a decision you have no authority to make. I want you to review protocols to re-familiarize yourself with the proper way to practice medicine. Are we clear?"
"Yes, sir!" she said smartly, when what she really wanted to do was crawl across that bed and shake him until his teeth rattled. Who did he think he was? And how dare he make judgments about her when he knew absolutely nothing about her or the way she worked?
"I will be watching you," he said sternly. "Now let's go on rounds."
She followed him, feeling like a dog on an extremely tight leash, waiting for a command to sit or roll over. A nurse didn't go on rounds with a doctor, didn't trot after him this way. A nurse was supposed to be treated as a professional who could read a patient's chart and follow the orders on it, not as someone who needed to be instructed on every step in the treatment plan, certainly not in uncomplicated cases like these.
With the patients, however, he was a different man entirely. Trying to swallow her anger with him, she watched as he spoke gently to the boy and to the older patients, showing genuine interest in everything they said as he checked them out and entered information about them on the computer that now held pride of place in each room, having replaced the old paper charts.
In the last room, however, things changed. Mrs. Hester Alexander lay on her bed, asleep. She was recovering from congestive heart failure. Her chart showed she had already lost about thirty pounds of excess water, and her urine outputs were subsiding as the edema vanished. Her heart monitor trace showed a slightly altered lambda wave, sure indicator that a heart attack at some point had caused enough damage to her heart muscle to lead to the arrhythmia which had caused the edema. The lady had been drowning in her own bodily fluids, but now was stabilizing at near normal. The arrhythmia was also being treated.
Dr. Marcus moved quietly, gently palpating the woman's skin to test its sponginess. "That's good," he murmured. "That's excellent. If she's still doing well tomorrow, we may be able to send her home."
"That'll make her happy," Krissie volunteered quietly. "Earlier she was talking about how tired she is of being here."
For the first time, David Marcus smiled. "She's been complaining about everything since she got here. She especially hates the salt-free diet."
"We talked about that. I made her promise to give it two weeks, and assured her by then she won't miss the salt anymore."
At that he faced her. "She has to stay on this diet forever, not just two weeks."
"I didn't tell her " Krissie trailed off as Marcus turned away. Her simmer rose a notch closer to boil.
"What's that doll?"
"Doll?" Reluctantly, Krissie stepped closer to look across the bed. On the pillow, partially tucked under the blanket, was an awkwardly sewn doll, made of stuffed hopsacking. The eyes and mouth had been stitched of brightly colored embroidery floss. "The family must have left it."
"It shouldn't be in the bed. We don't know what's in it."
At once Krissie stepped around him and removed it, placing it on the window ledge. She looked at it, feeling unnerved in some way. "It looks like a child did it."
David Marcus came to stand beside her. "Yeah," he said after a moment. "She doesn't have any small children or grandchildren, though."
"Maybe something she made when she was a child?"
"Could be." With that, the doctor turned away, as if he were done with the doll. He typed a few things into the computer. "I want to cut her dose of diuretics by half and see how she's doing in the morning. Start that immediately, and keep a close eye."
"If, for any reason, the change seems to cause the slightest distress, raise the dose immediately and call me."
Back at the nurses' station, he began to scrawl notes in manila folders he apparently kept for his personal records. Krissie left him to it, walking the floor again to find her LPNs busying themselves tightening beds and talking to patients in short, taking the low profile and staying out of the way.
Which told her a lot about Dr. David Marcus. The only question remaining was why he was such a pain. Was he an egotist? A perfectionist? Or was there something more?
And here she'd been thinking that she'd come home to calm and peace and a nursing job that wouldn't wake her with nightmares. Boy, her dad was going to have a laugh at this. The former sheriff had warned her just last week when she'd finally come home for good, "Krissie, baby, the harder you look for peace, the more elusive it gets."
Yup, he was going to have a major laugh at her expense.
David Marcus was still at the nurses' station when she returned. She considered walking past and finding another place to busy herself, then decided that avoidance wasn't going to solve the problem or make her situation with him any easier. Best to just act like nothing had happened.
She settled into the chair at the station, checking all the monitors and finding everything green. Even Mrs. Alexander appeared to be still soundly asleep. The poor dear probably needed to catch up on a lot of rest after what she had been through.
Dr. Marcus cleared his throat. Krissie reluctantly looked his way.
His expression revealed little, but he said, "I guess I should explain."
Krissie remained silent. She wasn't going to give this man an inch unless she had to. He wasn't the only one allowed to get angry.
"Until about three years ago, I was in the army. Iraq mainly."
The light in Krissie's brain began to come on.
He looked down at the folders in front of him. "Ms. Tate, I know what we had to do in those field hospitals. Medicine gets invented under those conditions. And before medical school, I was a medic. I just know that kind of experience can affect how we practice in the civilian world. Sometimes we do things that could cost us our licenses under normal conditions."
At that Krissie gave him a nod. No more, just a nod. He was looking at her now, his dark eyes steady.
"The transition can be difficult. I know from personal experience. I should have handled this better, but sometimes " He left the sentence dangling.
She understood a lot of the freight he was referring to, stuff that just stayed with you like coal dust in a rail car. She decided to meet him halfway.
Rising, she held out her hand. "Let's start again," she said. "Hi, I'm Krissie Tate. Nice to meet you, doctor."
"Just call me David," he said with a crooked smile, and shook her hand.
"Krissie," she agreed. She even managed a smile.
"Part of the reason I came home was because I don't want to have to invent medicine anymore."
He nodded and finally, finally, his face fully relaxed into a pleasant, even attractive, smile. "It can still come up to bite you. Take it from me."
And there it was. He had been reacting to his own difficult transition and to his expectation she would have the same problem, perhaps even make the same mistakes. And he might be right, she admitted honestly. While time with the VA had helped ease her back, she hadn't come back all the way, because VA hospitals were woefully underfunded and understaffed. She'd had to "invent medicine" there sometimes, too.
"Okay," she said. "I'll take the warning the way it was meant, not the way it was given."
At that, a chuckle escaped him. "Fair enough," he agreed. "I was heavy-handed about it, as if you'd already done something wrong."
"I haven't had time to mess up yet," she said on a humorous note.
"And you probably won't. It's just that I know how long it takes to come back from all that adrenaline."
"You walk in, you smell the antiseptics, the other things that you identify as hospital, and after years of experience in wartime conditions, the adrenaline automatically kicks in. We're like Pavlovian dogs in that respect. We go up the instant the smells hit our noses."
She nodded slowly. "I guess you're right. But I spent the last year and a half at the VA in Denver."
"Still stressful, even if it's not as bad. Anyway, you and I learned trauma medicine under the worst imaginable circumstances. It's not something you can shuck easily like worn-out clothes."
"No, it's not," she admitted. "I felt it when I first walked in here tonight. I had to remind myself this is different."
"Exactly. Anyway, I guess I was harsher and more critical than I needed to be by far."
She pursed her lips. "You might say that."
He flashed another smile, quickly. "The thing is, like it or not, we become adrenaline junkies after a while. That can affect our judgment. So just watch out for it. I found when I first came here that I had a tendency to magnify every symptom. If you're not careful, every cold can look like pneumonia or lung cancer or TB. I know that sounds like a stretch, but I've run that course. Sometimes still do. Where we've been, nothing was ever as simple as it looked at first glance. Now we're in a place where it most often is that simple."
"I can see that."
"I'm sure you can. Just remember, you've been conditioned to see things otherwise. Don't run on automatic. Ever."
With that, he picked up his charts and walked away, leaving her feeling as if, despite their friendlier conversation, she'd just been scolded again.
Posted April 11, 2013
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Posted February 2, 2011
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