Compromised, page 10
part #1 of MetroGen Forbidden Love Duets Series
Tiffany indicated him with her head. “It got a super busy night last night. They had fourteen deliveries and three C-sections. No one made it to the call rooms. When he came in to say good morning, he asked if he could sit on the couch. That was about an hour ago. I didn’t want to wake him up.”
“We need to get him up before rounds start. Even if he’s been up all night, he’s not supposed to fall asleep in a patient room.” Angela debated the best way to handle this.
“I’d hate to use the call button. The nurses thought it was hilarious when they took my vitals, so they left him there. He’s pretty cute as Bachelor Eleven.”
“His attendings won’t think it’s cute.”
“If I were allowed out of bed, I’d do it. I thought about throwing a bed pan at him. Or you could do it for me.”
“I guess.” Angela approached the couch, which was meant for the patient’s partner, and knelt next to Michael. He’d fallen asleep with his head tilted back, his patient paperwork on his chest and his pen on the floor. His curls were longer than the last time she’d been this close to him without his guard up.
He slept so peacefully, as if the anger and betrayal in his face from their most recent conversation faded in his sleep. How many mornings had she seen him like this? How many times had she woken up wrapped in his arms after they’d made love? The temptation to crawl on top of him and steal just a second of the solace his embrace gave was overwhelming.
Not overwhelming enough to forget they were in an occupied patient room, however.
“Harper,” Angela shook his shoulder, his body warm through his scrubs. “Wake up, Harper. Rounds are starting soon.”
Michael stretched, and his eyes fluttered for a second. “Angela. Morning.” He closed his eyes again.
That would not do.
“Harper, wake up. Rounds. You need to get up.” She exerted more force, shaking him harder.
His gorgeous brown eyes opened up and focused on her face. “Or we could go back to bed. I missed you.”
Unexpectedly, he wrapped his arms around her and pulled her overbalanced body onto his. Angela struggled before attraction and biology took over. Her paltry resistance gave way to his invading tongue, and she relaxed into him.
It took about ten seconds before Angela’s sanity returned. She absolutely could not have this happen, and any second anyone could walk in.
She rolled away from his seeking hands to land on the floor. “Harper, that was completely inappropriate. You need to wake up right now,” she said, using her most authoritative ‘I didn’t make out with my ex-boyfriend and love it’ tone.
Michael sat straight up, far more awake than before. He dropped his arms and took in Angela’s flushed face and Tiffany’s interested gaze.
“Go ahead, please. Don’t mind me,” Tiffany said. “This is the most interesting thing that’s happened in the two months since I got admitted.”
Angela shot to her feet, straightening her white coat and putting up her best façade. “Obviously, in your sleep you mistook me for someone else. It was an honest mistake, and let’s not speak of it again. Ever.”
A whirlwind of different emotions crossed his face. He stood, coming to his full height, towering over Angela by a foot. “My apologies, Dr. Perkins. I mistook you for my girlfriend, which is obviously not the case.”
Angela refused to react to the news of him having a new girlfriend. Bachelor Eleven was in high demand. There was someone out there for him who didn’t bring him pain the way she did.
“Oh, did you meet a new girl?” Tiffany must have known more of Michael’s personal life than Angela did.
Michael didn’t spare Angela a glance. “Sorry, I mistook Dr. Perkins for my ex-girlfriend, so I mistook and misspoke due to my exhaustion. Ms. Wickwire, this was a severe breach of my professional ethics to sleep here and invade Dr. Perkins’s personal space.”
Angela had to give him credit for driving the stake into her heart a little more. He might have been speaking to Tiffany, but the message was loud and clear. “It doesn’t matter now. I have to go to a cardiology division meeting and you should be with the OB team.”
“I will see you at multidisciplinary rounds. My apologies again.” He took his paperwork and left without delay.
Angela counted to thirty and decided to follow him out the door.
“Dr. Perkins?” Tiffany asked.
“Yes?”
“You didn’t listen to my heart.”
Angela counted to five before responding. “Yes, so I did not. I should do that now.”
She listened for a few seconds, hearing the unsteady beat. Did it sound different from yesterday or was she immune to hearing it, the same way she’d thought she was immune to the pain of seeing Michael?
Tiffany didn’t say anything until Angela, ready to leave, said, “I apologize for that interaction. That is not how the hospital staff at MetroGen should behave. I am sorry.”
“Yes, you both have told me how very sorry you are,” Tiffany observed.
“It’s better if it’s never mentioned. One simple confused mistake of sleep could have far-reaching consequences… for both of us.” Angela said, choosing her words carefully.
Tiffany looked from Angela to the door where Michael had departed. “I’m not going to say anything. Even though it seemed like an excellent kiss.”
“Which it was not,” Angela said.
“The nurses think he’s quite a catch, Bachelor Eleven. Except the lesbian ones, who sneak around holding hands on the floor,” Tiffany volunteered.
“If they’re making out, please don’t tell me. I’d probably have to make a report because it doesn’t sound like sleep-kissing mistaken identity,” Angela cursed how lame that sounded. Nescit vox miss reverti. Once said, the words cannot return.
“Well, yes, you’re right. Mistaken identity, as you said.” Tiffany seemed to be having a great time with the topic, despite her failing heart. “I’ve already forgotten that excellent mistaken identity sleep-kiss happened.”
“Thank you,” Angela said, needing to leave the room before her paper-thin excuses collapsed,
She’d gotten her hand on the door when Tiffany swooped in for the kill. “Dr. Perkins?”
“Yes.” Angela wondered what it would take to get out of there with any shred of her composure in place.
“Michael is my favorite person in the world, not counting Baby Girl Wickwire, and I would never do anything to hurt him or his career. I’d walk over hot coals for him, if I were allowed out of bed.”
“Very wise.”
“And since you’re the only one who was willing to try to save my baby girl, I’d walk back across those coals for you. So you have nothing to worry about.”
“Thank you.” Michael wasn’t in the room, but he might as well have been. He’d advocated the hardest for Tiffany, against Angela’s own objections.
And even now, he didn’t want to believe how sick Tiffany was.
Especially when Tiffany was grinning hard, full of mischief. Her words stopped Angela at the door. “But it’s interesting that he called you ‘Angela.’ Don’t you think?”
Since screaming was not an option, Angela said, “No. ‘Angela’ is a very common name.”
She closed the door and dragged her mind to the task at hand.
Not Michael. She needed Tiffany’s rhythm strips.
Chapter 15
Angela listened with half an ear to the divisional cardiology conference. In addition to the five patients on her own regular service, there were now eight consults waiting for her. Worse, she’d printed out a couple of Tiffany’s overnight rhythm strips, and her heart rate had runs of erratic beats.
The conversation flowed above her head, discussing patients who were interesting cases, how their research was progressing. Bradley Pegg was in the thick of it, undoubtedly cozying up to the Chiefs.
“Perkins?” Dr. Marshal broke into her train of thought.
“I’m sorry. What?”
“The pregnant patient on OB. I see she has not delivered.”
“Not yet, sir,” Angela said.
“How much longer?”
“Any day now,” she hedged.
The faces around the table communicated their displeasure. The shuffling of papers told her the attendings were checking their call schedules with the hope they wouldn’t be present.
“Get her delivered now,” he said. “Do not let this turn into a debacle, especially since anesthesia won’t come otherwise.”
“Chief Marin reassessed the situation and anesthesia is involved again,” Angela said as blandly as possible.
Clarissa Morgan worked some magic, because within forty-eight hours of Angela’s request, the Chief of anesthesia himself appeared at team rounds. Though he hadn’t spoken directly to Angela, he did have a Chief-to-Chief conversation with Dr. Feldsher.
Marshall grunted, and Angela allowed a thrill of satisfaction. According to the ever churning OB rumor mill, Dr. Marin was new to his position after retiring from the Navy.
And he was single, which also led to a vigorous debate about whether they could call him Bachelor Twelve behind his back.
“You consented her for autopsy. Correct?”
“Yes.” Angela’s sense of satisfaction disappeared.
“She also signed the consents for academic research and photography?”
“Yes, she wants to get as much information in the event it will help her daughter,” Angela said. Tiffany made those decisions early in her hospital stay. They’d seemed academic six weeks ago.
“I trust you will attend the autopsy,” Marshall said.
“Attend the autopsy?” Angela startled.
“Yes, attend the autopsy.”
Of the top ten things on the planet Angela DIDN’T want to do, going to the autopsy was probably number eight. It was going to be hard enough without seeing that…
Instead, she said, “Autopsies can take hours. I have a full set of consults.”
“Pegg can cover them. In this one in a billion case, it’s imperative you be present. She’s your patient, and you are responsible for the finish. I have a list of specific stains and tissue samples pathology collects to make sure we get the most out of this case.”
Angela gritted her teeth and found a tiny amount of comfort in the angry expression on Pegg’s face. He didn’t appreciate getting stuck with Angela’s work.
“I understand, sir.” Angela said.
They didn’t see Tiffany as a person. She was one case among thousands spread over their careers.
Her pager went off. She immediately recognized the phone number listed to belong to the L and D floor.
“Sorry, I need to return this.” Angela made her excuses and ran outside the conference room.
She called the number back right away.
“This is med student Nora Borenstein. Dr. Akimova wanted you to come back up here and see this new rhythm on patient Tiffany Wickwire.”
“I’ll be right there.” Angela took off.
She found the medical students, minus Michael, and the OB team crowded in the doctor conference room focused on Tiffany’s telemetry.
“I don’t know what this is,” Akimova said.
“It’s a combination of the huge left side of her heart and her Wolf Parkinson White acting.”
“What do you mean?”
“She has the second electrical pathway in her heart. It’s trying to fire, so you see it reflected inside her EKG.” Angela traced the places where the telltale delta waves of WPW were merging with the bigger QRS complexes, forcing them to widen.
“This is new,” Raj Patel said.
“It is, and it’s not good. How is the baby?”
“Thus far not affected,” Akimova said. “When the baby goes into distress, its heart rate will slow down or go very fast.”
Angela took a slow breath of her own. “How soon can you deliver?”
“The baby is about 33-weeks. It should make it. Do you think we can give her a dose of steroids today and tomorrow morning? It’ll give me a chance to reschedule the planned C-sections. We want the full team there.”
Angela nodded slowly. It was best Michael wasn’t here for this. “I agree. I’ve already maxed out her flecainide and sotalol. I can add an epi or dobutamine drip, which is pretty much rearranging the deck chairs on the Titanic. I hesitate to push her heart any more. We have to add amiodorne.”
Nora raised her hand. “Isn’t it toxic?”
“Long term, yes. We usually wouldn’t use it in a patient this young,” Angela said.
“This is it then?” Carlisle asked.
“Yes, we’re walking the tightrope in a hurricane. The wind is holding us up until it knocks us off,” Angela said. “Every med I’d use to treat her heart failure will harm the baby or push her into Wolf Parkinson White.”
“Steroids then,” Akimova nodded at Carlisle. “I will tell the patient.”
“I can do it,” Angela said.
“No,” Akimova said. “She is our patient, and it is I who will be the one cutting. Therefore, it is my job.”
The room was quiet for a few seconds. The day they had dreaded was nigh, and their only ability was to prepare, or as Feldsher said, mitigate the risk.
A nurse interrupted them by sticking her head in the room. “Precipitous delivery in triage.”
Angela was suddenly abandoned by the whole OB team.
She followed them down the hallway to the curtained area. There was a flurry of placing gowns on Akimova and Carlisle.
Until Akimova shouted, “Shoulder dystocia!”
They moved even faster then. There were shouts for the McRoberts maneuver and the staff shoved the mom’s knees upward. Angela couldn’t quite follow what else occurred. However, it seemed to work and the baby delivered successfully.
“I can’t believe you did that,” Angela shook her head as Akimova triumphantly handed the baby to the newly arrived respiratory therapy, peds hot on her heels.
“No kidding,” Carlisle said, bundling up her gown to drop in the biohazard container. “This is why OB is the greatest specialty. Primary care, surgery, procedures, and danger.”
“What would you have done if you couldn’t get the baby out?” Angela asked, having not had to deliver a baby for five years.
“The usual. If the McRoberts failed, then we’d have tried the Woods screw maneuver. And if that one didn’t work, she’d have broken the baby’s clavicle.”
“I remember that one,” Angela admitted.
“Of course, if we get really desperate, we’d tried the Gunn-Zavanelli-O’Leary maneuver.”
“Long names mean badness,” Angela said.
“You try to shove the baby back inside and run to C-section. Then f you get truly desperate, you grab the bone saw and snap the pelvis in half,” Carlisle was unfazed.
“Have you ever done that?” Angela assumed this was the OB version of story topping—the fish was this big.
“No, but I’d be ready if I had to be.” They watched the baby get cleaned up, unaware of its near death experience. “And this is why Akimova’s going to tell Tiffany, because it’s our job. You’ve been amazing to stand by us this long, and we owe you. Still, in the end, it’s on us.”
“It doesn’t feel that way sometimes,” Angela said. “My department wanted her delivered weeks ago. They’re sure this is going to blow up in our faces.”
“Even when you do everything right, something can go wrong. We’ll lose a mom or two this month, no matter how hard we try, even with everything we know. I had a mom a few months ago… shit happens when you least expect it, when you thought you were safe.”
“Ah, Feldsher’s risk mitigation?”
“Every day.” Carlisle assured her.
Angela’s pager didn’t care about the circumstances on OB because it went off again. It was the ER. “I need to go. Keep me updated on Tiffany. I’ll stop by tonight.”
Chapter 16
Fortunately for Michael, the morning team saw how frayed the overnight delivery squad was and asked minimal questions. They even excused them early and sent them to outpatient STI/birth control clinic rather than stick around for multidisciplinary rounds.
It was for the best. He’d been lucky no one had caught what happened in Tiffany’s room this morning. It was bittersweet to have tasted her delicious warm mouth and awoken from his dream to find reality unchanged. Tiffany was still terribly sick, and his ex-girlfriend remained the unyielding cardiology fellow.
The OB residents in clinic, no stranger to exhausted medical students, happily redirected his half-asleep body to the depo shot section.
Perfect. He was safer with a pointy needle than doing pelvic exams.
Ms. Hudgens was tall, with her hair pulled back in tight rows. To his better trained eye, he recognized her to be in ridiculously good physical condition. Unlike ‘Barry,’ Nora’s husband, she moved like a basketball player. He’d seen an email recruiting medical students for the co-ed city basketball tournament, and he’d heard the firefighters had a team.
“Are you sure you’re okay with that needle?” Erin watched him struggle to draw up the syringe of medicine.
“Of course I am,” Michael said, though his hand was shaking.
“Right,” Erin said. “You don’t look so good.”
“It was a long night.” He felt her deltoid for the intramuscular injection.
Erin gritted her teeth at the shot. He fumbled to remove it, and she said, “How many hours have you been awake?”
“Just thirty. Or more.” He disposed of the syringe in a sharps container. “You’re my last patient. I can go home now.”
“Are you driving?”
“Yeah, to the West Side.” He stood up and wove.
“Oh, you are not. You need sleep. Don’t you have callrooms?”
“For the people on call. I’m post-call.”
“Uber?”
“I’m fine.”
“Not without a nap you aren’t. Look, I can let you crash at my firehouse. We have random homeless people wandering in for showers sometimes.”
“Go to your firehouse?”
Ms. Hudgens appeared quite amused. “Yes. Come on.”
