Chapter 1 Nate #2
I parked in my usual spot, Section C, Row 4, third space from the end. Exactly eleven minutes from doorway to time clock if I maintained my standard pace.
My phone buzzed as I gathered my bag. A text from Meghan, my backup sitter for Thursday.
Hey Mr. C, so sorry but I can't make Thursday morning anymore. Got asked to cover a study group. Can still do pickup tho!
I stared at the screen, the carefully constructed scaffolding of my week already beginning to wobble. On Thursday, Mrs. Swanson had her garden club meeting. I'd need to find someone to make sure Paige got to school, and quickly, or else find someone to cover the first part of my shift in the ER.
The tremor in my hand returned, faint but unmistakable.
One problem at a time. I'd handle this. I always did.
I tucked the phone away and headed inside, my pace exactly as practiced, counting steps until the familiar rhythm steadied my hands once more.
The ER was already humming with morning activity. I clocked in at 0646—a minute later than my usual, but still within acceptable parameters. The night shift looked tired but relieved to see the day crew arriving.
"Morning, Nate," called Kirsten from behind the charge nurses' station, already deep in her handoff notes.
"We've got a full house. Five admits waiting for beds upstairs, one discharge teaching in progress, and a lovely gentleman in Room 4 who's been asking for 'someone competent' every ten minutes since 0500. "
"Charming," I said, pulling up the patient list on my tablet. "What's his story?"
"Post-op hip replacement complications, probably discharged too early, now waiting for a bed. Thinks nurses are his personal concierge service." Kirsten's expression was carefully neutral, but I caught the edge in her voice. "He's... particular about his care preferences."
I nodded, scanning over the digital greaseboard detailing patients and their chief complaints.
Mrs. Brooks in Room 2 with chest pain, ruled out STEMI, now waiting for serial troponins.
Mr. Rodriguez in Room 6 with diabetic ketoacidosis, stable but grumpy about the insulin drip.
The usual morning mix of emergencies and frustrations.
"Where do you want me?" I asked.
"Triage," Kirsten said immediately. "University Hospital went on divert twice yesterday, and I can’t imagine they’ll skip it today.
We need someone who can keep the waiting room from becoming a riot.
Tasha is handling Fast Track, but she's..." Kirsten paused, glancing toward where I could see Tasha moving efficiently between patients. "She's in one of her moods today."
I followed her gaze and immediately understood what Maria meant. Tasha's professional mask was firmly in place, but there was something sharper in her movements, a defensive edge I'd learned to recognize. Someone had gotten under her skin.
"What happened?" I asked.
"Mr. McAllister in Room 4 happened. The one I mentioned." Kirsten's voice dropped to a whisper. "And Tasha... well, you know how she gets when people are assholes."
As if to emphasize this, the call bell chimed from Room 4. Kirsten responded immediately.
"How can I help you?"
"I need a nurse to come hold me," came Mr. McAllister's voice through the intercom. "I can't use the urinal by myself."
I saw Tasha's head snap up from her charting, her expression darkening. Kirsten looked uncertain, glancing between the room and the nurses' station.
"Perfect," I said, already moving toward Room 4. "I got it."
I knocked once and entered to find Mr. McAllister looking considerably less helpless than his request had suggested.
"Oh," he said, his tone shifting immediately. "I thought... well, I was expecting..."
"You said you needed help with the urinal," I said pleasantly, moving to the bedside table where the urinal sat. "I'm happy to assist."
"Actually, I think I might be able to manage after all," he said quickly.
I tilted my head, maintaining my helpful expression. "Are you sure? You said you couldn't do it yourself. I really don't mind helping. It's no trouble at all."
"No, no," he insisted, reaching for the urinal himself. "I'm feeling much stronger now."
"Wonderful," I said. "Recovery can be unpredictable that way. I'll be right outside if you change your mind."
I stepped back into the hallway, where Tasha was watching from the nurses' station. Her expression was carefully neutral, but I caught the slight nod of approval.
No woman should have to deal with that kind of manipulation disguised as patient care. It was predatory behavior, plain and simple, and I'd seen enough of it over the years to recognize it immediately.
"Hey," I said, approaching her at the desk. "If anyone asks you to do something like that again, come get me. I don't tolerate that."
Tasha's lips curved in a small smile. "My prince charming," she said.
"Oh, no," I replied quickly, feeling heat creep up my neck. "I'd do that for anyone. Any of the nurses. It's just... it's not appropriate."
“No,” Tasha said, “I got that. I was just being a smartass.”
"Oh," I said, then paused, realizing I had no idea how to respond to that. "Right. Well. Good."
She grinned at my obvious discomfort before heading back to her patients, leaving me standing there feeling oddly off-balance.
I made my way to the triage desk, settling into the familiar rhythm of assessments and decisions. Everything was going as well as it could for triage.
Then came Mr. Shifflett.
"What's going on today, sir?" I asked, clicking up a fresh assessment form on the digital greaseboard.
"I'm having kidney pain on my left side, and I’m pissin’ blood," he replied without looking up from his phone.
He plopped himself down into my assessment chair and held his arm out automatically when I approached with the blood pressure cuff, but his eyes never left his screen.
"I'm pretty sure it's another kidney stone. "
"You have a history of kidney stones?" I asked, wrapping the cuff around his bicep.
He nodded, thumbs flying over his screen. I waited for him to elaborate, but he seemed completely absorbed in whatever he was typing.
"How many days have you been having symptoms?" I asked, fingers poised over my tablet.
Silence. I glanced up to see him completely engrossed in his phone, either not hearing me or choosing to ignore me.
"Mr. Shifflett?" I tried again, keeping my voice polite but firm.
"Yeah, what?" he said, still not looking up.
"How many days have you been having pain?"
"Oh." He seemed to consider this briefly, his typing slowing momentarily. "I don't know... probably a couple."
"On a scale of zero to ten, with zero being no pain and ten being the worst pain you've ever—"
"Eleven."
I made a note without comment. "Any allergies I should know about?"
This finally got his attention. He looked up, biting his lip thoughtfully. "Let me think... Tylenol, ibuprofen, Aleve, Toradol, tramadol, Zofran, droperidol, Benadryl, and medical tape." He paused. "I think that's everything."
I documented the extensive list, then glanced at his medication history. "I see you're prescribed Vicodin and Dilaudid?"
"Yeah, but I'm out of those."
"And you take the Vicodin okay, even with your Tylenol allergy?"
"Yeah, my doctor said Tylenol was fine when it's mixed with other stuff, just not by itself."
"We'll probably need a urine sample and discuss getting a CT scan to check for stones."
"No way," he said, shaking his head. "I don't do radiation. It's bad for you."
I kept my expression neutral, though internally I noted the refusal.
Considering kidney stones were consistently rated as being more painful than childbirth, someone genuinely suffering from them would typically want any test that might help diagnose and treat their condition.
The reluctance to confirm the diagnosis he was claiming was. .. telling.
"I understand," I said diplomatically, meaning it in more ways than one.
After completing his assessment, I directed him to the waiting room. As he stood to leave, he finally looked directly at me.
"Hey, how long do you think the wait will be? I've got plans later, and my ride's coming in about forty-five minutes."
I felt my jaw tighten slightly. "We see patients based on medical priority, sir. I'll do my best to keep things moving efficiently."
"Can you just try to hurry it along?" he asked, already shuffling toward the waiting room, phone back in hand.
I watched him go, then turned back to my computer to complete his chart. As I typed, I found myself thinking about the morning's earlier incident with Tasha, about Mr. McAllister's manipulative behavior, about Mr. Shifflett's casual dismissiveness.
Just another beautiful day in emergency medicine.
But even as I thought it, I realized something had shifted since this morning. The tremor in my hands from the nightmare had completely disappeared. The familiar weight of the day's routine had settled around me like armor, steady and reliable.
The dreams might still come at night, might still drag me back. But here, in the controlled chaos of the ER, surrounded by colleagues I respected and problems I could actually solve?
Here, I was exactly where I belonged.