Adriana
She was in Exam One with a trollish teenager when it happened.
“Ice it twenty minutes at a time for the next forty-eight hours, and keep it elevated. If you’re still unable to bear weight on it after that point, I’d like you back here for repeat imaging.
Assuming it’s only a sprain, you’ll still need to rest it for a minimum of three weeks. You’ll need to make your coach aware.”
“Three weeks?! But our season just started!”
“So, are we headed to the state championship next year?”
Adriana jumped at the deep voice behind her, catching her completely unaware as she gave her final instructions to the teenage troll and her mother.
“Dr. Marsh.” Adriana hoped that her voice hadn’t actually cracked over his name.
Maybe that was just in your head. It took her a moment to realize his words were directed at the teen on the exam table, his stance relaxed and his smile jovial, leaning on the door jamb, preventing her escape.
“Not if I’m going to be out doing physical therapy,” the young troll moaned.
“Well, you’re in excellent hands here. Hopefully there’s no occult fracture and you’re only looking at resting a mild sprain.”
Adriana listened as he conversed with the troll and her mother, knowing far too much about high school athletics, she thought.
The handsome shifter wasn’t that much older than she was herself, maybe only five or six years, a galling thought.
And he’s a partner in a cushy private practice.
Him and that blabbermouth orc. Guarantee they’ve never eaten a microwaved hot dog in the ambulance bay at 3 a.m. with vomit on their shoes just to get some peace and quiet.
One thing was certain — Dr. Marsh fit in here effortlessly, conversing easily with the troll and her mother, the same way he did with her support staff, with Deneen and Sora, right down to the gnome who came in each night to vacuum. She, by contrast, still didn’t.
Adriana felt invisible in the corner of the room, shrinking smaller and smaller, startling again when the shifter said her name.
“As Dr. Brunelli said, let’s make sure we ice and elevate. Rest now, play later.”
When the hobbling teenager and her mother had left the exam room — smiling, she noted sourly — he turned to Adriana with the same disarming smile.
“Mind if I steal two minutes of your day?”
She felt as though she were being marched to the gallows as she followed him up the short hallway to the tiny office she shared with Sora. The shifter pulled out a chair, indicating that she should do the same, giving her another warm smile. So much for only stealing two minutes.
“How have things been?” His voice was light, but his eyes were searching, and she remembered the intensity with which he’d watched her during both of her interviews.
Adriana cleared her throat. Breathe. She couldn’t sit straighter than she already was, pushing her shoulders back in an effort to stretch her neck, clearing her throat.
This, at least, she knew how to do. “It’s going well.
The pathology is straightforward. So far, it’s been typical low-acuity patients.
I’m ensuring that follow-up with the office upstairs is mentioned whenever warranted.
The biggest adjustment for everyone has been the pace, but I think we’re managing as well as we can.
” She didn’t want to admit to him that every single staff member she’d inherited from the practice upstairs moved so slowly they were in danger of going backward.
“The pace,” he echoed with a squint, a slight furrow between his brows as she moved the topic back to the clinic.
“Yes, Shileen mentioned that you’ve been very focused on .
. . pace. I know this environment is not what you’re used to, but the majority of folks coming in probably expect a bit more face time than they’ve been receiving, if only to feel that they know who you are. ”
She shifted, hands tightening around the tablet she still carried. It was hard not to feel as though she were a green resident again, standing before her attending on her very first shift, being forced to explain and justify her every decision, if only to make sure that she could.
“As I said, every case has been low-acuity. Rhinitis doesn’t require more than an eight-minute—”
“I’ve no doubt in my mind that you’re providing more than adequate care, Dr. Brunelli,” he interrupted, tempering his reproach with another warm smile, but she had already stiffened.
There was no way to receive his words as anything but a reproach.
“I looked at your charts before I came over. They’re excellent.
Thorough and concise. Your treatment plans are exactly what I’d expect.
But we’ve had several complaints from the last week over perceived .
. . brusqueness, let’s say.” Dr. Marsh held up what she was sure was meant to be a placating hand.
“I know it says ‘urgent care’ above the door, and I do appreciate the urgency you’re bringing to the role, but this is still family medicine.
The patients here are patients upstairs.
They don’t understand the difference between the offices. ”
“It’s our job to teach them,” she bit out, hackles raised, feeling a growl building within her.
“I appreciate that these are the same patients you see in the offices upstairs, but we shouldn’t be training the community out of understanding what urgent implies.
If crucial minutes are being taken up by chatting about tomatoes at the farmer’s market—”
“I was under the impression you came to us to get out of the emergency department?”
Her heart thumped, heat creeping up her neck. The overhead lights were suddenly too bright, the room around them pitching. He had watched her too closely during her interviews, had seen through her careful answers. They can all probably tell that you’re one bad day from shaking apart.
“Adriana, do you know why I hired you?”
Dr. Marsh interrupted her thoughts before she could give them voice, grateful her hands clutched the tablet instead of clenching into fists at her sides.
He paused, but Adriana only shook her head, afraid of what she might say if her voice reignited.
Her temper had gotten her into trouble before, and she couldn’t allow that to happen now.
“I wasn’t just looking for someone who could diagnose cellulitis or close lacerations.
Every physician who walks through this building can do those things.
But you’ve spent the last decade making life-and-death decisions in one of the busiest emergency departments in the Midwest, one with an unusually high number of nonhuman patients, and I wanted that judgment in this clinic.
We are at a critical time in nonhuman care.
Our partners next door are dealing with a record number of patients because the gap between the care they receive in human-run hospitals and our own has never been greater.
So if an orc walks through these doors having a myocardial infarction instead of the heartburn the human doctor in the city told them they had three days ago, the heartburn they think they’re coming in for, I already know I’m going to sleep better knowing you’re here.
They’re going to get the care they deserve. ”
He leaned forward, bracing himself on his elbows as he contemplated her.
“So I’m here to find out what the hell is going down here. Because I already know you’re an excellent doctor. But what I can’t figure out is why you’re letting a personal vendetta with one of our paramedics cloud your professional judgment so thoroughly.”
The tablet fell from her grasp, her fists balling. Fucking Trapp Hemming. “My judgment has never been compromised—”
“Then explain to me why three of the patient complaints came from mothers here with children you saw immediately after an EMS drop-off?”
Her mouth opened, jaw moving, but her voice had fled.
“I am assuming you were familiar with a procedural chain of command at your last department?” Dr. Marsh went on, his voice having lost a fraction of its warmth.
“Why, then, did I find out an incident report had been filed against the paramedic in question from this building without my knowledge? What is the purpose of you auditing the EMS run sheets? Is there not enough to do? Because my suggestion would be to start spending more time with your patients if you’re having trouble filling the hours of your day. ”
She was unable to draw breath. Eyla must have said something about the report she’d had the nurse run. Patients were unhappy with her bedside manner. This was supposed to be a new start, a real home.
“Look.” Dr. Marsh sighed, pinching the bridge of his nose.
“I’m going to tell you the same thing I told Trapp last week.
And in the spirit of transparency, yes, I did see him.
No, I don’t have a personal relationship with him, but I am close friends with his brother.
This is a personal vendetta. You’re both behaving childishly, and now it’s compromising patient care under my roof.
And it ends today. You’re a good doctor, Adriana.
Don’t get fired for something so stupid. ”
The silence between them stretched for too long, but she was unable to make her voice work without the threat of tears heating her face.
“Now what?” she scraped out at last, expecting a formal reprimand.
You’re still brand new. Probation, if you’re lucky.
An expensive townhouse you won’t be able to afford if you’re not.
Shouldn’t have spent so much money on that stupid goose.
Dr. Marsh grinned, sharp and without humor.
“I’ve been thinking on it. My main concern, Adriana, is that if you bring an emergency department mentality to this building, you’re not going to find relief from the burnout that led you to apply for this position in the first place.
You’ll never be happy here if you recreate the same stressors, and you won't stay. I’m looking out for my own interests.
” He shrugged unapologetically. “Your success is the practice’s success.
I want a minimum forty-minute throughput for every patient.
Ask one more question than you feel is medically necessary for treatment. ”
She blinked rapidly, waiting for the rest of the imprecise directive, squirming when it seemed the rest would not be forthcoming.
She disliked instructions for which there was no established policy, and “ask one more question” occupied an irritating middle ground between crunchy philosophy and hospital protocol.
What question? There was no billing code for it, no clinical guideline she could follow, no measurable outcome by which she could judge whether or not she’d succeeded.
“As far as you and Paramedic Hemming . . .”
She sucked in a breath, teeth pressing into a flat line. Her hands had refound the tablet on her lap, clenching around it.
“You’re going to complete a forty-eight-hour field rotation. A clinical ride-along. We have a new CNP from upstairs starting down here next week, so there will be enough slack in the schedule.”
She was shaking her head before he’d even finished. “No. That-that’s a direct conflict of interest. He and I . . . We have an established personal rela—”
“You have a personal war,” Dr. Marsh cut her off, all traces of warmth gone.
“And I’m ending it. The two of you are treating intake like a hostile border crossing, and it’s finished.
A forty-eight-hour clinical ride-along. And if the two of you can’t figure out how to get along by then, we’ll have to readdress the issue.
But I should warn you, Adriana — I will personally document your lack of institutional cooperation for the state licensing board.
I don’t want that to be our outcome, but I won’t jeopardize patient care. ”
She stayed in the office long after Dr. Marsh left.
She was furious. She was chastened. She was going to sit in an ambulance with Trapp Hemming, seeing him, smelling him, twisting in his presence every single day, and getting along with him was now a direct job requirement.
And all the while, the moon grew ever fuller.