Chapter 6
Chapter Six
COLE
“Patient is a twenty-six-year-old male.”
My intern’s eyes darted between me and the bedside computer screen as if he hoped I wouldn’t notice the gaps in his presentation.
“Motorcycle versus SUV. Uh—patient presented with blunt force trauma to the chest and abdomen. GCS was fourteen on scene, dropped to eleven during transport. Initial CT showed a grade three splenic laceration. Possible liver involvement, but radiology couldn’t confirm without contrast.”
Martin let the last words hang. I watched sweat bead along his hairline.
His hands trembled slightly as he held the tablet in front of him like a shield.
He was young and had a fresh-from-medical-school eagerness that made him volunteer to present cases even when he clearly had not prepared adequately.
Behind him, three other interns hovered in the hallway outside the ICU, watching the scene play out like they were witnessing an execution.
“Is that it?” I asked.
“Oh. Uhm. Hemoglobin on arrival was…nine point two,” Martin continued. “We started two units of packed red cells and he has been stable. Vitals are holding. Blood pressure is one-fifteen over seventy, heart rate is ninety-two, respiratory rate is eighteen on room air.”
I let the silence stretch for a beat. Then another. Martin’s confidence started to crumble around the edges.
“Hemoglobin was nine point two when?” I asked.
“Uhm…” Martin blinked. “On arrival.”
“What time was that measurement taken?”
He glanced down at the chart, fumbling with the tablet. “Oh-three-hundred hours,” he answered quietly.
“And what time is it now?”
He looked at his watch. His Adam’s apple bobbed when he swallowed. “Seven fifteen.”
“So why do I give a shit about that number?” I asked. “Your patient has a grade three laceration. He’s losing blood. You presented based on labs from four hours ago, so you don’t know if his hemoglobin is stable, dropping, or crashing.”
I kept my volume level but firm. I did not need to yell to make my point clear. Rounds were a time to learn, and sometimes learning looked like a reprimand.
“So what should you have done before report?”
Martin’s face went pale. “I should have checked recent labs first.”
“You should have checked recent labs first,” I parroted. “Dr. Martin, if your patient is bleeding into his abdomen and you’re presenting to me based on outdated information, what does that tell me about your understanding of trauma as a practice area?”
“That I don’t understand it well enough, sir.”
“You don’t understand it well enough yet.” I looked at the other residents, all of whom suddenly found the floor interesting. “Anyone else want to present a trauma patient without current vital information? We’ve got time to waste in the ICU, right?”
Three heads shook in unison. Nobody made eye contact.
“No, of course not. Martin, get current labs and a repeat abdominal exam. If his hemoglobin has dropped below eight or if there is any change, I want to know. Then we will talk about whether we are taking him to the OR. The rest of you, I want updates on your patients in one hour, and I want those updates to include data that’s less than thirty minutes old. Go.”
They scattered like I had fired a starting gun. I watched them disappear down the hallway, then pulled out my phone to check the time. Seven seventeen. Morning rounds on Friday always ran long because the interns’ brains were already on weekend time.
I pocketed the phone and headed down the hall. I had three post-operative patients from earlier in the week who needed checking, and if Martin’s trauma patient was still bleeding, I would need to schedule an emergency splenectomy.
Two nurses at the main station had been talking, heads bent close together in a conspiratorial way that meant they were discussing something they did not want overheard.
The conversation stopped the instant they saw me.
One of them, a younger woman whose name I could not recall, smiled at me.
The other, Karina, actually blushed and looked down at the computer screen in front of her.
I nodded at them and kept walking toward the computer station near bed three. I logged in and pulled up his chart. Vitals were stable, blood pressure was holding, heart rate had come down slightly. Oxygen saturation was ninety-eight percent.
I walked to the bedside. The patient had a full sleeve of tattoos visible on his right arm where the hospital gown did not cover. His eyes were closed. I did a quick physical exam. His abdomen was tender when I palpated the left upper quadrant, but it was not rigid. Bowel sounds were present.
“Dr. Vaughn?”
I turned to find Karina in the doorway, her dark hair hiding under a surgical cap. She was holding a tablet close to her chest.
“Yes?”
“Dr. Martin asked me to let you know the labs are ready for his patient.”
“Thanks.” I swung to the nearest computer and pulled them up.
Hemoglobin was eight point eight; down from nine point two, but not catastrophically low.
“Could you page Dr. Martin and tell him if hemoglobin drops below eight, start another unit and call me immediately? And someone needs to check him again in four hours.”
“Will do,” she said with a smile. I gave her an appreciative nod. Karina had been working in the ICU for five years, making her more valuable than half the residents on any given day.
Which was why it was odd that she just…stood there. Usually, the nurses hurried away after getting instructions. Lingering wasn’t part of the ICU routine—there was too much to do.
“Nurse?” I prompted, half-turning from the computer screen. “Was there something else?”
She startled slightly, as if she’d drifted and only now snapped back. “No—sorry,” she said, then smiled. It was a different smile than I was used to. Softer. Almost shy. “Have a good day, Dr. Vaughn.”
I stared at the empty doorway, trying to figure out what had just happened. Karina had never smiled at me like that before. This was new.
Or it wasn’t, and I had been completely oblivious to it until Jasmine pointed out the group chat.
I finished checking my other post-operative patients.
All of them were stable and boring, which was exactly how you wanted post-operative patients to be.
I signed off on discharge orders for two of them, wrote a note about weaning sedation on the third, and got out of the ICU as quickly as I could without looking like I was running away.
In the hallway, I passed two more nurses I recognized from the night shift. They both looked at me, then they looked at each other. Then one of them giggled.
Giggled. What the fuck?
I ducked into the stairwell and yanked out my phone.
Me:
Tell me something, Jas. Did I grow a second head overnight or is everyone acting weird?
The response came back almost immediately.
Jasmine:
No, baby. You’re finally noticing something that’s been happening a long time.
I shoved the phone back in my pocket and took the stairs down to the second floor. Only one person could make this day better.
She was coming straight at me, long strides eating up the hallway like she had places to be.
Her camel-colored suit was tailored to her frame, with heels that added at least three inches to her height.
Her hair was pulled back, a few strands escaping to frame her face.
She had a tablet tucked in her elbow, phone pressed tight to her ear.
From the outside, Harper was the full package: professional, polished, untouchable. Queen of the conference room.
But I’d already met the Harper who laughed at my jokes over drinks.
“I hear you, and I get that, Samuel,” she was saying into the phone, her tone clipped. “But an assessment is required and that means I need access to the complete file, not the sanitized version you’re comfortable sharing.”
After a pause, she rolled her eyes and huffed. “I’m not just anybody, Sam. I’m administration. I need the complete—”
Her eyes found mine and her expression instantly morphed. The mask slipped and I saw the same thing I was feeling—the urge to rush over and give her a hug and crack some inside jokes.
“You need some time to send my request up the chain. I’ll call you back,” she said, then hung up before they could say a word and came to a stop a few feet away from me. “Dr. Vaughn.”
“Ms. Sutton.”
I eyed the phone in her hand. It was a different model than she’d used the night before. “Looks like you got a replacement phone already. With a case.”
Her lips twitched in her attempt not to smile. “It’s a loaner. My new phone and case are on the way, though. How are you?”
“I’m, uh…” I glanced around. Two nurses at a nearby station were definitely watching us. I recognized one of them from this morning. She wasn’t even pretending not to stare. “I’m fine. How is your morning so far?”
“Bureaucratic,” Harper said, shifting the tablet to her other hand. “I shouldn’t have to beg for files but here I am, begging for files.”
“At least you didn’t spend the morning with interns who forget that trauma patients can bleed to death while you’re presenting old labs that tell you nothing about the patient’s current status.”
“Oh.” She winced. “I want nothing to do with that.”
“Yeah, I don’t blame you. I don’t want anything to do with it either.”
I wanted to keep talking. Actually, I wanted to ask her if she’d been thinking about last night, if she’d replayed the conversation in her head the way I had or if I’d blown it out of proportion.
But we were standing in the middle of a hospital corridor, people streaming past, nurses pretending not to listen but catching every word.
Instead, I asked, “You headed somewhere?”
“I have a meeting in about twelve minutes.” Harper glanced at her watch, then back at me. “Walk and talk?”
We fell into step together. Harper was tall enough in her heels that I didn’t have to slow my pace to match hers. She walked close enough to me that I caught her scent, that same vanilla and something warmer that I had noticed last night.
“So who’s making you beg for files?”
“Legal. They started putting up barricades the minute I asked for a complete patient history. They like to preach about proper channels, but we all know they don’t want to hand over anything. Ever.”
“Do they know who they’re dealing with?”
Harper grinned, her face brightening. “They’re learning.”
We walked past the cafeteria entrance. The smells of burnt coffee and steam table food drifted out. A few people glanced at us as we passed—two professionals walking together, nothing unusual about it, except I was hyperaware of how it looked for Harper and me to be walking side by side.
“So, you got big Friday night plans?” I asked, trying to sound casual.
She looked over. A note of curiosity, nothing more. “Tonight? Probably just go home, catch up on Reasonable Doubt. Why?”
“That’s your Friday night plan? Just going home?”
“What’s wrong with that?”
“I mean, it sounds kind of depressing.”
Harper laughed, a short, dry sound. “Or relaxing after a long week. You’re saying you have more exciting plans?”
“No, actually. I’m going to do the exact same thing,” I admitted. “I’ll probably go home, eat something out of a container, watch whatever’s on TV until I fall asleep on the couch.”
She gave me a look, her lips twisting. “I was at least going to cook. Your version sounds bleak.”
“It does.” I held the door open for her as we turned into the next corridor. “You want to save me from that?”
Harper stopped cold. We were near the elevators now, people flowing around us like water around rocks. She studied me for a long moment, her expression unreadable.
“Are you asking me to have dinner with you, Dr. Vaughn?”
“I am. Somewhere that’s not a lounge that closes at ten. Where we could talk without a last call.”
She didn’t answer right away. I could see her working it over, turning it around in her mind, a flicker of caution crossing her face.
“You do realize this is a terrible idea,” she said finally. “If anyone finds out—”
“Then we’ll deal with it.” I watched her, holding my ground. “My life doesn’t stop because some people have questions. I’d like to have dinner with you. Away from all this.”
“What time?”
Relief washed over me. “Seven? Seven thirty? I can pick you up or we can meet—”
“Let’s meet. Less complicated that way.” Her phone buzzed. She glanced at it and grimaced. “That’s my five-minute warning.”
“Go. I’ll text you the details.”
She started to walk away, then turned back. “Make it somewhere nice.”
“I got this.”
She disappeared around the corner toward the administrative wing, hips moving in a rhythm that made my pulse jump. As soon as she was gone, I pulled out my phone and immediately started searching for restaurants.