Chapter Ten
“Dr. Warren?” A head peeked around the side of my office door, and I glanced up, startled.
“Oh, hey, Loretta. What’s up?” I asked, setting the file for my final patient on my desk. I was ready to clock out and head home after a long day.
“There’s a gal in the ER with a scaphoid fracture of her left wrist. I know you aren’t the attending orthopedic doctor today, but I was hoping you’d take a moment to see her before you leave.
She’s a good friend, and I would consider it a personal favor.
Between you and me, she’ll need a fixation of the bone by the looks of it, and I want her to have the best of the best.”
My laughter filled the office. “Loretta, you are a sweet talker. You butter me up, so I don’t get offended that you’re doing my job for me.”
“I only speak the truth,” she assured me. “I wouldn’t be standing in your doorway if I didn’t feel that way. Bells Pass was lucky to get you. That said, I’m not doing your job for you. That came straight from the mouth of the ER attending.”
“Well, I appreciate the strokes to my ego,” I said, rising and walking around the desk. “I was teasing you, anyway. Chances are, you can probably diagnose most of what comes through these doors without our help, but since I’m here, we’ll take a look at it. Who’s our patient?”
“Have you been to The Nightingale Diner?”
“Do cows moo?” I asked as I laughed. “I don’t like to cook.”
“Noted,” she said with a grin. “Then you probably know her. Jaelyn Riba. Tall with long, dark brown hair.”
My heart sank. Not Jaelyn. She would be so upset if what Loretta said was true.
A broken arm was the last thing she needed, considering her job.
“I just saw her yesterday. I was the celebrity chef on the food truck. I’m a huge fan of the Spanish Rooster.
” And her, I thought as I tried not to grimace at the idea that the woman I’d come to daydream about was now lying in pain in my ER.
If she had a scaphoid fracture, I was going to be the cause of more pain for her, a thought I didn’t relish.
If she required a fixation procedure, she wouldn’t be waitressing anytime soon, which meant I’d have to find other ways to see her.
Deep breath, Major. Do your job and stop obsessing over this woman.
“That’s her,” Loretta agreed, leading me to a cubicle in the ER after she grabbed a tablet off the nurse’s station on the way by. “Her X-rays are cued up.”
Accepting the tablet from her, I brought up the radiologist’s findings, which revealed an offset fracture of the left scaphoid bone and a possible fracture of the lunate bone. I flipped the X-ray up on the screen and grimaced.
“Gnarly, right?” Loretta asked.
“For sure. That’s going to need surgery. I’ll see her. Thanks, Loretta.”
“No, thank you, Major. Call me if you need assistance. She’s had some pain medication, but not so much that she can’t make decisions for herself.”
With a nod, I pulled the curtain back far enough to speak through the hole. “Dr. Warren of orthopedics. Can I come in?”
“Yes,” a voice said. A voice that I most definitely recognized.
Once in the curtained space, I offered my friend a smile. “Hi, Jaelyn. I heard you had a bit of a snafu.”
“You could say that,” she agreed, pointing at her arm in a splint with a bag of ice on top. “It’s feeling better, though. I can probably go home if you give me a brace for it.”
After setting the tablet on the table, I moved a chair aside to examine the arm. “Thanks for your medical opinion, but if you don’t mind, I’ll give it a looksie myself.”
“Because I’m just a waitress and don’t know anything, right?”
Her sarcastic delivery had me glancing up instantly.
“I didn’t say that, Jaelyn, nor would I ever think it.
You’re probably scared and nervous, but it’s important that we take care of this arm properly, or you could end up with nerve damage from this break.
I just saw the X-rays, and while you’re beautiful, they aren’t pretty. ”
“Wait, it’s broken?” she asked, as though this was new information and my comment about her being beautiful hadn’t landed. Probably okay since it wasn’t exactly professional.
“They didn’t tell you that?” I asked, lifting the tablet to show her the X-ray and explain the break.
“Dang it,” she sighed. “I thought it was just sprained. When they didn’t come back in to tell me anything, I figured all was well.”
“Unfortunately, that’s not the case,” I said, unwrapping the bandage from the splint so I could look at the position of the bones. “Loretta was just hunting me down. I was upstairs seeing patients.”
“Oh, I’m sorry,” she said with a grimace. “I don’t want to keep you. I can wait.”
“No need. I was finished for the day, but when she told me you were here, I insisted on taking your case. To be honest, I planned to stop into the diner for dinner, hoping to see you. You saved me a trip,” I said, patting her shoulder.
“You are definitely our number one customer now.” That got a lip tilt from her, even if she stared at the wall as I checked the wrist. I didn’t remove the entire splint because if the fracture was unstable, I didn’t want to make it worse.
“Well, that shall continue because I haven’t learned how to cook in the last day,” I joked as I rewrapped the splint and lowered the ice back to the arm.
Thankfully, the early intervention helped keep the swelling down, making a fixation procedure possible today.
Rather than hover over her and make her more nervous, I sat beside the bed in the empty chair. “How did the injury happen?”
I noticed her eyes rolled before she answered, and I could tell it was aimed at herself. “I went tobogganing.”
“Did it snow since I last looked out a window? It was like fifty degrees.”
Her snort was short before she answered. “We were grass tobogganing.”
“That’s a thing?”
“Apparently,” she said, motioning at her arm. “It was new to me, too. I never should have let them convince me to do it. Now I won’t be able to work.”
“Ivy Lund may have a few choice words for you,” I agreed with a chuckle.
She turned her head and finally made eye contact with me. “Ivy Lund was driving the toboggan, Major. I mean, Doctor Warren.”
I waved that away. “We don’t need to rest on formalities here. Call me Major.”
“Okay, well, Ivy was piloting the sled when we hit a hole in the ground, and I went flying.”
“Is she okay?”
“Yep, but I was in the back and got flipped off. Thankfully, we were close to the bottom of the hill.”
“She’ll probably understand the situation then,” I said, trying to bite back a grin at the image of Ivy Lund flying down a grassy hill on a snow sled. It was nearly impossible not to laugh.
“She left to check on her kids, but I’m sure she’ll be back any minute. She’s been hovering.”
“That sounds like Ivy, at least what I know of her. She’s always sweet and loving to everyone who walks through her doors. You know she’ll do right by you.”
“If you can cast this and send me on my way, I can still work behind the counter or something.”
“Well, we will certainly cast it after we fix it.”
“Fix it? Like pop it back into place or something? There’s a jut to it that wasn’t there before.”
“You could say that,” I agreed. “But no, we won’t be popping anything back into place.
The bone that’s fractured is below your thumb,” I explained, pointing to it on my wrist. “The one next to it, the lunate bone, may also be fractured, but they touch, so it can be hard on X-ray to know for sure, especially with swelling. The scaphoid bone will certainly need to be realigned and screwed together. The jury is out on the lunate.”
“Screwed together?” she asked, swallowing hard when she realized what that meant.
“Yes. To stabilize the fracture and properly align the bones, a pin will be needed to facilitate healing. Once the bone is back in place, I’ll inspect the lunate for fractures and instability.
I’m confident the lunate won’t need any intervention, but I can’t be positive until I see what we’re dealing with in there. ”
“You're talking about surgery?”
“That’s the only way,” I agreed gently. “Remember when we talked about a malunion?” I asked, and she nodded. “That’s what we want to avoid.”
“I can’t do surgery. That’s expensive. I mean, I have insurance, but…”
“But nothing,” Ivy said, pulling the curtain back. “This is my fault, so I’ll be covering the deductible. You don’t need to worry about money right now. There's no choice here; it needs to be fixed. Hello, Dr. Warren. It’s nice to see you. I hoped you’d be the doctor Loretta wanted to hunt down.”
I stood and hugged her. “It’s good to see you, too, Ivy. Remember when I told you to call me Major?”
“Sure, in the diner, but this is your place of work, and you deserve the respect of your title.”
I brushed my hand through the air. “I never stand on titles. If you’ll excuse me, it’s time to round up some helpers to get this sweet lady’s arm fixed so she can return to serving those delicious tacos.”
“I know they’re your favorite!” Ivy said with excitement. “Wait until you see what we have going on for the holidays!” She gasped and turned to Jaelyn. “I just had the best idea! We can talk about it later. For now, we do need to get your arm fixed.”
“I’ll send the anesthesiologist in to talk to you while I fire up the operating room,” I said, patting Jaelyn’s leg. “When was the last time you ate?”
“About eleven,” she answered, and I checked my watch again. “It’s five now, so that’s six hours. We may have to delay the surgery an hour, but I’ll let the anesthesiologist decide on that.”
“Wait, you mean like doing the surgery right now? Don’t we have to wait for the swelling to go down?”
“Normally, I would say yes, but it’s not so swollen that I can’t do this simple fixation immediately. I’d rather we get it done now, as I’m worried about the risk of losing blood flow to the bone if we don’t. Will you consent to that?”
She bit her lip for a moment before she spoke. “I don’t have a choice, do I?”