2. Thirteen Weeks and Counting
Chapter two
Thirteen Weeks and Counting
NELLIE
There is a fishhook in Dwayne Pruitt's thumb, and Dwayne Pruitt is telling me how to remove it.
"My cousin says you push it through. Clip the barb."
"Your cousin sounds like a man with a lot of scars." I snip the line, numb the thumb, and back the hook out clean while he's still explaining the push-through method. I hold it up. "There. Tell your cousin I said hi."
He stares at his thumb. "Didn't feel a thing."
"That's the general idea, Mr. Pruitt."
Debbie Sue is waiting at the nurses' station with a tuna sandwich already unwrapped. She's not asking. She blew in an hour ago smelling like mesquite smoke, still tying her scrubs. When the tones go out in this county, brisket waits.
"You didn't eat lunch."
"I had crackers."
"Crackers are not food, Nellie. Crackers are what food stands on." She pushes the sandwich into my hands. "Eat."
Three weeks in Willowbend and Debbie Sue Monroe has appointed herself my work wife, my social director, and apparently my mother. I didn't interview for any of those positions. Doesn't matter. Debbie runs on casseroles and momentum, and I have learned it is easier to eat the sandwich.
Thirteen weeks. That's the contract. That's always the contract.
Willowbend General needed a nurse practitioner to cover the ER while they hunt for a permanent hire, and I needed a town I'd never heard of.
Locum work suits me. Full scope, no politics, and a built-in expiration date.
Week three of thirteen. In ten weeks I'll be somewhere else, and the little rental cottage on Juniper Lane will belong to whoever comes next.
There's a box in the corner of that cottage I never unpacked. There's always a box I never unpack. It's not laziness. It's policy.
I'm two bites into the sandwich when the radio at the desk crackles.
"Willowbend General, County. Be advised, working structure fire, Route 9. Two inbound. Elderly male, smoke inhalation, alert. And one of ours with a forearm lac. ETA six."
Debbie's already moving. "One of ours means a firefighter. This better be worth my brisket."
"I gathered."
"They're dramatic," she says, snapping on gloves. "Fair warning. Worst patients in Texas. My husband once tried to leave with a chest tube."
"He did not."
"He negotiated."
The bay doors bang open on the first rig. The farmer comes in gray-faced and coughing, seventy-something, overalls smelling like a burn barrel. Mr. Amos Kessler, the medic says. Barn fire. Went back in for his dog.
"Did the dog make it?" I ask, because that's the only vital sign Mr. Kessler cares about, I can see it on him.
"Dog's fine," the medic says. "Dog left first."
"Smart dog." I get Mr. Kessler on oxygen and a monitor, listen to lungs that sound like a screen door, order the chest film and the carboxyhemoglobin, and I am mid-sentence with respiratory when the second rig arrives and brings the noise.
The noise is a firefighter.
Debbie spots him from the station and lights up like a scoreboard. "Owen Peterson! You were supposed to come eat, not bleed—"
A monitor alarms down the hall and she's gone, pointing at him as she backpedals. "Don't you leave this building!"
He barely registers her.
He comes through the doors on his own two feet, which is his first mistake, because men who walk in think they get a vote.
Turnout pants, suspenders down, soot to the elbows, and a gash up his left forearm that has bled through one pressure dressing and started on a second.
Big. Built like the business end of an axe.
Jaw you could strike a match on, currently clenched.
And he is not talking about his arm. He is pointing across my ER at my patient.
"He was in that smoke eight, ten minutes before we got him out. He needs a CO level and a chest X-ray, and somebody needs to watch him, because these old boys minimize—"
"Sir."
"—and if his sats look fine on room air that doesn't mean anything with carbon monoxide, the pulse ox reads wrong—"
"Sir."
He keeps going. He's telling my respiratory therapist, a woman with nineteen years of experience, how a nonrebreather works.
So I step into his line of sight, plant myself there, and wait. It takes him a second to notice, the way it takes a freight train a second to notice a cow.
"You're bleeding on my floor," I say.
He glances at the arm like it belongs to somebody else. "It can wait."
"It's dripping. Dripping doesn't wait, it accumulates."
"The patient—"
"—has a nurse, a respiratory therapist, oxygen, a monitor, and a provider. Me. I ordered the CO level and the chest film before your rig cleared the driveway. What he doesn't have is a stranger in turnout pants directing traffic over my shoulder." I point at Trauma Two. "That bed. Sit."
He looks at the bed. Looks at me. There's a whole argument happening behind his eyes, and I watch him lose it.
"Fine," he says, like he's doing me a favor.
"Bless your heart," I say, like it isn't a threat.
He sits on the edge of the bed the way men sit when they're planning to leave. I cut the ruined dressing off and take a look. The laceration is long, deep at the middle, edges ragged. Metal, probably. It's going to need a layered closure and he's lucky it missed anything that matters.
"How'd you do this?"
"Barn had opinions."
"Tetanus current?"
"Yes."
"Allergies?"
"No."
"Charming personality, or is this a head injury?"
His eyes come up. Gray. Irritated. Something underneath the irritation that I decline to examine. "Are you always like this?"
"Only on days ending in Y." I draw up the lidocaine. "Small stick. Then pressure, no pain. If you feel sharp, tell me. Don't tough it out to impress me, it wastes both our time."
"Wasn't planning on impressing you."
"Good news. It's working."
I numb him and start irrigating, and he watches everything I do like he's grading it. When I set up my suture tray, he leans over to inspect it.
"You want to double-check my knots too?"
"Depends. Are they good?"
"Better than yours."
"You've never seen mine."
"I've seen your dressing." I nod at the soaked wad of gauze in the basin. "Field wrap, done one-handed, probably while yelling at somebody. C-minus."
"I was busy."
"You were bossy. There's a difference, and the difference is the C-minus."
Mr. Kessler laughs from across the ER, which turns into coughing, which puts the firefighter half off the bed before I put a hand flat on his chest and push him back down.
"He coughs, that's his job right now. Your job is to hold still and bleed less. Everybody in this room has a job. Stop applying for other people's."
His jaw works. "You're a real know-it-all with a stethoscope, you know that?"
"And you're a Labrador who thinks he's a doctor. Big, loud, no impulse control, convinced everyone needs fetching." I set the first stitch. "Hold still."
He holds still. He's good at it once he surrenders, which annoys me.
His forearm is warm under my glove, corded, a burn scar near the wrist that's years old.
He smells like smoke and something under the smoke, cedar maybe, and I focus on my knots because my knots are excellent and because there is no third reason.
"You're not from here," he says.
"Says the man in Chicago gear."
"I grew up here." Like that settles it. Like the Chicago stamped all over his gear is somebody else's problem.
"Well, congratulations. I'm a locum NP. Thirteen weeks, then the next town."
"Then what? Then thirteen weeks somewhere else."
He's quiet a beat. "So you pass through."
"I'm sorry, was that a question or a review?"
"An observation."
"Observe less. Bleed less. That's the whole program." Another stitch. My hands are steady. My hands are always steady. It's the rest of me I keep on a schedule.
"What about you?" I ask, because silence with this man has weight and I'd rather not carry it. "So, what's Chicago doing bleeding in my ER?"
The forearm under my hands goes to stone. Not a flinch. A door closing.
"Visiting," he says.
That's all. One word, sealed at the edges. Fine. I don't do backstories anyway. Backstories are how people get sticky.
I'm on the last stitch when it happens. He shifts, I steady his wrist, and my bare knuckles above the glove line settle against the inside of his arm where the skin is soft and untouched by any of this.
Neither of us moves. One second. Two. His pulse is right there under my fingers, and it is not the pulse of a calm man.
I have taken ten thousand pulses. I have never once taken one personally.
Mine's no better. Traitor.
I tie off, snap the glove for effect, and start wrapping. "Keep it dry twenty-four hours. Sutures out in ten to twelve days. Signs of infection, come back. Signs of stupidity, such as swinging an axe tomorrow, also come back, and I'll charge you double."
"You don't set the prices."
"I'll write a strongly worded note in your chart."
Something happens at the corner of his mouth. Not a smile. A rumor of one. He kills it fast, stands, and looks over at Mr. Kessler one more time, and this look is different. Nothing bossy in it. He watches the old man's monitor like the number matters to him personally.
"He going to be alright?"
"We'll watch him overnight. He's already asking for his dog, which is the best sign there is."
He nods. At the curtain he stops, half-turned, like there's something else. Whatever it is loses the vote.
"Thanks," he says. "For the arm."
"Try not to undo my work before the swelling does."
He frowns, doesn't respond, and pushes through the curtain, and the ER feels bigger and quieter and worse.
Debbie materializes at my elbow before the curtain stops swinging. She has the look of a woman who has been standing at that desk with her ears set to wide-band the entire time.
"So," she says. "That's Owen Peterson."
"That's a walking incident report is what that is."
"Tater's best friend from high school. Chicago fire. Tater's been after him for years to come home." She's watching me watch the doors. She's not even hiding it. "And here's the thing. Tater's talking him into staying. The whole summer."
The whole summer.
My stomach drops. Straight down, no warning, elevator with a cut cable.
And it is not dread.
Which is worse.