ACROSS TOWN IN the trauma suite of one of New York’s most prestigious hospitals, Dr. Ethan Black and the rest of the trauma team smoothly and efficiently cut away the ripped, bloodied clothing of the unconscious man to expose the damage beneath. And the damage was plenty. Enough to test the skills of the team and ensure that their patient would remember this night for the rest of his life.
As far as Ethan was concerned, motorcycles were one of the world’s worst inventions. Certainly the worst mode of transport. Many of the patients brought in following motorcycle injuries were male, and a high proportion had multiple injuries. This man was no exception. He’d been wearing a helmet, but that hadn’t prevented him from sustaining what looked like a severe head injury.
“Intubate him and get a line in—” He assessed the damage as he worked, issuing instructions.
The team was gathered around, finding coherence in something that to an outsider would have seemed like chaos. Each person had a role, and each person was clear about what that role was. Of all the places in the hospital it was here, in the emergency room, that the teamwork was the strongest.
“He lost control and hit an oncoming car.”
Screaming came from the corridor outside, followed by a torrent of abuse delivered at a high enough pitch to shatter windows.
One of the residents winced. Ethan didn’t react. There were days when he wondered if he’d actually become desensitized to other people’s responses to crisis. Working in the emergency room brought you into contact with the most extreme of human emotions and distorted your view of both humanity and reality. His normal would be someone else’s horror movie. He’d learned early in his career not to talk about his day in a social situation unless the people present were all medical. These days he was too busy to find himself in too many social situations. Between his clinical responsibilities as attending physician in the emergency room and his research interests, his day was full. The price he’d paid for that was an apartment he rarely saw and an ex-wife.
“Is someone caring for the woman on the end of that scream?”
“She’s not the patient. She just saw her boyfriend knifed. He’s in Trauma 2 with multiple facial lacerations.”
“Someone show her to the waiting room. Calm her down.” Ethan took a closer look at the man’s leg, assessing the damage. “Whatever it takes to stop the screaming.”
“We don’t know how serious the injuries are.”
“All the more reason to project calm. Reassure her that her boyfriend is in good hands and getting the best treatment.”
It was a typical Saturday night. Maybe he should have trained as an ob-gyn, Ethan thought as he continued to assess the patient. Then he would have been there for the high point of people’s lives instead of the low. He would have facilitated birth, instead of fighting to prevent death. He could have celebrated with patients. Instead his Saturday night was invariably spent surrounded by people at crisis point. The victims of traffic accidents, gunshot victims, stabbings, drug addicts looking for a fix—the list was endless and varied.
And the truth was he loved it.
He loved variety and challenge. As a Level 1 Trauma Unit, they had both in copious amounts.
They stabilized the patient sufficiently to send him for a CT scan. Ethan knew that until they had the results of that scan, they wouldn’t be able to assess the extent of his head injury.
He also knew that it was difficult to predict what the scan would show. He’d had patients with minimal visible damage who turned out to have massive internal bleeding and others, like this man as it later turned out, who had a surprisingly minor internal bleed.
He paged the neurosurgeons and spoke to the man’s girlfriend, who had arrived in a panic, wearing a coat over her pajamas and terror in her eyes. In the emergency room everything was concentrated and intense, including emotions. He’d seen big guys who prided themselves on being tough, break down and sob like a child. He’d seen people pray when they didn’t believe in God.
He’d seen it all.
“Is he going to die?”
He handled the same question several times a day, and he was rarely in a position to give a definitive answer. “He is in good hands. We’ll be able to give you more information when we see the results of the scan.” He was kind and calm, reassuring her that whatever could be done was being done. He knew how important it was to know that the person you loved was receiving the very best care, so he took time to explain what was happening and to suggest she call someone to come and be with her.
When the man was finally handed over to the neurosurgical team, Ethan ripped off his gloves and washed his hands. He probably wouldn’t see the patient again. The man was gone from his life, and he’d probably never know about the part Ethan had played in keeping him alive.
Later, he might check on his progress but more often than not he was too busy focusing on the next priority to come through the door to think about those been and gone.
Susan, his colleague, nudged him out of the way and stripped off her gloves too. “That was exciting. Are you ever tempted to take a job in primary care? You could live in a cute small town where you’re caring for three generations of the same family. Grandma, Grandpa, parents and a big bunch of grandkids. You’d spend your day telling them to give up smoking and lose weight. Probably never see a drop of blood.”
“It was what my father did.” And Ethan had never wanted that. His choices were the focus of lively arguments whenever he was home. His grandfather kept telling him he was missing out by not following a family through from birth to death. Ethan argued that he was the one who kept them alive so that they could go back to their families.
“All these months we’ve worked together and I never knew that about you.” Susan scrubbed her hands. “So you come from two generations of doctors?”
They’d worked together for over a year but almost all their conversation had been about the present. The ER was like that. You lived in the moment in every sense.
“Three generations. My father and grandfather both worked in primary care. They had a practice in upstate New York.” He’d sat, five years old, in the waiting room watching as a steady stream of people trooped through the door to speak to his dad. There had been times when he’d wondered if the only way to see his father was to get sick.
“And your mother?”
“She’s a pediatrician.”
“Jeez, Black, I had no idea. So it’s in the DNA.” Susan yanked a paper towel from the dispenser so vigorously she almost removed it from the wall. “Well, that explains it.”
“That explains what?”
“Why you always act like you have something to prove.”
Ethan frowned. Was that true? No. It certainly wasn’t true. “I don’t have anything to prove.”
“You’ve got a lot to live up to.” She gave him a sympathetic look. “Why didn’t you join them? Doctors Black, Black and Black. That’s one hell of a lot of Black right there. Don’t tell me, you just love the warm fuzzy feelings that come from working in the emergency room.” Through the door they heard the woman yell fuck you and exchanged a wry smile. “All those cute patients enveloping you with endless love and gratitude—”
“Gratitude? Wait—I think that did happen to me once, a couple of years ago. Give me a moment while I cast my mind back.”
He didn’t feel as if he had to live up to anything.
Susan was wrong about that. He walked his own path, for his own reasons.
“You must have been hallucinating. Lack of sleep does that for you. So if the rare dose of gratitude isn’t what does it, it must be the patients who curse you, throw up on your boots and tell you you’re the worst doctor that ever graced god’s earth and that they’re going to sue the hell out of you. That works for you?”
The humor got them through days that were fraught with tension.
It sustained them through the darker shifts, through witnessing trauma that would leave the average man on the street in need of therapy.
Everyone in the trauma team found their own way of dealing with it.
They knew, as most people didn’t, that a life could change in an instant. That there was no such thing as a secure future.
“I love that side of it. And then there’s the constant buzz of working with adoring, respectful colleagues like you.”
“You want adoring? Pick a different woman.”
“I wish I could.”
Susan patted his arm. “In fact I do adore you. Not because you’re cute and built, although you are, but because you know what you’re doing and around here competence is as close as it gets to an aphrodisiac. And maybe that’s driven by a desire to be better than your daddy or your granddaddy, but I love it all the same.”
He shot her an incredulous look. “Are you hitting on me?”
“Hey, I want to be with a man who is good with his hands and who knows what he’s doing. What’s wrong with that?” Her eyes twinkled and he knew she was winding him up.
“We are still talking about work?”
“Sure. What else? I’m married to my job, same as you. I promised myself to the ER in sickness and in health, for richer and for poorer and I can tell you that living in New York City the emphasis is definitely on poorer. But don’t worry—I wouldn’t be able to stay awake long enough to have sex with you. When I leave this place I fall unconscious the moment I arrive home and I’m not waking up for anyone. Not even you, blue eyes. So if you’re not here for the love and positive feedback, it has to be because you’re an adrenaline junkie.”
“Maybe I am.” It was true that he enjoyed the fast pace, the unpredictability, the adrenaline rush that came with not knowing what would come through the doors next. Emergency medicine was often like a puzzle and he enjoyed the intellectual stimulation of figuring out where the pieces fit and what the picture was. He also enjoyed helping people, although these days the doctor-patient relationship had changed. Now it was all patient satisfaction scores and other metrics that appeared to have little to do with practicing good medicine. There were days when it was hard to stay in touch with the reasons he’d wanted to be a doctor in the first place.
Susan stuffed the towel into the bin. “Know what I love most? When someone comes in all bandaged up and you never know what you’re going to find when you unwrap it. Man, I love the suspense. Will it be a cut the size of a pinhead or will the finger fall off?”
“You’re ghoulish, Parker.”
“I am. Are you telling me you don’t like that part?”
“I like fixing people.” He glanced up as one of the interns walked into the room. “Problems?”
“Where do you want me to start? There are around sixty of them currently waiting, most of them drunk. We have a guy who fell off the table during his office party and hurt his back.”
Ethan frowned. “It’s not even December.”
“They celebrate early. I don’t think he needs an MRI but he’s consulted Dr. Search Engine and is insisting on having one and if I don’t arrange it he is going to sue me for every cent I’m worth. Do you think it would put him off if I tell him the size of my college loans?”
Susan waved a hand. “Ethan will handle it. He’s great at steering people toward the right decision. And if that doesn’t work he’s good at playing Bad Cop.”
Ethan raised an eyebrow. “Bad Cop? Seriously?”
“Hey, it’s a compliment. Not many patients get one past you.”
Backache, headache, toothache—all commonly appeared in the department, along with demands for prescription pain meds. Most of the experienced staff could sense when they were being played, but for less experienced staff it was a constant challenge to maintain the right balance between compassion and suspicion.
Still pondering the Bad Cop label, Ethan walked to the door but his progress toward the patient was interrupted by the arrival of another patient, this time a forty-year-old man who had suffered chest pains at work and a cardiac arrest in the ambulance. As a result, it was another thirty minutes before Ethan made it to the man with the back injury, by which time the atmosphere in the room was hostile.
“Finally!” The man stank of alcohol. “I’ve been waiting ages to see someone.”
Alcohol and fear. They saw plenty of both in the emergency room. It was a toxic mix.
Ethan checked the records. “It says here that you were seen within ten minutes of arriving in the department, Mr. Rice.”
“By a nurse. That doesn’t count. And then by an intern, and he knew less than I do.”
“The nurse who saw you is experienced.”
“You’re the one in charge so it’s you I want, but you took your sweet time.”
“We had an emergency, Mr. Rice.”
“You’re saying I’m not an emergency? I was here first! What makes him more important than me?”
The fact that he’d been clinically dead on arrival?
“How can I help you, Mr. Rice?” He kept it calm, always calm, knowing that in an already tense environment a situation could escalate with supersonic speed. The one thing they didn’t need in the department was a bigger dose of tension.
“I want a fucking MRI,” the man slurred. “And I want it now, not in ten years’ time. Do it, or I’ll sue you.”
It was an all-too-familiar scenario. Patients who had looked up their symptoms on the internet and were convinced they knew not only the diagnosis but every investigation that should be performed. There was nothing worse than an amateur who thought he was an expert.
And the threats and the abuse were just two of the reasons emergency room staff had a high burnout rate. You had to learn to handle it, or it would wear you down like the ocean wore away at rocks until they crumbled.
In the crazy period between Thanksgiving and Christmas, it was only going to get worse.
Anyone who thought it was the season of goodwill, should have spent a day working with Ethan. His head was throbbing.
If he’d been one of his patients, he would have demanded a CAT scan.
“Dr. Black?” One of the residents hovered in the doorway and Ethan gave him a quick nod, indicating he’d be there as soon as he could.
As attending physician, everyone looked to him for answers. Residents, interns, ancillary staff, nurses, pharmacists, patients. He was expected to know it all.
Right now all he knew was that he wanted to get home. It had been a long, miserable shift and that didn’t seem likely to change anytime soon.
He examined the man thoroughly and explained calmly and clearly why an MRI wasn’t necessary.
That went down as well as he’d thought it would.
Some doctors ran the tests because at least then the patient left happy. Ethan refused to do that.
As he listened to a tirade describing him as inhuman, incompetent and a disgrace to the medical profession, he switched off. Switching off his emotions was the easy part for him now. Switching them back on again—well, that was more of a challenge, a fact borne out by his disastrous relationship record.
He let the abuse flow over him, but didn’t budge in his decision. He’d decided a long time before that he wasn’t going to let his decision-making be ruled by bullying or patient satisfaction scores. He did what was best for his patients, and that didn’t include subjecting them to unnecessary testing or drugs that would have no impact or, worse, a negative impact on their condition.
“Dr. Black?” Tony Roberts, one of the most senior pediatricians in the hospital, was standing in the doorway. “I need your help urgently.”
Ethan issued instructions to the resident caring for the patient and excused himself.
“What’s the problem, Tony? You have an emergency?”
“I do.” Tony looked serious. “Tell me, do you believe in Santa Claus?”
“Excuse me?” Ethan gave him an incredulous look and then laughed. “If Santa existed, he’d probably threaten me for pointing out that not only should he lose a few pounds for the good of his health, but that if he intends to ride in a horse-drawn vehicle at an altitude in excess of thirty thousand feet he should probably be wearing a safety helmet. Or at least leathers.”
“Santa in leather? Mmm, me likey,” Susan murmured as she passed on her way to speak to the triage nurse.
Tony grinned. “Just the cynical answer I expected from you, Black, which is why I’m here. I am going to give you an opportunity you never thought would come your way.”
“A year’s sabbatical in Hawaii on full pay?”
“Better. I’m going to change your life.” Tony slapped him on the shoulder and Ethan wondered if he should point out that after a shift in the ER it wouldn’t take much to knock him flat.
“If I don’t get to the next patient fast, my life will be changed. I’ll be fighting a lawsuit. Can we make this quick, Tony?”
“You know Santa visits the children’s ward every Christmas?”
“I didn’t, but I do now. That’s great. I’m sure the kids love it.” It was a world far removed from the one he inhabited.
“They do. Santa is—” Tony glanced around and lowered his voice. “Santa is actually Rob Baxter, one of the pediatricians.”
“No kidding. And I thought he was real.” Ethan signed a request that an intern thrust under his nose. “That’s the last of my illusions shattered. You have broken my heart. I might have to go home and lie down.”
“Forget it.” Susan was passing again, this time in the other direction. “No one lies down in this place. Unless they’re dead. When you’re dead, you get to lie down and only after we’ve tried to resuscitate you.”
Tony watched her go. “Is she always like this?”
“Yes. Comedy is all part of the service. Laughter cures all ills, hadn’t you heard? What did you want, Tony? I thought you said it was an emergency.”
“It is. Rob Baxter ruptured his Achilles running in Central Park. He’s going to be off his feet until after Christmas. This is close to a crisis for the pediatric department, but even more of a crisis because he is Santa and we don’t have a backup.”
“Why are you telling me this? You want me to take a look at his Achilles? Ask Viola. She’s a brilliant surgeon.”
“I don’t need a surgeon. I need a backup Santa.”
Ethan looked at him blankly. “I don’t know any Santas.”
“Santas are made, not born.” Tony lowered his voice. “We want you to be Santa this year. Will you do it?”
“Me?” Ethan wondered if he’d misheard. “I’m not a pediatrician.”
Tony leaned closer. “You may not know this, but Santa doesn’t actually have to operate or make any clinical decisions. He smiles and hands out presents.”
“Sounds like my average working day,” Ethan said, “only here they want you to hand out MRIs and prescription pain meds. Gift-wrapped Vicodin is this year’s must-have.”
“You are cynical and jaded.”
“I’m a realist, which is precisely why I’m not qualified to deal with wide-eyed children who still believe in Santa.”
“Which is exactly why you should do it. It will remind you of all the reasons you went into medicine in the first place. Your heart will melt, Dr. Scrooge.”
“He doesn’t have a heart,” Susan muttered, eavesdropping shamelessly.
Ethan glanced at her in exasperation. “Don’t you have patients to see? Lives to save?”
“Just hanging around to hear your answer, boss. If you’re going from Scrooge to Santa, I need to know about it. In fact, I want to be there to watch. I’d work Christmas just to see it.”
“You’re already working Christmas. And I’m not qualified to be Santa. Why would you think I’d agree to this?”
Tony looked at him thoughtfully. “You get to make a child’s day. It doesn’t get any better than that. Think about it. I’ll call you in a week or so. It’s an easy and rewarding job.” He strode out of the department, leaving Ethan staring after him.
“Dr. Scrooge,” Susan said. “How cute is that.”
“Not cute at all.” Surely Tony couldn’t be serious? He was the last person in the world who should play Santa with wide-eyed believing children.
He noticed one of the interns hovering. “Problems?”
“Young woman with an ankle injury. Badly swollen and bruised. I’m not sure whether to x-ray or not. Dr. Marshall is busy or I would have asked him.”
“Is she on the hunt for Vicodin?”
“I think she’s genuine.”
Because Ethan knew the young doctor didn’t have the experience to know if someone was genuine or not, he followed him through the department. Vicodin was an effective painkiller. It was also a commonly used recreational drug, and he’d ceased to be surprised at the lengths some people would go to get a prescription. He didn’t want anyone dispensing strong painkillers to someone who was simply hoping to get high from Vicodin.
His first thought when he saw her was that she was out of place among the rainbow of humanity that decorated the halls of the emergency room on a Saturday night. Her hair was long, and the color of creamy buttermilk. Her features were delicate and her mouth was a curve of glossy pink. She was wearing one shoe with a heel so high it could have doubled as a weapon. The other she held in her hand.
Her ankle was already turning blue.
How did women expect to wear heels like that and not damage themselves? That shoe was an accident waiting to happen. And although she seemed normal enough, he knew better than to let appearances dull his radar for trouble. A few years before, a student had presented with toothache, which had turned out to be a way to get pain meds. She’d overdosed a few days later and been brought into the emergency room.
Ethan had been present for her second visit, although not her first. It was a lesson he’d never forgotten.
“Miss Knight? I’m Dr. Black. Can you tell me what happened?”
It must have been a great party, he thought as he examined the ankle.
“I twisted it. I’m sorry to bother you when you’re so busy.” She sounded more than a little embarrassed, which made a change from the two patients he’d seen immediately before her, who had taken his care as their God-given right.
He wondered what she was doing here on her own on a Saturday night. She was all dressed up, so he doubted she’d spent the evening on her own.
He guessed she was mid to late twenties. Thirty possibly, although she had one of those faces that was difficult to put an age to. With makeup she could look a little older. Without, she could pass as a college student. Her eyes were blue and her gaze warm and friendly, which made a refreshing change.
Generally speaking, he didn’t see a lot of warm and friendly during his working day.
“How did you twist it?” Understanding the mechanism of the injury was one of the most helpful ways of piecing together a picture of the injury. “Dancing?”
“No. Not dancing. I wasn’t wearing shoes when I twisted it.”
He watched in fascination as her cheeks reddened.
It had been a while since he’d seen anyone blush.
“So how did you do it?” Realizing she might think he was after details for his own entertainment, he clarified. “The more details you give me, the easier it is for me to assess the injury.”
“I jumped from a window. It wasn’t far to the ground but I landed awkwardly and my ankle turned.”
She’d jumped from a window?
“You’re a bit of a risk-taker?”
She gave a wry smile. “My idea of risk is reading my Kindle in the bath so no, I don’t think I’d describe myself as a risk-taker.”
Ethan’s senses were back on alert. Instead of thinking possible addict, or potential adrenaline junkie, he was thinking possible abuse victim. “So why did you jump?” He softened his tone, trying to convey with his voice and actions that he could be trusted.
“I needed to get away from someone.” She must have seen something change in his expression because she shook her head quickly. “I can see what you’re thinking, but I wasn’t being threatened. It really was an accident.”
“Jumping from a window isn’t usually an accident.” Unless she was intoxicated, but he didn’t smell alcohol and she seemed perfectly composed. More composed than most of the people around her. The ER on a Saturday night wasn’t a pretty sight. “Why not leave by the front door?”
Her gaze slid from his. “It’s a long story.”
And one she obviously didn’t intend to share.
Ethan thought through his options. They saw plenty of domestic abuse incidents in the ER, and they had a duty to offer a place of safety and whatever support was needed. But he’d also learned that not everyone wanted to be helped. That it was a process. “Miss Knight—”
“You don’t need to worry. I was on a date, if you must know, and it wasn’t going well. My mistake.”
“You jumped to get away from your date?”
She stared at a point beyond his shoulder. “He wasn’t exactly the way his profile described him.”
“You’d never met him before?” And now he was thinking trafficking. And maybe he’d been wrong about her age and she was closer to twenty than thirty.
He checked the form and saw from her date of birth that his first guess had been the correct one. She was twenty-nine.
“I was trying online dating. It didn’t go quite the way I thought it would. Oh, this is so embarrassing.” She rubbed her fingers over her forehead. “He lied on his profile, and I didn’t even realize people did that. Which makes me stupid, I know. And naive. And yes, maybe it also makes me a risk-taker, even if I’m an unintentional risk-taker. And I’m horribly bad at it.”
He was still focused on her first words. “Lied?”
“He used a photo from thirty years ago and claimed to be all kinds of things he wasn’t.” She squared her shoulders. “I found him a little creepy. I had a bad feeling about the whole thing so I decided to make an exit where he couldn’t see me. I didn’t want him to follow me home. You don’t need to hear this, do you?” She leaned down to rub her ankle and her hair slid forward, obscuring her features.
For a moment he stared at it, that curtain of shiny gold.
He breathed in a waft of her perfume. Floral. Subtle. So subtle he wondered if what he was smelling was her shampoo.
He never became emotionally involved with his patients. These days he didn’t become emotionally involved in anything much, but for some reason he felt a spurt of anger toward the nameless guy who had lied to this woman.
“Why the window?” He dragged his gaze from her hair and focused on her ankle, examining it carefully. “Why not go out through the front door? Or even the kitchen or the rear entrance?”
“The kitchen was in sight of our table. I was worried he’d follow me. And to be honest I wasn’t thinking about much except getting away. Pathetic, I know. Is it broken?”
“It doesn’t seem to be.” Ethan straightened. The injury was real enough. Her hurt was real enough, and he suspected it extended a whole lot further than a bruised ankle. “I don’t think you need an X-ray, but if it gets worse you should come back or contact your primary care provider.”
He waited for her to argue with him about the need for an X-ray, but she simply nodded.
“Good. Thank you.”
It was such an unusual response he repeated himself to check she’d heard him correctly. “I don’t think an X-ray is necessary.”
“I understand. I probably shouldn’t have wasted your time, but I didn’t want to make it worse by doing something I shouldn’t. I’m grateful to you, and I’m relieved it isn’t broken.”
She was accepting his professional judgment just like that?
No arguing? No cursing? No questioning him or threatening to sue him?
“You can use whatever pain meds you have in your cabinet at home.”
This was the point where a large proportion of his patients demanded something only available on prescription.
Or maybe he really was turning into a cynic.
Maybe he needed a vacation.
He had one coming, the week before Christmas. A week in a luxury cabin in Vermont.
He met up every year with family and friends and this year he needed the break more than ever. He loved his job but the relentlessness and the pressure took its toll.
“I don’t need pain meds. I wanted to check it isn’t broken, that’s all. I walk a lot in my job.” She gave him a sweet smile that fused his brain.
In his time in the ER he’d dealt with panic, hysteria, abuse and shock. He was comfortable with all those emotional reactions. He even understood them.
He had no idea how to respond to a smile like hers.
She struggled to her feet and he had to stop himself from reaching out to help her.
“What’s your job?” The question had clinical relevance. Nothing to do with the fact that he wanted to know more about her.
“I run a dog-walking business. I need to be able to get around and I don’t want to make it worse.”
A dog-walking business.
He looked at the freckles that dusted her nose.
He could imagine her walking dogs. And believing in Santa.
“If dog walking is your livelihood, you might want to steer clear of stilettos in the future.”
“Yes, it was a stupid idea. A whim. I’ve been trying to do things I don’t normally do, and—” She broke off and shook her head. “You don’t need to hear this. You’re busy and I’m taking up your time. Thank you for everything.”
This one patient had thanked him more in the past five minutes than he’d been thanked in the past five weeks from all his other patients combined.
Not only that, but she hadn’t questioned his clinical judgment.
Ethan, who was never surprised by a patient, was surprised.
And intrigued.
He wanted to ask why she’d been trying to do things she wouldn’t normally do. Why she’d chosen to wear stilettos. Why she’d had dinner with a man she’d met online.
Instead he kept it professional. He talked to her about rest, ice, compression and elevation, the whole time feeling guilty that he’d doubted her.
He wondered when, exactly, he’d started being so suspicious of human nature.
He definitely needed a vacation.