All I want for Christmas is … Inappropriate
Leonard McCoy strode into the University of Iowa Hospital Emergency Department just before seven thirty in the evening on Christmas. A year ago, he would’ve done anything—anything—to get out of a Christmas shift. Not just because anyone who came to the hospital on Christmas probably really had something serious going on, but because it was a family time.
But that was when he had a family.
Jocelyn wasn’t answering the phone. Len even tried calling from a pay phone, which he hadn’t realized how hard it would be to find, in case she was just blocking his calls. He tried all her numbers, plus his ex-in-laws’ number, but nobody answered anywhere. She was just plain shutting him out, viciously not allowing him to speak to his daughter on her favorite holiday.
He wondered, as he started looking through the charts of the patients in the various exam rooms, what Jocelyn was telling Joanna about why she hadn’t gotten to speak to her father today.
Or, even worse, maybe Joanna hadn’t noticed that she hadn’t talked with Daddy on Christmas.
Sure, Len thought, I fucked up bad. Real bad. But does my one affair trump Joce’s three, just because mine happened to be with a man? Hell, her affairs were all with men, too.
Len resolved to speak with his lawyer, first thing after the holidays, because no matter what was happening in Georgia, no matter why his daughter was being kept from him, it was unacceptable.
Their initial custody agreement had been based on the assumption that Leonard wouldn’t be leaving the Atlanta area. He certainly hadn’t planned to. At first, Jocelyn’s father, the director of the hospital Len was working at, had fired Leonard—without any reason except personal conflict, which Leonard couldn’t disagree with. But then, her father had spread vicious and untrue rumors about him, seemingly to every hospital in the state, and Leonard had had to leave Georgia to find employment.
“Merry Christmas, Len!” said a hearty voice from behind Len’s seat at a computer terminal.
Leonard jumped a foot in the air.
“Jesus, Jacob,” Len sighed. “You have to stop doing that!” He spun his chair around to see Jacob Steinhart, the doctor he was about to take over from.
“But it’s so much fun!” Jacob said. “And whoops, I see you’re not in the mood. Sorry.”
“Never mind,” Len said. “So what’s on deck? Room twelve looks potentially problematic.”
“He’s waiting on the cath lab,” Jacob said. “Room eight needs some sutures—sorry I didn’t get to it, but the guy in twelve came in just at the wrong time.”
“No problem,” Len said. “Any spectacularly stupid Christmasy accidents that’ll cheer me up?”
Jacob didn’t hesitate. “Oh yeah. This guy was deep-frying his turkey, and—”
“Wait wait, don’t tell me—he dropped a frozen turkey in the hot oil?”
“No, that’s so last year. He sloshed oil on the deck, and slipped and cracked his head open on the deck rail.”
Leonard frowned. “That’s not all that spectacular.”
“Oh, but I didn’t finish. He fell right near the stairs to the yard, and grabbed the railing to try to stay upright. It didn’t work. There was a Santa of some sort on the railing, and he caught his hand in the sleigh and ended up with a compound fracture of the radius and ulna, on top of a concussion and thirty staples in his head.”
Len whistled. “Okay, now that’s a Christmas to remember. Or maybe not, if he got any amnesia with the concussion. Wow.”
“Well, let’s hope you don’t get any that top that one,” Jacob said. “Anyhow—I have a date with the wife and kids for Chinese, so I’m outta here. Good luck tonight.”
“Thanks,” Len said. “Have a good night.”
Leonard finished looking over the charts, and talked to the charge nurse briefly. He checked on the cardiac patient in twelve, who was stable for the moment. The clot-busting medication that Dr. Steinhart had given didn’t seem to be doing the trick, so the patient was waiting his turn for balloon angioplasty.
“Julianna, can you come into eight in a second and set me up for sutures?”
“Sure—I just finished discharging six, so I’m all yours,” the nurse said.
He knocked on the wall outside of room eight, where a patient was awaiting sutures to a sliced hand.
“Yep,” the patient said, and Len pulled the curtain back.
“Mr. Swanson? I’m Dr. McCoy—I just took over from Dr. Steinhart, and I’ll be taking care of your stitches.”
“It’s about time,” the patient griped. “I’ve been here for like three hours.”
Len didn’t bother mentioning that on most nights, the wait would be even longer.
“Sorry about the wait, but another patient came in who was really sick. In any case, I’ll do your sutures right away.”
“Yeah, okay. So, uh, how does this work? I can’t say I like the idea of, uh, getting a sewing needle stuck in and out and in and out of my hand.” The patient’s face was suddenly several shades paler than it had been when he was complaining about the wait.
“I’ll numb the area with a few shots of lidocaine. I’m not gonna lie—that stuff stings like the dickens when it goes in, but only for a few seconds. Then, once it’s working, you won’t feel a thing when I stitch up that hand. Okay?”
“I guess,” the man said. A sheen of sweat appeared on his upper lip. “How many stitches do you think I’ll need?”
Leonard examined the wound carefully. “Five or six.”
“Oh God,” the patient said, flopping back in his bed, just as the nurse arrived and started getting out the supplies.
“Let’s get this over with, why don’t we,” Len said.
“Okay,” the man said weakly. “Sorry if I pass out. I’m really a wimp when it comes to this stuff.”
“It’ll be fine,” Leonard said. “It’s just a few stitches. Lidocaine, please, nurse.”
Julianna handed him the syringe, and Leonard gently prepped the areas where he’d be putting the local anesthetic in.
“Ow ow ow!”
Leonard bit back an annoyed noise that he really would have preferred to let out.
“I’ll try to make this quick,” he said instead.
He held the man’s hand gently at the wrist, and put in the first shot. He had to be less gentle at the wrist when the man nearly yanked his hand away as he yelled.
Leonard gritted his teeth. “Mr. Swanson, you’re going to need to try to hold still.”
“All right, all right! I’m trying!”
Like hell you are, Len thought, as he grasped the man’s wrist firmly before putting in the next shot.
“Ow ow! Fuck! That stings like a motherfucker!”
And I’ve seen four-year-olds who tolerate this a lot better than you, Len thought. Maybe a teddy bear would help. He put the next two shots in as quickly as he could, and set the syringe down on the tray.
“All right—that’s the worst part done. The anesthetic needs to work for ten minutes or so, and then I’ll be back to put in the stitches. Okay?”
“And that won’t hurt, right? You said it wouldn’t hurt, after the shots.”
“That’s right. If you feel anything, I can always add a little more lidocaine, but I don’t think you’ll need it.”
“Okay,” the patient said shakily.
“See you in ten,” Leonard said, yanking the curtain shut on his way out.
He returned to his computer terminal, and gently beat his head against the desk a few times.
“Unbefuckinglievable,” he muttered to himself. He typed a brief note into Mr. Swanson’s chart, just barely restraining himself from using any subjective language. As he finished, the radio console behind him came to life.
“UI Hospital, please pick up for Riverside Ambulance.”
Leonard turned around, and picked up the handset.
“Go ahead, Riverside.”
“BLS crew on scene with a male patient, age twenty-six, conscious and breathing, but not alert per normal, with a fever of one-oh-two point five and severe vomiting and diarrhea for twelve hours. He had a brief loss of consciousness following a bout of vomiting at home, after which the family called 9-1-1. Last vomitus contained bright red blood. He has a history of stomach flu beginning seven days ago and ending two days ago. Three other family members are also ill, and are arriving separately by car. Pulse is 120 and thready, BP is 80/50, and respirations were twenty-four, decreasing to eighteen with four liters O2 by nasal cannula. Occasional arrhythmias have been noted on the monitor. IV attempted times two unsuccessfully. ETA twenty-five minutes. Please advise.”
Leonard frowned. This guy really needed fluids, and he needed them now. But since they had only a Basic Life Support crew, more invasive interventions weren’t on the table.
“One more IV attempt, Riverside, then get on the road. Get me a blood glucose level, and update in five minutes.”
“Copy, UI: attempt IV once more, BGL, and update in five. Riverside out.”
Leonard drummed his fingers on the desk, and waited for the ambulance to get back to him. The timing was going to be tricky—he didn’t want to rush his way through Swanson’s stitches, but he needed to be available when the ambulance from Riverside came in with this patient.
He stood up, and went to find Julianna. She was in the process of triaging an incoming patient, an elderly woman who looked like she might have broken her wrist. He signaled to the nurse that he needed her.
“Excuse me a moment,” Julianna said to the patient and her husband, who was hovering anxiously.
“Sorry to interrupt, but Riverside is bringing us an unstable dehydration patient who’s going to need my attention as soon as they roll in. Can you let me know the minute room eight is ready for those stitches?”
“Sure. Can you write an order for x-rays for this patient?”
“Yep. Just the wrist?”
“Okay. Send me the chart when you’re done, and I’ll write the orders.”
“Thanks,” Julianna said. “Looks like it’s gonna be one of those nights.”
“For sure,” Len said. “The dehydration patient has three other ill family members, all coming in by car.”
“Terrific. I’ll be ready for them.”
The radio station came to life again.
“UI, from Riverside.”
Len hurried to the radio.
“Go ahead, Riverside.”
“Third IV attempt unsuccessful. Patient’s BGL is thirty-one. Attempted oral glucose, but patient was unable to tolerate and vomited twice. BP 78 palp, pulse 122 and thready, with arrhythmias noted on monitor approximately twice per minute. Respirations twenty. Please advise.”
“Expedite your response. Update if there are any changes.”
“Copy that, UI. Going hot, and updating upon changes.”
Leonard heard the sirens kick in just as the ambulance’s transmission ended. He was worried about this patient. In an ideal world, he’d have a paramedic—the most advanced level of EMT—in the rig with him, who could do a 12-lead EKG, and determine what kind of arrhythmias the patient was having. And, a paramedic could also drill a catheter into a bone for emergency fluid delivery, which, at this point, he would have ordered for this patient. But it wasn’t an ideal world. Riverside was a small town, with a volunteer ambulance service.
He quickly wrote up the orders for the elderly woman’s x-rays, and waited for an update from Riverside’s volunteer ambulance crew.
“Dr. McCoy?” Julianna said, sending Len a foot in the air again. “Sorry.”
“No, it’s my fault. What’s up?”
“Eight’s ready for his sutures.”
“Right—thanks. Can you keep an ear on the radio? Riverside’s patient isn’t sounding so good.”
Leonard returned to room eight, and gloved up. “You ready to get sewn up, so you can get out of here?”
“You bet. It’s not gonna hurt, right?” The patient’s eyes darted nervously to the suture tray.
“It shouldn’t. You’ll feel pressure and pulling, but you shouldn’t feel any pain. Some people prefer not to see what’s going on,” Len said, “so feel free to close your eyes or look away.” He knew he’d be dealing with justifiable puking soon enough, and didn’t really need any as a warm-up. “If you feel any pain, let me know if it’s intolerable, and I can add some more lidocaine.”
“Okay. Uh, let’s get this over with.” Swanson closed his eyes tightly.
Leonard started stitching.
“Uh, did that truly hurt?” Leonard asked, surprised by the outburst.
“Um … no, I just thought it was going to.”
Len continued his work. It was just a laceration to the meat of the thumb, caused by a slip of a knife, but he didn’t want to leave any more of a scar than was necessary. Six careful sutures later, he inspected his work, and was satisfied.
“All done, Mr. Swanson.”
The man opened his eyes. “Really? That wasn’t so bad. Thanks, Doc!”
“You’re welcome. Now—the nurse will give you your discharge instructions—how to take care of the stitches, and when to get them out. Take care, and I hope the rest of your holiday is pleasant.”
“Thanks. You too. But you’re probably stuck here all night, huh?”
“It’s all right. I’m new in town, so I’m not missing anything tonight.” Except my beautiful daughter, Len thought. “Take care, now,” he said, as he exited the treatment room.
“What’s the news from Riverside?” he asked.
“Riverside reports no change,” the nurse said. “ETA is now seven minutes. And Cardiology just picked up room twelve.”
Len finished Swanson’s charting, and used the bathroom, because Lord only knew when he’d get another chance, with a whole family coming in with what sounded like a nasty case of food poisoning.
Just as Len emerged from the restroom, he heard the beeping of a rig backing up in the ambulance bay. The doors whooshed open, letting in a blast of cold air, and the Riverside EMTs wheeled the patient in. The unignorable smell of a violently ill patient followed shortly afterwards.
“This is Jim Kirk; since our last report he’s become markedly more lethargic,” the EMT said, handing the nearby nurse the middle copy of the paperwork she’d done en route.
“Room two,” the nurse said.
They wheeled the gurney into the small room, and the four of them—the two EMTs, Len, and the nurse—worked together to transfer Jim onto the bed. An aide stripped away and bagged the patient’s soiled clothing, and cleaned him up a bit as Dr. McCoy started examining the patient, who was too lethargic to protest being stripped.
Len leaned towards the patient, whose eyes were closed.
The young man’s eyes struggled opened, and Len was immediately struck by their sapphire-blue color, sharp even through the haze of severe dehydration.
“Mr. Kirk, I’m Dr. McCoy. Do you know where you are?”
The patient’s eyes started to slide shut again.
“Mr. Kirk! Jim! Come on, now; I need you to stay with us.”
The patient didn’t open his eyes. Len grabbed him firmly by the muscle between his shoulder and his neck, and squeezed hard, to try to get a pain response. The patient moaned and tried to pull away slightly, but didn’t open his eyes.
“Nurse, IV pack, Ringer’s. And get him on a twelve-lead.”
Len surveyed the fellow’s arms, as the nurse started applying electrodes to the patient’s chest. With his BP in the toilet the way it was—along with a good percentage of his body weight, Len guessed—it was no surprise that the EMTs had had a hard time starting the IV, but Len knew he could do it. And he would have to—he could tell from the way the patient’s skin felt cold and clammy that he was getting shockier by the minute.
He pumped a BP cuff up on the guy’s left arm, and was able to palpate a vein that might just work. He held his breath as he pulled the too-loose skin tight, trying to anchor the vein so it wouldn’t roll, and slid the needle in. He saw the flash of blood, and released his breath as he pulled the needle, leaving the catheter in place. He hooked the bag of fluid up to the catheter, and set the valve to wide open, so the fluid would drip in as quickly as possible.
Just as he finished starting the IV, the patient vomited, and started coughing, but only weakly.
“Suction!” Len called, and a nurse used a wall-mounted suction device to remove the vomit from the patient’s upper airway.
“Ms. Sanders, I need a bolus of D25W,” he said. “We’ve gotta get this guy more alert so he can protect his airway.”
The nurse quickly handed him a large syringe filled with the sugar solution. Len pushed it through the IV port, and then flushed it with saline.
Len tried again to rouse his patient.
“Mr. Kirk? Can you open your eyes?”
The startlingly blue eyes opened, and this time, stayed that way. He blinked a few times, looking back and forth between the nurse and Len. His eyes settled on Len.
“I’m so fucked up,” he said hoarsely.
“You’re pretty sick,” Len said. “Can you tell me what’s been going on?”
“Puked all day. Had the runs all day. Feel like crap.”
“Did I hear right that you were sick last week, too?”
The young man nodded. “Yeah. Nothing like this, though. That was just a bug. This is … this is total hell. And oh shit, look out.”
“What?” Len asked, stupidly looking behind him. But it was too late. The patient leaned forward reflexively as his abdominal muscles did their part in making him vomit. On Len’s white coat.
The nurse grabbed a sickly yellow plastic basin to catch the rest. Once the heaves had subsided, the patient flopped, panting, back onto the raised bed, face pale and sweaty.
“Sorry,” the patient croaked out.
“It’s all right,” Len said mildly. There were indeed flecks of blood in the vomit on his coat, but it was bright red blood. From the small quantity, it was probably just a burst vessel from violent vomiting, and nothing more sinister.
“The EMTs said other people in your family are sick as well?” Len said.
“Yeah. Mom, brother, sister-in-law. Kids are okay. Oh shit!”
This time, the basin was handy. Jim Kirk dry-heaved several times, and lay back again, panting.
Len watched the cardiac monitor as Jim lay there, sweating and shaking. He saw several PVCs go by during the bout of vomiting, and the patient’s heart rate remained markedly elevated. Len didn’t like it—not one bit.
“Jesus. Fuck this. You gotta help me, Doc.”
“You’ve got an IV, which will get you rehydrated. I’m ordering some blood work to check on a few things, like your electrolytes and your kidney function. And I gave you something to boost your blood sugar, which was pretty low. That helped with your alertness, but I’m afraid there’s really nothing I can do about the vomiting at the moment,” Len said. He desperately wanted to make it all stop, but antinausea meds were generally contraindicated in suspected food poisoning. He watched the monitor again, and saw another PVC.
“What was that?” Jim said in alarm, clutching his chest.
“Tell me what you felt,” Len said.
“It was like my heart stopped for a second!”
The kid looked absolutely terrified.
“You’re having some arrhythmias—irregular heartbeats—probably from the dehydration. Have you ever had anything like that before?”
“No! Oh man, am I having a heart attack? I can’t be! I’m only twen—”
Jim’s imploring speech was interrupted by another bout of retching, which brought up watery bile and some more blood. His heart rate shot up to nearly 150, and his eyes were darting around wildly.
“It’s not a heart attack. I promise,” Len said. “The IV fluids should help soon. Listen—let’s get you a second IV, okay? To move things along a little.”
“Whatever you say, Doc. ’Cause this totally sucks.”
The nurse set another IV pack on the tray next to the bed.
“Doctor, do you want me to put the IV in?” the nurse asked.
“No no!” Jim said, flailing to grab Len’s arm. “No, you do it, Doc—please!”
“All right,” Len said soothingly. The kid was scared to death, and Len’s heart was breaking for him. “I’ll do it, okay? You try to relax, okay? Slow breaths, in through your nose, out through your mouth.”
Len watched as the patient took a few breaths, and noticed that the guy’s attention kept turning to the steadily-beeping cardiac monitor. He reached up and shut down the volume control for the heart-rate function, eliminating the constant frantic echo of the patient’s elevated heart rate. With that noise gone, and after a few calming breaths, the patient’s heart rate went down to 120—still tachycardic, but better than 140.
“Good,” Len said. “That’s real good, Mr. Kirk. Now, I’ll start that other IV. Like I said, it won’t stop the vomiting, but rehydration should help with the irregular heartbeats.”
“Jim,” the guy said.
“Okay, Jim,” Len said, as he pumped up a BP cuff on Jim’s right arm. The two best places for an IV had already been tried by the EMTs, but there was a vein in the back of his right hand that looked all right.
“Sorry, this is going to sting,” Len said, as he prepped the spot he’d chosen.
“I usually pass out when people stick me with needles, but I prob’ly won’ even notice,” the kid slurred, exhaustion taking over as the panic subsided.
Another nurse came to the entrance of the room. “Dr. McCoy, the other sick family members are here.”
“All right—you two triage them and get them set up in rooms, and I’ll come have a look when things are more stable here.”
The two nurses left the room, leaving Len with the patient. Len finished prepping the back of Jim’s hand, and stuck the vein with the needle. He swore silently as he had to fish around until he got the catheter well placed. Once it was in, he taped everything down, and hooked up another bag of fluids, letting it run wide open.
“Jim, I’m gonna go have a look at—”
The kid lurched forwards again, and added some more watery bile to the emesis basin he held in his lap. Leonard found himself holding Jim’s head, and gently pushing the hair off his sweaty forehead.
“Okay?” he said gently when the round of heaving was over.
“Fuck no,” the kid groaned, and Leonard couldn’t help grinning at the total honesty of the remark as he wet a washcloth and gently wiped his patient’s face. He also couldn’t help noticing that behind the day’s worth of stubble, the hollow cheeks, and the sunken eyes, Jim was extremely good-looking.
Len had to get out of there. Fast. And not because of the smell.
“Jim, I’m gonna go have a look at your family, all right?”
“They’re gonna wanna know how you’re doing. Can I talk to them about you?”
“Course. Family,” Jim said.
“Didn’t want to assume. You rest up, as best as you can.”
“You comin’ back?”
“Of course. I have a couple more patients to look in on, but I promise, I’ll come back soon to check on you.”
Len watched as Jim lay back and closed his eyes. When he realized he was no longer watching with a physician’s eyes, but with … something else entirely, he scowled at himself, left the room, and yanked the curtain shut angrily on the way out.
The triage nurse caught him as he started washing his hands at one of the sink stations.
“I’ve got the rest of the Kirks in one, three, and four. They’re all stable, but miserable. The mom’s in one—she’s the next worse off, and she also thinks she knows what did this.”
“Got it,” Len said. “I’ll go talk to the mom.” He dried his hands on some paper towels, and tossed them in the trash. He entered room one, just as a mid-fiftyish woman retched into her own yellow basin.
The woman nodded as Len scanned the chart.
“I’m Dr. McCoy. It sounds like your whole family maybe ate something that’s making you sick.”
“How’s Jim?” she asked, clearly having only one thing on her mind at the moment. “He was so sick.”
“Better. He was dangerously dehydrated, and his blood sugar was low, but he’s more alert now. He’s got two IVs in, for rehydration and electrolytes. He’s looking better.”
Mrs. Kirk sighed in relief. “Thank goodness. He passed out in the bathroom, so I called 9-1-1. None of the rest of us are nearly as sick as Jim, but we figured we should all come in and get checked out, since he’s so bad and we probably all have the same thing.”
“Did you all get sick at the same time?”
Mrs. Kirk nodded, but then hesitated.
“Well … Jim was throwing up before the rest of us this morning, but honestly I just thought he was hung over. I’m afraid I wasn’t very sympathetic. I yelled at him for making himself sick by drinking too much so soon after his stomach bug last week,” she said. The tears squeezing through the corners of her eyes proved she wasn’t nearly as dehydrated as Jim.
“He’ll be all right,” Dr. McCoy said gently. “Let’s talk about you for a moment. It looks like you’re feeling pretty sick, but all your vital signs are in the normal range except for the fever you’re running. I’m going to have a nurse get you an electrolyte drink—like a sports drink, really—to sip on very, very slowly. You may still vomit, but most people in your situation can do well with oral rehydration therapy. Do you think you can try that?”
“I’ll try,” Mrs. Kirk said wanly. “And … ah, is there a restroom nearby?”
“Right across the hall.”
Mrs. Kirk raced out of the room. Len made a note in her chart on the laptop in the room, and went over the charts for the other two family members while he waited for her to return.
“Sorry,” Mrs. Kirk said.
“Not a problem. The nurse who admitted you said you had an idea about what might have caused this illness?”
Mrs. Kirk nodded. “Yes—you see, only the adults got sick. The children—Sam’s boys—are fine. The only thing we could think of that we all had, but they didn’t, was the neighbors’ homemade spiked egg nog that all us adults indulged in last night. So I think there must’ve been something wrong with the brandy they put in it, if that’s even possible.”
“Nope,” Len said dryly. “Raw eggs. Salmonella. Classic. Nobody should ever eat raw eggs. Or drink them, for that matter. Ever.”
“But the eggs were fresh!” Mrs. Kirk protested. “The Petersens have their own chickens, and they would’ve just gotten the eggs that morning! I know you’re not really supposed to have raw eggs, but honestly, we all thought that was just because you never knew how long grocery store eggs have been sitting around by the time you get them! That’s why I thought it had to be the brandy, somehow.”
Len shook his head. “Doesn’t matter. Even the freshest eggs can already be contaminated. Which it seems you’ve all learned the hard way.”
The bathroom door opened and closed again across the hallway—probably another Kirk, Len thought.
“Now I feel so stupid,” Mrs. Kirk said.
Well, you should, Len thought. “It would be a good idea to call your neighbors—to see if they’re sick, too.”
“Oh, God,” Mrs. Kirk said, burying her face in her hands. “They’ll feel awful if it turns out to be the eggnog. Which I suppose we’ll never know for sure. But if they’re sick too, I’d put money on it being the eggnog.”
“I’d pretty much put money on it at this point anyhow,” Len said. “I’ll have the nurse bring you the electrolyte drink. You’ll probably feel terrible for a few days, but there’s no reason you shouldn’t go home tonight if you can keep even a little liquid down.”
“All right,” Mrs. Kirk said. “Honestly, we wouldn’t normally come to the hospital for something like this—it’s just that Jim was so, so sick, and we figured we all had the same thing.”
“Did anyone else in the family have the stomach bug he had last week?” Len asked.
“Just Jim,” Mrs. Kirk said. “Is that why he’s so much sicker than everyone else?”
“Hard to say,” Len said, “but it’s certainly possible. And right now, I need to check on the rest of your family. So you try to rest, and the nurse will bring you the drink.”
“All right. Thank you, Dr. McCoy.”
“You’re welcome. No more raw eggs. Ever.”
Leonard got much the same story from the two other Kirks, Jim’s brother Sam, and Sam’s wife Aurelan, when he visited the other two rooms. He had the nurses get stool samples from all four patients—a task he was happy to pass the buck on—to send to the lab to confirm his tentative diagnosis of salmonellosis. He ordered the electrolyte drink for Sam and Aurelan, and, after washing his hands for what seemed like the millionth time, sat down at the computer to write a note in each patient’s chart. He checked on the elderly woman, whose wrist was indeed fractured, gave her a small dose of painkillers, and wrote a note for the on-call orthopedist, who was still in surgery from a car accident earlier that day.
Len decided to try to call Joanna one last time, even though it was late enough that she should’ve been sleeping for hours. Once again, his call seemed to be blocked or ignored. He shoved his phone back in his pocket again in disgust, and did his best to return his mind to his work.
The patient in room twelve had been admitted to the Cardiac ICU, and Mr. Swanson and his stitches were on their way home. Len sat at the desk for another minute, wondering why he was putting off going to check up on Jim Kirk.
For some reason, he was finding it harder to go see him than it was to look in on Swanson, or, on his last shift, a homeless guy who’d ODed on heroin, or, on the shift before that, the skinhead who’d gotten the swastika tattoo on his scalp sliced open with a broken beer bottle and was tweaked out on meth to boot.
There was nothing for it, though. Jim Kirk was currently the sickest patient in the ED, and needed his attention. So Len rubbed his eyes—was it really only ten o’clock?—and returned to room two. He tapped on the wall, and then slid the curtain open as quietly as he could.
Jim appeared to be dozing lightly. A clean emesis basin rested on his lap, and his mouth was slightly open. His lips were dry and cracked, and there was a fleck of dried vomit on his chin. The nasal cannula had gone slightly askew. He looked like hell.
But Leonard just couldn’t stop looking.
The buzz of the automatic blood pressure cuff pumping up startled Len out of his inappropriate reverie, and roused Jim as well. His eyes drifted open, and Len had to tear his gaze away to glance at the monitor.
“Blood pressure eighty-four over sixty, pulse one-fifteen, respirations eighteen. Nice progress, Mr. Kirk,” Len said, hoping he sounded at least somewhat professional. He examined both the IV sites, and found them to be in fine shape.
“Hafta take your word for it,” Jim said, “since I don’t know what any of those numbers really mean. And if you keep calling me Mr. Kirk, I’m gonna think you’re talking to a ghost, ‘cause my father’s been dead for twenty-six years. But that’s a story for another time. So, can I go home now?”
Len just barely bit back a bark of laughter that he knew would’ve have been both unattractive and, yes, inappropriate. The word of the evening, Len thought.
“Ah, that’s a resounding ‘no,’ I’m afraid,” he said.
“But why not? I’m feeling much … oh, fu—”
Len winced as the kid’s own abdominal muscles wrenched his torso forward. He helped steady the basin, and Jim’s head, as Jim puked and retched. The monitor bleeped, complaining about another string of arrhythmias, and Jim’s pulse shot back up into the 130s. The smell in the room strongly indicated that vomit was not the only bodily effluvium that had just been produced.
Leonard wet another washcloth, and sponged Jim’s face down again. He handed him a cup of water.
“Rinse and spit—don’t try to drink any,” he cautioned.
“Not on your life,” Jim said, now that he was able to speak again. “Fuck. Fucking fuckity fuck. Can I please just die now? This is so fucking embarrassing.”
“No, you may not die.” Len replied sternly. “I won’t allow it. I’ll have someone help you clean up, and then I’m admitting you upstairs.”
“Admitting?” Jim said, physically recoiling in horror despite his weakened physical condition. “As in, putting me in the hospital?”
“As in, yes.”
“But at home I can sit on the toilet with a bucket in front of me! I’ll be much more comfortable!” Jim protested.
“You need to be in the hospital,” Len said. “You’re doing a little better, but you’re still severely dehydrated. You need IV rehydration, and you need monitoring.”
“What’s your living situation?” Len interrupted.
“I live in the farmhouse with my mom,” Jim said sullenly. “No laughing. We work the farm together. It works.”
“All right—well, think of it this way,” Len said. “Your mother is sick, too. Not nearly as sick as you’ve managed to get, but plenty sick enough that she doesn’t need to be worrying about you.”
“Do you not remember, that just ninety minutes ago you were unconscious? That you were so sick you didn’t even notice when the nurse and the orderly stripped you naked and cleaned you up? That you were terrified because you felt your heart skipping beats?”
“Um, kind of? But—”
“But nothing, Mr. Kirk,” Leonard said sternly.
“Jim,” Jim insisted again.
“All right, Jim—look at this, then.” Leonard turned the monitor towards Jim so he could look at it. “The thing where you feel like your heart is skipping a beat? You’re only actually feeling a small percentage of them.” He pushed a button on the monitor to show Jim’s heartbeat. “Watch. When it looks like this—” Len pointed to the squiggly wave— “it’s called a normal sinus rhythm. Well, not actually totally normal, because I’m betting that 120 is about twice as fast as your pulse usually is. And—look, there it was. Did you feel that?” Len pushed a button to freeze the display, and pointed to a spot where the wavy line shot way up, and then dipped down farther than usual.
“That was one of those thingies?” Jim said.
“Yep. They’re happening a couple times every minute, probably because your blood is sludgy and thick from dehydration, and because your electrolytes—chemicals in your blood that can affect heart rhythm—are totally out of whack, also from the dehydration.”
Jim raised his eyebrows. “You really are a doctor, aren’t you?” he said in an impressed tone.
Len put his hands on his hips and rolled his eyes. “Well of course I’m a doctor! What do I look like, with this white coat, and a stethoscope crammed in my pocket—a trapeze artist? A fireman? A pilot?”
“Well, it’s just that you look too—”
Jim got that pre-puking look again, and as he vomited, Len once again supported him and smoothed the hair off his forehead, with a gentleness that completely contradicted the crankiness in his voice. They repeated the face-wiping and mouth rinsing routine.
Jim sat silently for a moment as he regained some composure. “Fine,” he croaked. “Okay. You win, Dr. Sawbones. I’ll submit to shitting myself and having my ass wiped by strangers, for the sake of my mother. And because you’re a doctor, not a trapeze artist.”
“Good.” Len allowed one corner of his mouth to quirk up in a fraction of a smile. “Now, the rest of your family should be getting discharged in not too long, and they’ve all asked if they could come see you. Is that all right?”
“Sure. As long as I’m not stewing in my own shit, that is.” He pulled the sheet up around him more tightly, as if he could hide.
“I’ll send someone in to help you get cleaned up right away,” Len said. “After that, one of the nurses will do the admitting paperwork with you. I should warn you, it might take a while to get you a bed upstairs. We’re running a little slow tonight, what with the holiday and all. I’ll be back to check in on you after I look in on the other patients again.”
“Thanks, Dr. Sawbones.” Jim cleared his throat. “I appreciate it. I really do. Sorry I’m such a pain.”
The sapphire blue eyes gazed at him intently, and Len couldn’t help gazing back. Inappropriately.
“You’re not a pain. You’re just really sick. Now, you rest, and I’ll see you in a while.”
Len sent an aide in to help Jim clean up, and checked in on the rest of the Kirks, who were in the process of being discharged home.
“Are you sure it’s salmonella?” Mrs. Kirk asked.
“Well, the lab test takes three to five days, but it’s pretty certain you all have a food-borne illness. And I think your theory about it being the eggnog is probably right on the money.”
Mrs. Kirk sighed. “Salmonella has to get reported to the health department, right?”
“It does. I’ll report four suspected cases tonight, and the lab will follow up with me and the health department when the results come back.”
“Oh—and I reached the neighbors on Sam’s cell phone. They’re sick too—but just the adults, the same as us. Does … is … will the health department … do anything to them?”
Len frowned. “To be honest, Mrs. Kirk, I don’t know what exactly they’ll do. I’ve only been in Iowa for a few months, and this is my first reportable food-borne illness since I’ve been working here.”
“Oh. I suppose we’ll all learn, then. Uh—excuse me.” Mrs. Kirk dashed out of the room again, across the hall to the bathroom.
Leonard checked on the other two Kirks, who had finished their paperwork and were keeping each other company in one of their rooms.
“The nurse said we could wait here until Mom was discharged,” Sam said. “How’s Jim doing?”
“Better,” Len said, “but I’m admitting him overnight. He’s still working on IV rehydration, which I suspect is just keeping up with the fluid loss at this point.”
“It was really scary to see how sick he got,” Sam said. “I mean, we were all feeling pretty awful, but he just really crashed.”
“You were smart to call 9-1-1,” Len said.
“We had to,” Sam’s wife Aurelan said. “I mean, there was this crashing sound in the bathroom, and then he wouldn’t open the door when we knocked. The EMTs had a hell of a time getting him out of there—it’s so small, and the door opens in, and he was on the floor in front of the door.”
“EMTs are used to hauling people out of bathrooms,” Len said. “It happens all the time. Though usually it’s elderly people, or people who’ve had heart attacks. I almost think building codes should require that bathroom doors open outwards.”
“So, can we look in on Jim?” Sam asked.
“Why don’t all three of you look in on him briefly on your way out? He’s in room two. Check with a nurse before you go in, though,” Len said, not wanting Jim to suffer any more embarrassment than he already had.
“We will. Thanks,” Sam said.
Len sat at his computer terminal and updated Jim’s chart.
The charge nurse was standing in front of him.
“Iowa City PD just called—they’re riding in with IC Ambulance, bringing a male, 54, highly intoxicated, with a head laceration, and extremely noncompliant. Oh—he’s wearing a Santa suit, and insists he’s the real Santa.”
“Terrific,” Len said. “At least there’s no kids in here right now.”
It was shaping up to be a long, long night.
The police and EMTs brought in the raving, bleeding Santa in restraints, but the treatment of the wound needed to wait until he could be more cooperative.
Another potential cardiac patient was brought in; Len stabilized him and determined he wasn’t having a heart attack, but transferred his care to Cardiology as soon as he could.
During a lull, Len thought about his last conversation with Jim Kirk. What was it the kid had said right after he’d finally decided maybe Len really was a doctor, and not some kind of impostor?
“It’s just that you look too …”
And then the barf.
Too stupid? He’d never been told he looked stupid before.
Too young? Fat chance—the gray hair seemed to be creeping in more and more every day.
Another patient rolled in; a toddler who’d just had a seizure. Working out that it had probably been a febrile seizure, and reassuring the parents, took his mind off the question for half an hour.
But as he did the paperwork for the toddler, the question seeped into his mind again.
Too what, though?
In Len’s fantasy world, it would be something like “too hot,” or “too good looking.”
“Bah, humbug. You old fool,” Len muttered to himself. “What the hell are you thinking, anyhow?”
Len’s self-castigation was interrupted by the arrival of a new patient, a woman in her forties who was sure she was having a heart attack. The monitor showed nothing but an elevated heart rate, blood pressure, and respiratory rate. On further inquiry, it turned out the woman had a history of panic attacks and anxiety, and had just had an unpleasant encounter with her passive-aggressive mother-in-law. She hadn’t taken her medication, because she’d been drinking, and knew she shouldn’t mix alcohol with Xanax. Len was sure this wouldn’t be the last ER visit related to family dynamics on one of the most stressful holidays of the year.
By the time Len was able to go check on Jim Kirk again, it was nearly midnight. Half of him was peeved that the admission process was so slow, but the other half of him was perversely glad he’d be able to see him again without it being odd.
Once again, Len tapped on the wall next to the curtain that was the door to room two.
Leonard ducked into the room, feeling guilty about it even though he was supposed to be there. It was his job to be there.
Did Jim actually brighten up a bit when Len entered the room?
“Look!” Jim said, pointing to the monitor. “My pulse is lower, and my blood pressure is higher—that’s good, right? And I haven’t puked in like half an hour!”
“That is good. And before you even ask, yes, you do still have to stay in the hospital tonight.”
“Oh, I know. My mom made me promise I wouldn’t give you a hard time. Except there is this one thing.”
“What is it?”
“Can I please, please, pretty please, get up to use the bathroom? Please? With sugar and a cherry on top?”
Len rolled his eyes. “What are you, six? But sure. I can unhook your IVs for a minute. And the monitor.”
“Wait—hang on—will that mean I have to get stuck with new IVs?” Jim asked.
“Nope—the catheters stay in; I can just unhook the fluids from the tubing, just like this. See? No new needles required.” Len finished unhooking the IVs, and then pushed a button on the monitor to pause it while he removed the wires from the electrodes and took the BP cuff off Jim’s arm.
“Whew, you didn’t have to yank those stickers off me either. I mean, I wasn’t worried about putting new ones on, but it’s gonna smart, ripping those off. All zillion of them,” Jim said. He started to swing his legs over the edge of the bed, but McCoy stopped him in a hurry.
“Now, hold on there for a second, champ. Take it slow and easy—I don’t want you to pass out.”
Leonard helped Jim sit up slowly.
Jim nodded. He looked down at himself, and frowned.
“Holy crap, I’m not wearing anything!”
Len opened a cabinet, and tossed him a gown.
“Oh, great—this is one of those hospital gowns, right? The kind that’s real breezy in the back?”
“Function over fashion, pal,” Len said, smirking at him.
“But … but …”
“Exactly,” Leonard said, the smirk intensifying.
Jim met Len’s smirk with an even gaze, and then a genuine smile.
“I thought I liked you, Dr. Sawbones, but now I’m sure. And don’t take that lightly—I’m a life-long iatrophobe, and I’m not kidding.”
They stared at each other for a few seconds, and a sudden wave of propriety came over Len. He helped Jim get his arms through the front of the gown without snagging the hardware.
“All right—let’s get you standing up. No—slowly, you idiot!”
Jim stood wobbling on his feet, as Len held him up by one elbow.
“I’m fine. Okay. You can let go now.”
Len let go slowly (and, when he was honest with himself, reluctantly).
“I’ll let you get yourself collected. Do you want someone to help you to the bathroom?”
“I think I can handle it. Thanks, Dr. Bones.”
Len left before he had a chance to wrestle with himself about offering to help Jim fasten the ties of the gown, and sat back down at his station to look over some lab results that had just come in. He was interrupted by a snicker from a nearby desk, and looked up to see what had caused the normally staid nurse to lose her cool.
Jim Kirk was strutting back from the bathroom, gown dangling every which way, ties unfastened, leaving absolutely nothing to the imagination.
“Looks like your patient in two forgot something,” the nurse said.
Len planted his face into his open palm. “Good grief.” And he didn’t, absolutely didn’t, open his fingers ever so slightly so he could have a peek at what was going by. Which was shapely, and firm, and—
He stood up and returned to room two, since, after all, the IVs and the monitor needed to be reconnected. Urgently.
He didn’t bother to knock, since his patient obviously didn’t care about his privacy.
“You know, those gowns do have ties on them,” he said.
“Isn’t this the part where you’re supposed to say ‘don’t worry, it’s nothing everyone here hasn’t seen before,’ instead of complaining?” Jim said, as he settled himself back into the bed.
Len silently reconnected the monitor, and plugged the IV fluids back into the line in Jim’s left arm, then his right hand. He couldn’t come up with anything witty to say, but he trusted that Jim would have some choice phrase come to mind shortly. He looked back up at Jim, expecting to see a mighty smirk or grin, but instead saw a sheen of sweat on his upper lip, and a greenish tone to his suddenly pale face.
Len grabbed the basin from the table, and thrust it in front of Jim, just in time for Jim to make a deposit.
When that moment of Jim’s ordeal was over, he lay back, eyes closed, apparently concentrating on breathing. Len watched the monitor, concerned that perhaps he shouldn’t have let Jim get up after all, and was relieved to see the numbers returning to close to where they’d been before Jim’s trip down the hallway. He silently went to the sink and wet yet another cloth with warm water, and gently wiped Jim’s face for him again.
“You’re gonna be okay,” he said quietly. “I know it feels like this is gonna go on forever, and that you’ll never feel better again, but I promise, this won’t last forever.”
Jim’s eyes stayed closed, as he settled his breathing down to a more normal rate. He opened them again, and squinted at the doctor.
“Thanks,” Jim said.
They looked at each other again, bloodshot blue eyes meeting hazel ones, but neither one of them could think of anything to say.
There was a tap on the wall outside the curtain, interrupting the moment.
“Mr. Kirk?” said a woman’s voice.
“That’s me,” Jim said.
The woman entered. Len recognized her as a nurse from the medical unit upstairs.
“I’m Mrs. Greene; I’m a nurse on the medical floor. We’ve got a bed ready for you up there. Sorry it took so long to get you admitted, but we’re a little short-staffed at the moment.”
“It’s okay,” Jim said.
“Well: let’s get you out of here, and someplace a little more comfortable than the ER,” the nurse said. “You ready to go?”
Jim looked at Len again. “I guess,” he said, not breaking his gaze, as the nurse began unhooking him from the monitor.
“Dr. McCoy!” called a voice from the ER floor.
Len didn’t look away, and neither did Jim.
“Dr. McCoy! There’s been a multi-car MVA on the I-80! At least five patients!”
Len unlocked his gaze from Jim’s. “Take care, Jim,” he said quietly, as he left the room.
“Thanks, Doc,” Jim said.
Len didn’t have time to sort out what had just happened. After the first report from the officer at the scene, he switched straight into overdrive. He called in all the people who were on call for such emergencies, and helped the nursing staff get ready for several major trauma patients. By the time the first ambulance rolled into the bay, the well-oiled machine of the University of Iowa Emergency Department was ready to uphold its reputation as a first-class Level 1 Trauma Center.
Eight hours later, everyone who came to the ER alive was still alive. Leonard heard there were two people who didn’t make it to the ER, but he knew there was nothing he could do to fix that. Three patients had already been through surgery and been admitted to the Surgical ICU. Two more were awaiting surgery to repair fractures. Four had been treated and released. One of those four was released to the custody of law enforcement, as he had caused the accident, and had blown a .16 on the Breathalyzer.
It was nearly nine in the morning before Len had his paperwork wrapped up. It seemed to him that the second he logged out of the medical records system, the incomplete question reappeared in his mind:
He sighed heavily as he opened the program again. It wasn’t unethical to check on the disposition of a patient he’d admitted to the hospital, he told himself.
He called up Jim Kirk’s chart. He paged through the nurses’ notes, and was appalled to see that Jim had had an anaphylactic allergic reaction to the first antibiotic they’d given him, which had set his progress back considerably. Len paled at the idea of a patient who was already that ill having anaphylaxis on top of everything else. It could easily have killed him.
He wanted to go upstairs, on his way out, and check on Jim. But he couldn’t sort out whether his interest was professional, or something else.
Len chewed on his fingernail, and wrestled with his conscience. Something had clearly passed between him and this patient. Sure, he’d been attracted to patients before, and had empathized with patients before. But he’d never felt such an intense draw to a patient before.
He’d had enough experiences with patients falling in love with him to know that such occurrences were commonplace. When a person takes care of someone else, especially in a crisis situation that’s emotionally charged for the patient, it’s common for the vulnerable patient to develop feelings of closeness to their caregiver.
And that, Leonard realized, was the problem. No matter what he felt, it would be inappropriate to act on it, even if Jim Kirk were willing, because of that dynamic.
With the weightiest sigh he’d produced during his entire shift, Len closed Jim Kirk’s records again, and went to the staff locker room. He tossed his coat and scrubs in the laundry, and changed back into his civvies. He left the hospital, squinting in the bright sunlight, got in his car, and drove home.