Dr. Jim Brillhart was seated behind his minuscule desk in the director’s office by the time Cheyenne arrived.
She slumped into the empty chair across from his desk. “So, what’s up, Jim?”
He hesitated for a full second before unfolding his long legs from their cramped position. He stepped around the desk. “Can I get you a cup of coffee? Ardis brought some doughnuts. I know you like the chocolate-iced ones.”
Cheyenne studied his expression. “No, thanks. I’m not really hungry right now.” Something was making Jim edgy. “Is everything okay?”
He closed the door and returned to his chair, folding himself beneath the desk once more. “I noticed you’re scheduled for two weeks of vacation. Going anywhere special?”
Please don’t tell me you need me to work. “I hadn’t made any plans. Why?”
“I was just checking your records, and you have an anniversary date coming up next month.”
That had to be it. He wanted her to work. “Yes, and I haven’t had a vacation for a year.”
“Exactly.” He tapped the tip of a pen on the desk, watching the movement of his hand.
“Is there some trouble covering the shifts?” It wasn’t as if she had something special planned.
He stopped tapping. “I don’t need you to work.” He straightened and scooted forward, still looking at the pen. “In fact, if you haven’t used up the four weeks before your anniversary date, you’ll lose what you don’t take, according to company policy.”
“I was afraid of that, but I just couldn’t find the time….”
“I have a proposition for you. I would like you to take all four weeks, starting now. In addition, I’d like you to take additional leave time.”
“Additional?” She tried to read his expression. “Why?”
He met her gaze, held it, sighed. “You need it.”
“I’m doing fine. I don’t—”
“I heard about your episode this morning. It’s obvious to me and to the staff that you’re still struggling with your sister’s death.” His words tumbled over one another. It was well-known to the staff that their director hated confrontation.
“I dropped a clipboard, for Pete’s sake. Big deal.”
“Arlene said you were shaking visibly.”
Cheyenne made an ostentatious show of looking at her watch. “It’s been barely forty-five minutes since that happened. Arlene sure didn’t waste any time.”
“And the fact that this annoys you tells me you’re still being affected by grief over Susan’s death, because I know you, Chey. You don’t get rattled that easily.” His chair squeaked as he leaned forward to place his elbows on his desk. “Face the facts. You had a devastating experience, and you haven’t been given the time to deal with it. I’m giving it to you now.” He held up an April schedule. “I’ve already removed your name.”
Cheyenne stiffened. “Over a silly little incident this morning? You can’t be serious.”
“That kind of thing has happened more than once in the past month.”
“Three times. Yes, Jim, I know that. I’ve had some trouble sleeping, but don’t you think that’s normal after a loss like mine?”
“Sure. It’s perfectly understandable after what you went through, and you need time to deal with the loss. You’re one of our best doctors, Chey, and your emotional health is important to everyone here, including your future patients. You know how quickly ER docs burn out.”
“Save the lecture, I’ve heard it all before.” This was crazy. How could he do this to her? “Are you telling me I can be replaced that quickly? We’re already working a doc short.”
“Another Missouri ER is closing near Saint Louis. The physicians there will be out of a job in two weeks.”
“Why is it closing?”
“The hospital couldn’t afford the increase in their insurance rates. Three of their docs are looking for temporary work, and I plan to grab them up and use them as much as possible. That’ll give all of us a break. The rest of us will hold out until they come on board.”
“Jim, I don’t need that much time off.”
He gestured to a stack of files on the far right corner of his desk. “Your quality control reviews have not been impressive lately.”
That hurt. She hadn’t seen the reports for this past month. “I’ve worked fifty percent more shifts than last month, Jim. All of us are a little tired.”
“I saw your patient this morning,” he said. His voice was soft, sorrowful.
“Which one?”
“The one with the chest pain. Crosby. The one who looked like Susan.”
“But I did everything appropriately. I did a cardiac workup and EKG and she was fine.”
“Chey, did you even consider a pulmonary embolis?”
“No, why would I? She was young—”
“She had multiple risk factors. She was a smoker, she took birth control pills.”
“Yes, but—”
“She was wearing an air stirrup splint.” He dropped the pen onto the desk and leaned back, as if he wanted to cross his legs but didn’t have room beneath the dinky desk. “She’d been practically immobilized for three days with a badly sprained ankle. I did a D-dimer test on her.”
Cheyenne’s thoughts froze. “The result?”
“Positive.”
She gave herself time to recover from the blow. “The woman was having a pulmonary embolis?”
He nodded.
“I’m sorry, Jim. I—I told you I’m not sleeping well.” The woman could have died! If Jim hadn’t seen that ankle brace…
“You’re not focusing, Cheyenne. That isn’t like you. Your tragedy is way too fresh. For your own good and the patient’s, I have to consider you an impaired physician and take the necessary steps to help you.”
“Impaired! Jim, I’m not an alcoholic, and I don’t have a drug—”
“The problem is, the last place a physician’s struggle ever shows up is at work. You must be going through some nasty stuff at home.”
She nodded, her mind still reeling with shock.
“It took you three weeks to recover from your flu. You worked sick during that time. I want you to take some sick
