so she was a bit spoiled. She’d admit it if anyone—Damien—cared to ask but, since he wasn’t asking, she wasn’t telling. Not a blessed thing! “The sheet you’re describing would have cost a hundred and twenty times more than all the sheets in this ward put together. And that would be just one sheet.”
“Ah! A lady with a passion for sheets.” Damien arched mocking eyebrows. “I hope that same passion extends to your medicine.”
“You mean a lady doctor who’s being interrupted while she’s trying to do her job.” She regarded him for a moment. Well-muscled body. Three or four days’ growth of stubble on his face. Over-the-collar hair, which he’d pulled back into a ponytail, not too unlike her own, only much, much shorter. Really nice dimples when he smiled. Sexy dimples. Kissable dimples... Juliette shook her head to clear the train wreck going on inside and went back to assessing her overall opinion of Damien Caldwell. He was stunningly handsome, which he probably knew, and probably used it to his advantage. Insufferably rude. Intelligent. Good doctor.
“Does it bother you that I’m watching?” he asked.
“What bothers me is that you think you know all about me through my bedsheets. You’re judging me, aren’t you? You know, poor little rich girl. Never changed a bedsheet in her life. That’s what you’re thinking, isn’t it?” Judging her based on what she owned and not what she could do as a doctor.
“I wasn’t but, now that you brought it up, I could. Especially if you do own Egyptian cotton.”
“What I do or do not own has no bearing on the job here. And if you want to stand there speculating on something as unimportant as my sheets, be my guest. Speculate to your heart’s content. But keep it to yourself because I need to get these beds changed and I don’t need any distractions while I’m doing it.”
The ad she’d read about this job should have warned her that it came with a pompous boss because he was, indeed, pompous. Full of himself. Someone who probably took delight in the struggles of others. “And in the meantime I’m going to smooth this stupid wrinkle so I can get on to the next bed.”
“Well, if you ever get done here, I’ve got a patient coming into the clinic in a little while who has a possible case of gout in his left big toe. Could you take a look at him when he arrives?”
Gout. A painful inflammatory process, starting in the big toe in about half of all diagnosed cases. “I don’t suppose we can test for hyperuricemia, can we?” Hyperuricemia was a build-up of uric acid in the blood. With elevated levels, its presence could precipitate an onset of gout.
“Nope. Haven’t got the proper equipment to do much more than a simple CBC.” Complete blood count. “And we do those sparingly because they cost us money we don’t have.”
“Then how do we diagnose him, or anybody else, for that matter, if we don’t have the tests at our disposal?”
“The old-fashioned way. We apply common sense. In this particular case, you assess to see if it’s swollen or red. You ask him if it hurts, then find out how and when. Also, you take into account the fact that the patient’s a male, and we all know that men are more susceptible to gout than women. So that’s another indicator. And the pain exists only in his big toe. Add it all up and you’ve got...gout.” He took a big sweeping bow with his pronouncement, as if he was the lead character in a show on Broadway.
Juliette noticed his grand gesture, but chose to ignore it. “OK, it’s gout. I’ll probably agree with you once I’ve had a look at him. But, apart from that, what kind of drugs do you have on hand to treat him with? Nonsteroidal anti-inflammatories? Steroids? Colchicine? Maybe allopurinol?”
“Aspirin,” he stated flatly.
“Aspirin? That’s it?” Understaffed, understocked—what kind of place was this?
“We’re limited here to the basics and that’s pretty much how we have to conduct business every day. We start on the most simple level we can offer and hope that’s good enough.”
“What else do you have besides aspirin?”
“Antacids, penicillin, a lot of different topical ointments for bug bites, rashes and whatever else happens to a person’s skin. A couple of different kinds of injectable anesthetic agents. Nitroglycerine. Cough syrup. Some antimicrobials. Antimalarials—mostly quinidine. A very small supply of codeine. Oh, and a handful of various other drugs that we can coerce from an occasional outsider who wanders through. When you have time, take a look. We keep the drugs in the locked closet just outside the clinic door.”
“Are any of these expired drugs?”
“Hey, we take what we can get. So if it’s not too expired, we accept it and, believe me, we’re glad to get it. One person’s expired drug may be another person’s salvation.”
“Isn’t that dangerous?”
He shook his head. “I check with the pharmaceutical company before I use it. I mean, commercial expiration date is one thing, but some drugs have usable life left beyond their shelf life.”
“But you do turn away some drugs that are expired?”
“Of course I do. I’m not going to put a patient at risk with an expired drug that’s not usable.”
“So when you call these pharmaceutical companies, don’t they offer to stock you with new drugs?”
“All the time. But who the hell can afford that around here?” Damien shrugged. “Like I say, I check it to make sure it’s safe, then I use it if it is, and thank my lucky stars I have it to use.”
She hadn’t expected anything lavish, but she also hadn’t expected this much impoverishment. Of course, she knew little clinics like this operated all over the world, barely keeping their doors open, scraping and bowing to get whatever they had. But, in her other life, those were only stories, not a real situation as it applied to her. Now, though, she was in the heart of make-do medicine and nothing in her education or experience had taught her how to get along within its confines.
“How do you learn to get by the way you do?” she asked Damien. “With all these limitations and hardships?”
He studied her for a moment, then smiled. “Most of it you simply make up as you go. I was a general surgeon in Seattle. Worked in one of the largest hospitals in the city—a teaching hospital. So I had residents and medical students at my disposal, every piece of modern equipment known to the medical world, my OR was second to none.”
“And you gave it all up for this?” It was an admirable thing to do, but the question that plagued her about that was how anyone could go from so modern to so primitive? She’d done a little internet research on Damien before she’d come here, and he had a sterling reputation. He’d received all kinds of recognition for his achievements in surgery, and he’d won awards. So what made a person trade it for a handful of expired medicines and good guesses instead of proper tests and up-to-date drugs?
Maybe he had a father who ran the hospital, Juliette thought, as her own reasons for leaving her hospital practice crossed her mind.
“This isn’t so bad once you get used to it,” he said.
“But how do you get used to it? Especially when it’s so completely different from your medical background?”
“You
