known Brooke wouldn’t touch the injury without seeing an X-ray first. No doctor would. The X-ray was necessary to verify that no debris existed that might be driven deeper into the soft tissues of the injured leg while it was being set. A compound fracture, one with the bone protruding from the skin, could only be set temporarily, at any rate. The injury would undoubtedly require surgery within a few hours. That was a job for a different type of doctor, in a different part of West Central.
“Tetanus?” Nurse Loretta asked. “Whichever antibiotic is handy today?”
“Yes on both. Whatever cephalosporin is in the machine, if there are no allergies.”
Loretta had suggested exactly what Brooke would have ordered.
See? My decision was rational. It has nothing to do with keeping away from Zach Bishop a woman who is younger and single and more likely to appeal to him.
Brooke was not the type to be possessive when it came to a handsome face, a hard body or a deep cowboy voice. She tended to date men who were more bookish. Intellectually stimulating. Men she could engage in conversation without first needing to brace herself against the distraction of purely physical perfection.
Brooke paused outside room three and braced herself.
It did no good. As she walked in, her attention was caught by the most commanding presence in the room: his. It was human nature, she supposed, to notice who was dominant in every situation, and the tall man in the black firefighter’s T-shirt was definitely the most physically dominant man in the room.
Distraction over. Get to work.
Brooke was in charge once she entered a treatment room, so she focused on the elderly man on the gurney.
“Good afternoon. I’m Dr. Brown. You’re Harold Allman, is that correct?”
The man looked frail despite being heavyset. His white face and the stiff way he was holding himself meant he was in pain, but he still chuckled and looked up at Zach.
“Boy, times have changed,” he said conversationally, ignoring Brooke’s question. “Not only do we have lady doctors, but good-looking ones, too. This one’s a real looker.”
“That she is,” Zach said.
Brooke neither frowned nor smiled. She was accustomed to hearing this kind of tedious “lady doctor” comment from men of a certain generation. Beyond the patient’s bed, Loretta rolled her eyes and shook her head. Obviously, she was tired of the same old comments herself.
“Harold, how did you break your leg?” Brooke stepped forward to start the hands-on part of her exam, but Zach didn’t move out of her way as he normally would. At this point, with responsibility for the patient turned over from the paramedic to the hospital staff, he’d usually tell the patient goodbye and leave. But Harold, she realized, was clinging to Zach’s gloved hand with a white-knuckled grip at odds with his chuckle.
As Brooke pulled on her own latex gloves, she walked to the far side of the bed. Far be it from her to deny the old man comfort. If hanging on to a strong man like Zach gave Harold a little courage, that was fine with her.
Harold spoke with a noticeable hitch in his breath. “I’d like to tell you I did something that would impress you, young lady. I could’ve broken my leg sky diving. That would’ve been something, wouldn’t it? But the truth is, I just fell down my own porch stairs.”
“Were you dizzy before you fell?” Brooke asked.
“No, I’m just—I’m just turning into a clumsy old man.” He sounded sad.
“Nah, anyone can trip,” Zach said, and Brooke saw him give the old man’s hand a quick squeeze. “Happens to the best of us.”
“I’m going to look for other injuries. If anything is tender, let me know.” She checked Harold’s scalp, turned his head from side to side, pressed on his ribs and palpated his arm from shoulder to wrist. Judging by how tightly he gripped Zach’s hand, Harold’s other arm wasn’t injured, so Brooke decided to forgo that part of the exam.
She lifted one edge of the paper tent that was hiding the patient’s broken leg from his own view. The bone was protruding from the skin. Just seeing this type of injury could send patients into shock, so she kept the paper in place.
Pain also contributed to shock. Harold was being brave in his benignly chauvinistic way, but he was clearly suffering.
Brooke addressed Zach. “What have you given for pain, Mr. Bishop?”
“Morphine, two milligrams.”
She raised a brow at him. That dose was low. “Only once?”
Zach shrugged a bit. “Didn’t want to mask any chest pain.” His tone said it was no big deal, nothing to worry about.
“I see,” Brooke said, and she did. Zach suspected severe heart disease in this patient. A more potent dose of morphine could have meant the man would have a heart attack without feeling it. The attack would have to reach great severity before symptoms would be noticeable in a morphine-drugged, pain-free man.
The patient was already anxious and his body was under significant stress. Brooke knew Zach’s shrug and easy tone of voice were meant to keep the patient’s anxiety levels from skyrocketing. She envied Zach’s bedside manner.
“Nitroglycerin at the scene, Mr. Bishop?” Brooke could never match Zach’s life is good approach, but she did her part to keep the patient calm by continuing her methodical exam, palpating his undamaged leg as if she weren’t discussing a potentially life-threatening event with Zach.
Anticipating Brooke’s next order, Loretta opened a drawer and pulled out a pack of ECG leads, ready to place the little sticky circles on Harold’s chest so they could monitor his heart, although that wasn’t a typical part of treating a fracture. As if they’d choreographed it, Brooke moved to the foot of the bed as Loretta took her place.
While Loretta unbuttoned Harold’s shirt and attached the leads, Brooke pressed her fingertips to the ankle of Harold’s broken leg. She took his pulse without jostling the injury, needing to confirm that blood was still circulating past the fracture to reach his extremities.
The patient looked up at Zach and scolded him. “Now, don’t go embarrassing me in front of these pretty ladies. That chest pain comes and goes, I told you. I just take one of those tiny white pills, and I’m fine. Fit as a fiddle, except for my leg.” But his chuckle was forced and he rubbed at the center of his chest with his free hand.
No sooner had the nurse turned on the television-like monitor over the bed than Harold’s worried rubbing motion changed. He clutched at the open edge of his shirt. “Maybe...one of my pills?” he gasped.
Brooke read the jagged line of his ECG in a glance. A myocardial infarction—a heart attack—was underway. “I’m going to take good care of your heart, Harold. Let’s do something about that pain, too.”
From that moment, time slowed down and sped by simultaneously. It was always that way for Brooke while she led her team through an emergency. When she had to function at a high level of complex decision-making, everything seemed paradoxically simple.
At her word, the crash cart was called. Extra
