CATEGORY: KW/LKo/JC/Ensemble Cast/Drama
SPOILERS: this is written as an episode occurring about three months after May Day.
DISCLAIMER: These characters belong to Warner Brothers, etc. and are used without permission. This story is for entertainment only, to occupy our time until Season Seven starts, etc. etc.
AUTHOR'S NOTES: the medical situations in this story were researched and are based on information found on various medical web pages and reference texts. However, I am not a medical person and my research does not guarantee a correct interpretation.
Although not necessary, it might be helpful to read my previous fanfics: "Aftermath," "Uncharted Territory," and "Friends and Lovers."
Thanks: my continued appreciation to three extraordinary friends who give me constant encouragement, feedback, and inspiration.
Comments and suggestions are welcome.
SUMMARY: this is written as an episode occurring about three months after May Day. Kerry has a bad day with a patient and Romano; Elizabeth and Mark consider something new; and both John and Luka deal with the families of patients.
"Yes, mom," Abby said, trying to keep the exasperation from her voice. "Yes, I'm taking the money to the financial office when they open up at eight." She was standing at the admit desk, using the phone at the end.
She listened to a response. "Yeah, I got three thousand dollars of the loan money back from him, and with your two, that's just half the amount. I've taken some nursing shifts too."
Again she listened as she watched the traffic building in the ER hallway. "I don't know, mom. Yes. Thank you. Yeah, I'll let you know. I gotta go. Bye." Abby gave a long sigh as she hung up the phone, then headed down the hall.
Luka sat on the couch in his sparse apartment, fiddling with various envelopes and a checkbook. The coffee table was still stacked with things to read. The overstuffed couch, a dark blue tweed, looked comfortable if not old and a little worn. He opened one envelope, examined the bill, and set it aside. Then he wrote out a check and tore it from the checkbook.
After putting the check in his wallet, he stood up and looked out his window into a space shaded by a large tree, the branches hanging low and obscuring the view just a little. The room behind him held only the couch, the coffee-table, television set and two stand lamps. Beyond, in the small but clean kitchenette, an old formica kitchen table and four chairs sat in front of an old small stove and refrigerator. The only concession to modern life was the microwave.
Kerry, dressed in a beautiful silk robe with a dark Oriental flower print, was spending the early morning hour at her desk. Beside the latest computer and printer, two stacks of folders and an open one just in front of her crowded the desktop. Without looking, she reached out and picked up a large coffee mug to take a sip while continuing to read the papers she held in the other. A small amount of coffee slopped from the mug onto her robe.
Disgusted, Kerry got up, went to the bathroom in the hallway just outside the door, and started dabbing at the spot. After a bit, she looked into the mirror and surveyed her image with first surprise and then disappointment. She brushed the edge of her hair back a little, looking for gray at the edges and then examined the circles beneath her eyes. After a long sigh, she finished with the spot, turned, and went back to her desk. With clear disgust, she picked up the papers again.
Unaware of what was going on, Haleh came through the doors of the lounge and then took in the sight. Cleo, Dave, and Jing-Mei were all sitting at the table with books in front of them. "My, my, what have we here?" she asked, teasing the group.
All three looked up from their books.
"Boards are in four weeks," Cleo answered.
"We've organized these study sessions," Jing-Mei added.
Dave looked sheepish. "I need all the help I can, and these two wonderful women are helping me."
Cleo thumped Dave on the shoulder and Jing-Mei rolled her eyes.
Haleh smothered a laugh. "Flattery will get you everywhere," she chortled.
"Believe me," Cleo laughed. "He's absolutely right on both counts."
"That is obvious," Haleh responded, leaving them to study.
John sat at the computer in his bedroom, typing furiously with a look of concentration of his face. He was already showered and dressed for the day in his shirt and tie. The radio was playing and the announcer gave the weather forecast.
"You can expect clear skies and a high of ninety-eight by evening rush hour," the announcer said. "No rain in sight to end our heat wave, so take it easy out there."
"Breakfast is ready," his grandmother's voice rose up from below.
"Be right there," John answered. He finished the typing, clicked the mouse, and sat staring at the screen while the file closed. Mustering a smile, he stood and headed downstairs.
Elizabeth brought a cup of coffee into the bedroom to Mark who was just beginning to stir from his sleep. He opened his eyes and smiled back at her as he took the cup.
"Good morning, beautiful," he smiled.
"Top of the morning to you," she answered, sitting on the edge of the bed.
"You feeling better this morning?"
Elizabeth nodded tentatively. "So far, so good. I'm sure it was just a touch of the flu yesterday."
"Good," Mark smiled, touching her cheek.
Peter sat Reese on the shelf of the daycare center and signed to him, "Your mother will be with you tonight." He wasn't sure Reese understood all that, but the young boy did sign back 'mother.'
He smiled, leaned in, and kissed Reese on the cheek, then set him on the floor. Reese ran to a pile of toys and began playing. Peter nodded to the attendant and left.
Act One 8am
"Lizzie," Robert Romano gave his favorite greeting as he stuck his head in her office door.
Elizabeth looked up from her paperwork at the irritation. "Robert," she said cautiously. "What can I do for you?"
"Just wondering how the comparison study was going for our pharmaceutical grant?" he asked.
"The data is in," she answered. "I have a med student drafting the first conclusions. It should be ready in two weeks." She went back to her reading.
Robert invited himself into the office and sat down. "Good." He played with his fingers, uncharacteristically hesitant, then spoke, his voice uncharacteristically soft. "You're looking particularly luminous today."
Elizabeth looked up, surprised. "Thank you Robert," she answered coolly. "I wish I felt so."
"Hmm," he responded, sounding sincere in his own way. "Touch of the summer flu?"
"Probably." Elizabeth returned her attention to her papers. "If you don't mind, I've got a lot of work to do."
"Of course," Robert said, rising. Then he hesitated again. "Have you seen the latest report from Kerry Weaver about the patient/time/cost ratio in the ER?"
Elizabeth sighed and looked up again. "No, I have not."
"Both time and cost per patient are up," he told her. "And up more than the usual June/July bump."
"There were several major traumas," Elizabeth tried to counter.
"And a resident on an extended leave of absence," Robert continued. "Lots of overtime for the attendings, I see, as well as the use of a lot of moonlighters."
"Summer is the time for vacations." The man was starting to annoy her.
Robert nodded. 'The M&M report was also disappointing."
"How so?" Elizabeth said, wishing the conversation were over. She shifted uncomfortably in her chair and put a hand over her stomach that had begun to feel nauseous, turning her face away from Romano.
"Higher mortality rates than the pattern," he answered, peering at her.
"Again, Robert, they had several major traumas, including that church school bus that was hit and overturned on the expressway."
"How does Mark, uh, Dr. Greene feel about the operation in the ER?" Robert finally got to his point and looked at Elizabeth's reaction carefully.
Elizabeth tried to hide her disgust. "If you want to know Dr. Greene's opinion, you should ask him, not me."
Robert started to say something else but changed his mind. "Lizzie," he said in farewell as he left the office.
Elizabeth stood as well, still gripping her stomach but looking after Robert with a thoughtful look on her face that grew into concern.
"He'll stay in the ICU about a week, most likely," Peter was saying to Mark as they walked towards the elevators. "After another week in the step-down unit, he'll be transferred to a rehabilitation center."
"Thanks, Peter," Mark said and then shrugged. "He's the bread-winner for his family -- wife and four kids. They seemed really nice, good people and I just hope he gets back to work as soon as possible."
"He should recover very well," Peter offered as the arrived and the elevator door opened and Elizabeth got off.
"Mark," she smiled at him, then turned towards her friend. "Peter."
"Hi honey," Mark said warmly. "How's the writing coming?" He took one of her hands in his.
"Fine," she answered in kind, then turned to Peter. "I'm going a peer review of a study by two orthopedic surgeons from UCLA on diskectomy and spinal fusion. Would you do me a favor and look it over when I get it written?"
"Sure," Peter smiled. "Be glad to." His smile faded as his view changed to Cleo passing in the hallway, obviously headed towards Curtain Three.
Mark noticed the shift of attention. "Things still not patched up?" he asked.
Peter shook his head. "No." He offered no further explanation.
"The residents are spending all their spare time studying for the annual boards," Mark offered. "You remember what that was like."
"Yeah," Peter answered dejectedly, and then expelled a breath.
"She's a catch, Peter," Elizabeth tried to cheer him up. "I think she is quite taken with you. Give her some space and she'll come around." The elevator door behind them dinged with its arrival and the door began to open.
Peter nodded. "I've got a surgical follow up. See you two later." He mustered a smile and got on the elevator.
"Later," Mark said as the door closed. He turned to Elizabeth and they started walking down the hall. "How are you feeling?"
Elizabeth shook her head. "A little nauseous, but it seems better than yesterday."
"Well, don't over do it," he responded, concerned. "I can't talk, I got a patient almost ready to move up to medicine."
"That's okay," she answered. "I came down to see Kerry about something."
Mark waited for an explanation.
"Just business," Elizabeth said cautiously. "I'll talk to you later."
They smiled at each other, then Mark peeled off towards Curtain Two and Elizabeth went to the admit desk in search of Kerry and found her looking at the board.
"Kerry," Elizabeth spoke, getting her attention. "You have a minute?"
"Sure, Elizabeth," Kerry responded pleasantly, turning towards her. "What can I do for you?"
Elizabeth hesitated a moment. "I need to trade a favor for a favor."
Kerry immediately became concerned. "What is it?"
Still, Elizabeth hesitated again. "I need a confidential pregnancy test. I was hoping you could route it through under a different name." She shifted uncomfortably.
"Of course," Kerry said quickly, immediately reassuring her.
"Thanks. And in return," Elizabeth continued, "you should know that Romano is trying to stack up negative information on the operation of the ER."
Kerry took the information in, and then finally spoke. "I'm not surprised. He's been nosing around more than usual, which is a lot."
The two women smiled in understanding.
"He's got the latest PTC and M&M reports," Elizabeth offered. "I'd be careful."
"Thanks, I will," Kerry assured her, then changed the subject with concern in her voice. "You think you need the test?"
"I fear I have the symptoms," Elizabeth sighed.
"You take precautions?" Kerry asked, then regretted the question. "I'm sorry, it's none of my business."
Elizabeth shrugged away the intrusion. "Oh yes, the pill. But we all know that it doesn't always work."
"Well, let's not worry until the tests are back," Kerry said. "Come on, I have a few minutes now. Let's take some blood."
Elizabeth nodded, smiling tentatively and the two women headed towards Exam One as Abby and Malucci arrived.
"Good call," Malucci told her.
"Thanks," she said, her voice not really expressing pleasure at the praise.
"Something wrong," he asked Abby as he wrote on the chart. Dave looked up to see Kovac walking by with Jing-Mei who stopped at the desk, engaged in conversation about a patient.
Abby sighed as Cleo arrived and stood next to them. "I need five thousand dollars more to pay off my tuition," she explained. "I don't have it -- my ex-husband tried day-trading on high-tech stocks with my loan money and lost most of it. The tuition is due today."
"Geez," Dave commiserated. "What are you going to do?" He stepped aside so Chuny and Mark could pass by, also deep in conversation.
"If I can't find it, I'll have to drop out. I can always go back to nursing." Abby shook her head dejectedly.
"But it's your last year of medical school. You are so close to graduating," Cleo chimed in.
Chuny reached in front of them for a folder and then left.
"Yeah," Abby frowned. "And I want to finish, but I may have to wait a year -- or more."
Malucci searched for something to say. "Come on," he finally said. "I'll buy you both of you a cup of coffee in the lounge."
Abby smiled weakly and agreed. Dave put a protective arm around her and the three headed off to the lounge.
"Yeah, coffee there is free," Cleo laughed.
"Hey," Dave protested as they moved into the lounge.
John shook his head and took a breath, then looked back at Luka. "It's just that, sometimes it feels like I'm under a microscope with everyone here."
Luka nodded. They were standing in a quiet corner near Exam Four and the suture room.
"I can't stub my toe but someone is running over, asking if I'm okay," John continued. "I can't have a down moment because I lost a patient, or an up one because something turned out well. They are always asking if everything is okay, if I'm all right."
"It's nice to have people concerned about you, huh?" Luka responded.
"Yeah, I know," John answered, agreeing a little. "But it is tough. I feel like I have to keep this pleasant face all the time." He looked in the distant and busy hallway.
"Now perhaps you are beginning to really understand why I don't speak of myself," Luka offered softly.
"Yeah," John agreed.
"They are looking for the old Carter. They just want you to be happy, healthy."
John took a breath. "There is a lot of the old me still here," he said, placing his hand on his chest. "But there are new parts to me as well."
"And it will take them some time to understand that as well." Luka thought for a moment. 'You are like a movie and they think they know how it turns out. But the plot has now taken a twist. I think they will like the ending. So will you." He smiled at John. "You just have to sit through the whole movie."
John finally smiled as well and then saw Peter striding down the hall towards them.
"You called for a surgical consult, Carter?" Peter asked John directly.
John greeted him, "Yeah, thanks. That was quick -- we just called five minutes ago."
Peter shrugged. "For you, I was available. Whadda you have?"
John smiled wanly, understanding the real reason for Peter's rapid response. "A patient with possible subdural hematoma. We thought you should take a look."
Peter glanced briefly at Kovac then turned his attention to the chart John was handing him. He flipped through the pages. "He's been to CT?"
"Yes, we have the results," Luka answered, eyeing both Peter and John, taking in their non-verbal cues.
Peter nodded and looked at John. "Okay, let's look at him."
Luka hesitated. "You go ahead, I've got to check on a fractured radius."
John looked back at him. "Okay. But can I find you later?"
"Sure," Luka answered. "Later." He gave a small smile and turned away.
John turned into Trauma Two with Peter who had not looked back during John's last exchange with Luka. He appraised Peter's attitude. "Something wrong?"
Peter shook his head. "You just seem pretty friendly there."
John furled his eyebrows at Peter's attitude and then tried to deflect. "He's a good teacher," he said, but then immediately regretted his choice of words as Peter's sour look became bitter. "Don't you like him?"
"Its not a matter of liking, Carter, it's a matter of competence," Peter spoke quietly, looking over his shoulder.
Once again, John was surprised at Peter's words. "I think he's a good doctor. Pretty unflappable, you know? He listens well."
"Yeah, well," Peter said. "My advice to you is not to get too close to him. Don't tell him of your troubles -- you have plenty of friends here to support you."
John started to object. "I don't understand."
"You trusted me before, Carter," Peter stopped walking and turned to him, his voice low. "Just trust me again. Now, show me your patient."
Nodding tentatively, John lead Peter further into the room, but his eyes held something else in addition to interest in his patient.
Act Two 1pm
Kerry arrived at the admit desk to find it crowded. Mark was erasing a name from the board. Several nurses were around, filling out charts or filing. Luka was exchanging a chart and looking in a reference book. Randi was on the phone at one end and Abby doing the same at the other. Malucci arrived shortly as well.
Abby put the phone down with a broad smile on her face and turned to Kerry. "Dr. Weaver?"
Kerry looked up.
"Do you know anything about a scholarship program for emergency tuition payments at the medical school?" Abby's held wonder.
"No," Kerry answered, curious. "Why do you ask?"
"That was the business office," Abby said, amazement creeping into her voice. "I still owed half my tuition for this year. But, they just said it was covered by some scholarship." Her voice rose in excitement and several of the other staff looked up from their tasks.
"That's great," Kerry smiled.
"But I didn't even apply for any scholarship," Abby countered, but still smiling. "When I asked last spring, they said all the scholarship money was gone for this fall."
The implication hit Abby. "This means I don't have to drop out of medical school!" she started laughing. "I don't have to drop out!"
"Congratulations," Malucci said, stepping closer to her, joining in the laughter. "That's just amazing. See, you were worrying about nothing."
The others gathered around, smiling and offering congratulations as Randi approached Kerry.
"Dr. Weaver," Randi began. "I have a pregnant lady in Exam One who is concerned about her baby."
Kerry looked at the board. "I'll take it." She headed across the short space to Exam One.
"This is Becky and Tom Greenfield," Chuny said as Kerry entered the room. She turned to the Greenfields. "This is Dr. Weaver."
"Thank you Chuny," Kerry spoke warmly, taking the chart from Chuny and then smiled at the couple.
Becky Greenfield looked terrified as her husband held her hand. They seemed both about twenty-five; he wore jeans and a plaid shirt but she had gotten into a hospital gown.
"How far along are you?" Kerry asked.
"Nineteen weeks," Becky answered.
Kerry looked at the chart. "And what are you worried about?"
"It feels different," Becky started. "I've been able to feel movement since the twelfth week, but I haven't felt anything in two days."
"Have you had an amniocentesis?"
"No," Becky answered.
"We don't have insurance," Tom spoke up. "We've read the books, but we haven't been able to do any tests."
"Or see a doctor regularly?" Kerry inquired gently. "So you haven't had an ultrasound either?"
The Greenfields both nodded 'no.'
Kerry looked at Tom. "Why don't you have a seat and I'll get you as soon as I take a look. There is a chair right outside the door here."
Tom nodded grimly. After squeezing his wife's hand one more time, he reluctantly let go and backed out of the room.
Chuny rolled in the ultra sound.
"Get me a CBC and coag panel," she said to Chuny and then started to examine Becky's abdomen. "The uterus is palpable but seems small."
Chuny nodded knowingly while Becky lay with her eyes closed.
"Mr. and Mrs. Hansen?" Luka asked as he walked into Curtain Three and towards the middle bed. "I'm Dr. Kovac."
Mr. and Mrs. Hansen looked up through the concern on their faces. They were modestly dressed, perhaps in their early thirties and holding hands. In Mrs. Hansen's other hand, she held a clearly used Bible.
Mr. Hansen held out his other hand. "I'm John, this is my wife Cheryl." Luka shook John's hand, and then Cheryl held hers out as well, which Luka returned.
Then John Hansen turned towards the bed to reveal two children. As Luka looked more closely, the boy and girl were clearly twins, but the boy was the sick one, his face a pasty white and a fever in his eyes. Still, the boy smiled readily at Luka while the girl's expression was the same as her parents. She was sitting on the bed next to her brother who had changed into the hospital gown.
"These are our children, Timmy and Ashley," John Hansen continued.
Luka smiled at both of them. "Hello. I'm Dr. Kovac."
"Hi, Dr. Kovac," Timmy responded immediately.
"Doctor," John Hansen began quickly. "We're from a small town outside of Springfield. We came up for a couple of days to see some baseball games. The Cubs."
Mr. Hansen looked down and continued, knowing the information by heart and simply reciting it by rote. "Timmy was diagnosed with thrombotic thrombocytopenia purpura about three years ago. The doctors think it probably is a result of a dose of penicillin."
"How old is he now," Luka asked, smiling at Timmy.
"He's thirteen. This may be his fourth relapse. He had his spleen removed last year. We brought him in today because he started running a temperature and has some abdominal pain."
Luka nodded, glancing at Timmy. "Why don't you all wait outside and I'll give Timmy a look, huh?"
The older Hansens looked at each other, then took Ashley's hand, and helped her off the bed. "Thank you, Doctor," Mrs. Hansen said at they left the room.
Luka turned back to Timmy to see him giving a broad smile to his departing family. "So you feel like you have the flu, huh?" Luka asked.
Timmy turned serious as soon as his family was out of sight. "Dr. Kovac, I may only be thirteen years old, but I know what is going on. Headache, tired, my eyes look yellow just like last time. I know what I have and I don't think it is good this time."
"Okay," Luka said tentatively, a little surprised but quickly acc3epted Timmy's attitude. He listened to Timmy's heart, lungs and last the abdomen, then pressed gently in that location. "This hurt?"
Timmy grimaced a little.
Luka rose to his full height. "You may be right, but I think we should run some tests to be sure."
He turned to Lilly who had finished the blood pressure and pulse ox measurements and showed him the chart. Luka nodded.
"CBC, LDH and RBC, UA and let's do a Chem Twenty," he listed the tests for her then turned back to Timmy.
"I hope you won't tell me to have hope," Timmy said matter-of-factly as Lilly gathered the supplies from the cabinets in the room.
Luka shook his head. "You know your body. But your parents will want the tests to be sure."
Timmy nodded knowingly. "This is going to be hard on them."
"Yes, it will," Luka said softly, still surprised at the young man's perceptiveness.
Timmy changed the subject, putting a smile on his face. "Hey Dr. Kovac, do you like baseball?"
Luka smiled in return and shook his head. "I'm afraid I don't understand it too well. You come to watch the Cubs?"
"Yeah. They are the greatest," Timmy grinned, then looked at Luka. "It's okay that you don't understand the game, you can just cheer for them."
"Why do you like them?" Luka asked.
Timmy shrugged philosophically. "They never win the division championship or the World Series. But they are a great team. They always are out there, trying."
"Yes," Luka said playfully. "I think I have heard something about them." Then his eyes held a far off look. "I even sat in their stadium once."
"You did? Wrigley Field?" Timmy brightened. "Did you see a game?"
Luka attention returned to Timmy and he laughed. "No, no. I just saw the stadium as they prepared for one." He smiled once again at Timmy. "Let's get these tests done, huh, and then you can tell more about baseball. I need to better understand that infield fly rule."
Timmy nodded enthusiastically as the nurse stepped near.
"Hey, you like the Cubbies?" a teenager in the next bed asked Timmy. "Me too!"
Timmy and the boy started talking baseball while the nurse started drawing blood for the lab work.
Kerry walked back into Exam One to find Tom Greenfield back at his wife's side, their faces tight. Kerry stepped up to the bed, her own face strained as well.
"I've called for an obstetrics consultation," she began, then shook her head. "I'm sorry, but I can't find a heartbeat from the baby on the ultrasound. We're going to need a second opinion before we can say for sure what's happened."
"What does this mean Dr. Weaver?" Becky asked, the tears starting.
"If what I suspect is true, you have a missed, spontaneous abortion," Kerry said gently.
"Abortion?" Tom asked, rejecting the word.
Kerry tried to choose her words carefully. "In this case, it is spontaneous, meaning you didn't intend to abort the baby. It just died and was not expelled."
The shock rolled over both Greenfields.
"We can call it a miscarriage if you like, and your body simply has not expelled the ---." Kerry stopped and then took a breath. "Miscarriages happens in ten to fifteen percent of all pregnancies."
"Why?" Becky choked.
"Any number of reasons," Kerry explained. "It could be physical, or genetic, hormonal, or something do to with your immune system. They'll do a number of tests upstairs to determine the cause."
"What will happen to the -- the baby?" Tom finally found his voice.
"Kerry," the recognizable voice came from behind her. She turned to see Romano at the exam room door.
"Robert," Kerry acknowledged him. "I'm just a little involved here." She returned her gaze to the distraught couple.
"I can see that," he said, unimpressed. "I just read your recommendations for the press release on our Pediatric Level One Trauma rating renewal. It needs a revision before I can release it to the press."
Kerry nodded, trying to dismiss him, not even looking at him. "Thank you. I'll get to it shortly."
"You don't emphasize enough the rapid response we have and our low infection rate," he continued unabated.
"Yes, Robert," Kerry said, the exasperation rising in her voice. "I'll start on it shortly."
"I need it now," he insisted. "The entire press packet is going out within the hour to make the local television station new cycle."
Becky and Tom looked even more stricken as the conversation continued.
"Robert," Kerry finally turned to him again, her voice firm and rising. "I am busy right now."
Romano took a step closer. "If you don't fix this, I will do it myself."
"Fine," Kerry answered, her temper gaining control. "You go ahead and put any words in my mouth that you want. You will anyway."
For once, Romano lost his voice. He glared at Kerry and stormed out of the room.
Kerry turned back to the distraught couple and took a breath to calm herself. "I'm sorry for the interruption. If OB confirms this diagnosis, they will either induce labor, or do a dilatation and evacuation of the uterus." Kerry's voice was finally back to a level of compassion.
Becky began sobbing.
"I've arranged for you to be admitted. You'll need to stay for a twenty-four hours after the procedure to make sure you're not bleeding. I'll also call for a grief counselor to come and talk to both of you."
Kerry gave a look to Chuny who was nearby. Chuny nodded and left the room.
"Why would God take our child?" Tom said, his own eyes filling with tears as he held Becky's hand.
Kerry looked at him. "I don't know," she answered, her own emotions brimming. "You are still young -- once they identify the cause, you should have more success with the next pregnancy."
Tom looked at his wife. "We didn't know if it would be a boy or girl, so we painted the nursery in all the colors." He took a breath. "I don't know if I can go through this again, knowing this is a risk."
"This is very painful for both of you," Kerry said, looking down. "But you have time."
"I'm so afraid I did something wrong, that God is punishing me. Did I do something wrong?"
Kerry was totally at a loss for words. "I don't think so. Maybe God will bless you again."
Tom looked away and Becky continued to cry.
"You have time," Kerry said quietly. You are only twenty-six. You have plenty of time." She turned her head away from the couple, trying to think of words to say.
"I can't even think about trying again," Becky said between breaths.
"Of course," Kerry responded quickly. "No need to think about that now. I'm going to let you be alone right now. Shortly, someone will come to take you upstairs. And a counselor should be with you shortly."
The Greenfields nodded.
"You can use the phone there on the wall to call whomever you need."
They nodded again,
Kerry tried to give them an encouraging smile, then turned and slowly left the room. Outside the door, she paused amidst the bustle of the hallway, her own face nearing tears.
"Kerry?" Elizabeth's voice came to her. "You left a message for me?" she asked expectantly.
She looked up to see Elizabeth striding down the hall.
"Are you all right?" Elizabeth asked as she got closer.
"Yes," Kerry sighed. "A difficult case -- I had trouble finding the words." She nodded her head back towards the exam room door and was going to say more but changed her mind, pulling herself together. "Elizabeth, your tests came back. You are not pregnant."
Elizabeth absorbed the news, her face showing an odd combination of relief and sorrow. She leaned against the wall.
"I'm sorry," Kerry said quickly. "Were you hoping to be?"
Elizabeth shrugged. "I don't know. I've never really thought about having children. But all morning I kept thinking about it. And now, I do think -- I do think I'm disappointed." She looked at Kerry.
"I haven't thought about it much either, until recently." Kerry looked away, embarrassed that she had revealed such a personal matter.
Elizabeth nodded knowingly. "We are getting older, nearing that magic line of forty."
They were both silent for a moment, then Kerry spoke. "I just -- I haven't met anyone that I'm interested in -- and who is eligible and interested in me -- for a long, long time."
Again, Elizabeth nodded. "I feel that Mark is pretty unusual. He doesn't seem to be bothered by the fact that I have a position of authority."
"Yes," Kerry said. "That's part of the problem." She looked away, then steeled her face, and turned towards Elizabeth. "You going to tell Mark?"
"I suppose," Elizabeth said. She looked at Kerry. "Thank you."
Kerry nodded as Elizabeth turned to leave then looked back at the Greenfields through the exam room door.
Act Three 3pm
"How's the studying going?" Peter asked, forcing a pleasant look on his face.
Cleo looked up from the reference book at the desk and shrugged. "Okay." She took a breath and shifted her weight. "Look, Peter, I'm sorry if it seems like I'm being remote, or -- difficult."
A flicker of a grimace passed his face but he quickly erased it. "I understand." He spoke low to keep his voice away from Randi and Kerry who were both working in the area.
"It's just that I feel a lot of pressure to do well." Cleo searched for the words. "To be perfect. And with the double specialty --"
Peter broached a subject that had been on his mind. "Why did you choose pedes in addition to emergency medicine?"
Cleo stared at him, the irritation returning. "You mean, do I really love kids enough to do emergency pedes?
"Well, sorta of," he said, trying to make light of the question.
"I do love kids." She looked away, softening a little. "I am the oldest in large family and I always helped to take care of my young brothers and sisters. As I went through medical school, I found that I still liked to take care of children -- but I really looked forward to going home alone at the end of the day."
Peter thought about her answer.
"Growing up, there was never time for my own thoughts, my own dreams," Cleo tried to explain further. "Now, I am doing it my way. And I like that."
"I'll try to be more understanding," Peter said.
Cleo smiled broadly at him. "Thank you." She looked at the clock. "You got time for a cup of coffee?"
"Sure," Peter returned the smile. "Magoo's?" They both turned and walked towards the bay doors.
"Luka, your tests just came in for Timmy Hansen," Randi said, handing him a sheet of paper as he walked up to the desk
He took the paper and scanned the results, then sagged a little against the desk. Kerry looked over from the computer where she was working.
"What'd you have?" she asked.
Luka looked at her with concern in his eyes. "A young boy with TTP -- this is the fourth occurrence."
Kerry looked his elbow at the results. "Thrombocytopenia, anemia, elevated reticulocytes, plus proteinuria and microscopic hematuria. LDH and RBC look normal, but elevation usually follows."
"I better tell the parents," Luka said. "They've been waiting two hours for the results."
"Do you want some support?" Kerry asked.
"Sure," he answered grimly. He turned Randi. "Please call hematology and tell them we need the consult I warned them about."
Randi nodded. Luka and Kerry left the desk and walked down the hall towards Curtain Three as Mark set a chart down in the rack and looked up to see Elizabeth coming his way.
He smiled in greeting. "Hey. Nice to see you early."
Elizabeth gave a small smile. "Do you have time to talk?"
A look of concern came over his face. "Sure," he answered. He looked around. "It's too hot outside. Let's go to the lounge."
"Only if it is empty," she said, trying to keep her voice light.
Mark looked at her again, and they walked towards the door. The lounge was empty and they both sat at the table. Elizabeth took his hand.
"I -- I had a pregnancy test today," she started.
Mark's eyes went wide in surprise. "Are you -- are you pregnant?" he finally asked.
Elizabeth shook her head. "No."
Mark looked down. "What's wrong then? Are you alright?" he finally asked.
"I seem to be fine," she answered, trying to smile.
Mark was at a loss for words.
"But the experience has given me a lot to think about," she said, trying to be philosophical.
Mark slowly looked at her. "You mean -- if you had been pregnant."
"Yes," she answered. "I never really considered having children. I just always considered my job to be my child, in a way."
"But I started feeling different as I considered this."
Again, Mark nodded but said nothing.
Elizabeth looked closely at him. "What do you think about more children for yourself?"
He smiled. I love Rachel, and I miss her a great deal. But I would like to think about another child."
She smiled back at him.
The Hansens were standing outside the door to Curtain Three as Weaver and Kovac approached the room.
"Dr. Kovac?" Mr. Hansen asked. "How is he?"
Luka motioned for the couple to step to the side of the corridor.
"Mr. and Mrs. Hansen, this is Dr. Weaver, head of the ER," Luka introduced her.
The Hansens nodded briefly then returned their questioning looks to Luka.
"I'm sorry, but the TTP has returned. I've already called for a hematologist. They'll want to try another plasmapheresis, and he'll need hemodialysis for the renal failure."
Luka looked down for a moment and then continued. "But you know that with each recurrence, the replacement of the plasma becomes less and less effective. There have been some experiments using vincristine, a drug that has worked in some leukemia cases, but the results for TTP are not definitive. I am sorry."
Mrs. Hansen began crying softly and Mr. Hansen put his arm around her, then looked at Luka. "We've prayed and prayed. Why would God choose to take Timmy like this?" His face was full of hurt.
Luka's face took on a similar hurt, but he spoke softly, reaching his hand out to Mr. Hansen's shoulder. "Maybe God isn't doing the choosing, huh?"
Kerry looked at him sideways but remained silent.
The Hansens were surprised. "What do you mean?" he asked.
Luka leaned against the wall, bending his head down to speak softly to the couple. "Is He choosing Timmy and not choosing Ashley because she is without disease? Or -- is He choosing Timmy to go to heaven and not choosing the rest of us to go to that place of peace?"
This gave the Hansens pause and they looked at each other. Kerry looked down but was interested in the reasoning.
"Perhaps bad things just happen -- accidents or natural disasters, or -- the evil of people -- no matter prayers, or lack of prayers, or the quality of prayers."
"But we've seen the miracles of prayer," Mr. Hansen offered. "Our pastor says, in this case, God has simply not answered our prayers the way we want."
"I don't mean to insult your faith," Luka said. "And if you have found your answers in prayer, then who am I to say, huh?"
He looked into the distance and Kerry could not see his eyes.
Luka continued. "For me, I try not to say God answers the prayer of one person but then -- not those of another. For me, it is possible that God does not choose."
"Then, what do you pray for, Dr. Kovac?" Mrs. Hansen asked.
Luka did not answer, but pointed at the twins through the window. Ashley was sitting by Timmy's side, holding his hand. Timmy was smiling, talking with Ashley as she cried. The Hansens looked through the window as well.
"Look at your son. He is giving love to Ashley, to each of you. Have you seen the smiles he has brought to the others who come in this room? Certainly, the rest of us can do no less, no matter what happens, huh?"
Mr. Hansen looked back at Luka with some resolve building on his face, then gripped his wife a little tighter. They both took a breath and stepped back inside the room.
Luka looked after them for a moment, then turned, and went down the hall, moving towards the exit door. Kerry watched him go but after moment, followed him.
From behind her, the EMTs wheeled a patient towards Trauma One, Carter and Malucci at their side.
"Twenty-eight year old woman," they were saying. "Heat stroke. We administered Ringer's IV, oxygen by mask and a cooling blanket."
A man, clearly the husband, stuck with them. He was a large man, linebacker size with a direct, worried look.
"Pulse is one-thirty, BP is ninety palp," the EMTs continued. "CNS deteriorated in route."
"Sir," Yosh spoke to the husband. "You can wait in the chairs near the front door. We'll get you when we know something."
"I'm staying with her," the man said, his voice was loud and insistent.
"Tell me what happened," John instructed. "Then you'll have to wait outside."
The man shook his head. "It's my fault. She was watching me while I played a game of touch football. I wouldn't leave when she said she didn't feel good." His voice rose in panic. "I guess she didn't drink any water."
"Was there any shade or was she in the sun?" Dave asked.
"Only the shade of the cars," he answered, his eyes darting between his wife, John and Dave.
"Is she used to being outside in the heat?" John asked.
"No, no," the husband said, nearly crying now. "She works in air-conditioning. She hardly ever goes outside in heat like this, doesn't like it. It doesn't bother me -- I work highway construction."
They lifted the wife to the examination table while the husband paced in a small space next to the gurney.
"CBC, coag panel, Chem Seven and U-A. Wet a sheet in tepid water," John gave instructions. "Sir, please wait outside the door. I'll come tell you how she is as soon as I can."
The husband nodded just slightly and stepped back just slightly towards the door, but then froze in place, watching.
Luka stepped next to the window beneath the stairs. He leaned against the wall and took a breath. Quietly, Kerry came up beside him.
"You've given such things a lot of thought, Luka," she said after a while.
Luka continued looking out the window. "I hope it helps them deal with what is coming."
Kerry spoke carefully. "Is that how you cope? I mean, with what you told me along time ago?"
He was silent for a moment. "Sometimes it helps. Sometimes, it doesn't matter whether God chooses or not. They will feel the pain just the same."
"But maybe they won't be mad at God now," she offered carefully. "May I -- borrow your words for my next difficult case?"
Luka almost smiled. "Sure."
Kerry hesitated. "And I was reminded about the important things from what you said."
He finally looked at her.
"You're right -- despite whatever happens to us, it is how we respond that matters. It's the time we spend with others and what we do for others that matters." She stuck her left hand in her coat pocket, looked out the window, and sighed.
Luka took in Kerry's countenance. "But some days are harder than others, huh?"
"Yes, that is true," Kerry said philosophically.
Suddenly, loud voices came from Trauma One. Both Kerry and Luka turned their heads then started rapidly walking in that direction.
Act IV 3:30pm
"You save my wife!" Mr. Peterson screamed, advancing towards John. "Put ice on her -- anything!"
Haleh immediately moved towards the phone.
"Ice will make her worse," John tried to say gently, surprised at the man's outburst. "I can't help her if you don't calm down."
"Security to Trauma One," Haleh spoke into the phone. "Page Dr. Benton, too."
"Rectal temperature is forty-two point nine," Yosh said.
"Save my wife!" the husband continued without stopping. He advanced towards Carter, his hand thrusting in the air, pointing. John backed away from the taller man, a look of shock etching deep lines on his face, his breathing increasing in speed and volume.
"What's wrong with you?" Peterson shouted and then sobbed. "Get back there! Do something! Now!"
Malucci looked on in shock, as did Haleh and Yosh.
Without stopping, Peterson continued to rant, backing John towards the wall as two security guards rushed in from the hallway. The guards ran to Peterson, grabbed him on both arms, and started pulling his out of the room.
Haleh stepped in front of John and attempted to talk to him as Luka and Kerry quickly entered the room behind her. "It's okay, Dr. Carter," she tried.
"Let go of me!" Peterson yelled. "This doctor has to save my wife!" He struggled but the guards, still moving him backwards, were able to get him out of the door.
"Do what you can for the wife," Kerry spoke firmly, looking at Malucci.
Dave came to his senses. 'Set up the foley," he started in. "Get some fans and another wet sheet."
Luka walked directly towards John who was backed up into the corner of the room, next to the light board. Haleh was still trying to talk to him but he was looking downward and his chest heaving. Luka slowed down about five feet from John.
"John, its me, Luka," he said quietly.
Haleh turned around at Luka's voice and his eyes told her to get out of the way. She backed up quickly but then stood at his shoulder as Luka took a small step forward.
"John, listen to my voice and take a deep breath," Luka continued, his voice still soft. "You have a choice of how you want to respond here."
John took a large breath and expelled it slowly. Kerry stood a few feet behind Haleh.
"Good choice. Now look at me, John, and take another one." Luka kept his eyes on John but felt a crowd gathering behind him. He took another step closer.
John looked at Luka and took another deep breath, exhaling slowly.
"Good. You know how this is done. First, we'll count to five and you will feel your heart slow down, huh?"
Luka counted to five slowly as the rest of the room worked silently on Mrs. Peterson.
"You feel your heart slowing. Okay?" Luka continued.
Luka kept advancing and John started looking a little better.
"That's good, John. Control your breathing and look at me, hmm? I'm going to call Don. Focus on your breathing," Luka maintained an intensely quiet tone of voice.
John nodded, closed his eyes, and continued a measured breathing.
Luka turned his head slightly to the presence he felt on his right, not really seeing Haleh or Kerry standing there. "Dr. Don Kyrkendall."
Luka shook his head, continuing to look at John. "Private practice. In the book, under psychiatrists."
Haleh nodded and started to move away but Kerry was immediately at her side. "I'll do it," Kerry instructed in a whisper. "I have the number." She turned and left the room quickly.
"We're getting Don on the phone," Luka said, trying to put lightness in his voice. "Hey, it's crowded in here. Let's go some place quiet, okay?"
John nodded quickly. "Okay." He shifted on his feet and stepped towards the nearest door, Luka moving next to him, glancing at the staff still working on Mrs. Peterson and the other staff members who had gathered. The tilt of his head and glare of his eyes told them to scatter.
"Okay, let's find an empty Exam room. Dr. Malucci will take care of your patient."
"Four is empty," Haleh spoke up.
Luka nodded and picked up the pace with John, still keeping his voice low and away from the other in the room. "We're going to do the visualization and you will relax, okay?"
John shook his head affirmatively.
"Good," Luka said. "Good choice."
They left Trauma One, the nurses and other staff scattering before them, Malucci and Yosh still working on Mrs. Peterson, but stealing glances at the drama leaving the room.
"Thirty-five milligrams of thorazine," Dave ordered. "And another Ringer's."
Yosh responded as a nurse arrived with Lydia and with two additional fans that they started setting up.
"How's the renal output?" Dave asked.
"Nothing in the foley," Yosh answered.
"Let's get another rectal temperature," Dave instructed.
Mark burst in the side door of the trauma room. "I saw the security guards hauling someone off. What happened? Is Carter okay?"
"The husband went ballistic," Dave tried to explain, "when we said his wife's condition was very grave."
"Security got him out of here," Haleh added as Peter and Cleo arrived. "But Dr. Carter's pretty upset."
"Where is he?" Peter demanded.
"Dr. Kovac took him to Exam Four," Dave said.
Mark turned to Peter and after a glance of concern between them, they turned and headed towards the exam room.
Through the half-opened blinds on the door's window, they saw John sitting on the exam table and Luka talking to him. Without knocking, they burst in the door. Both Luka and John looked up in surprise.
"John," Mark began, his voice rising in concern. "Are you okay?"
"Yeah, yeah," John started to explain as Mark and Peter stepped between the two men.
"We can handle this now," Peter turned to Luka, dismissing him with authority.
"No," John tried to object.
"It's okay, Carter," Mark said. "What happened?"
"I really think we should speak softly," Luka tried. "We're doing some visualization techniques."
But neither Mark nor Peter heard him as they pressed John for details.
"What can we do for you, Carter?" Peter asked.
"No, I'm alright, but I need to be quiet for a moment," he tried to explain.
"Please," Luka continued to object.
"Why did you react this way, John?" Mark asked. "You've had angry family members before, angry patients."
"Because the husband got irate and I got scared," John answered, an embarrassment creeping into his face.
Both Peter and Mark looked confused.
"Don't you get it?" Carter was exasperated at trying to explain the obvious but didn't want to explain at all. "I took the narcotics to keep from being scared when things like this happen -- to keep from always worrying that I could get hurt again -- because they made me feel invincible!"
Peter looked surprised and stared at the floor.
John's voice became intense. "And without the narcotics -- this scared me," he said, enunciating every word in an effort to make his friends understand.
Mark reacted visibly, then turned quickly to Luka. "Thank you, Luka," he said with dismissal in his voice. "He needs his friends right now. Thank you."
John looked at Peter, then at Mark, and finally at Luka. He gave him a nod of understanding. "I'm okay."
Luka looked only at John and left the room, his face grim, passing Jing-Mei as she went in. He took a quick glance through the window again to see them crowding around Carter. Jing-Mei attempted to hug John and he responded but stiffly. Luka turned to see Kerry coming.
"I got a hold of Dr. Kyrkendall," she said quietly. "He can see John in ninety minutes."
"Tell them." Luka nodded back towards Exam Four.
Kerry gave a puzzled look and stepped inside the room.
"I'll be okay," John was still protesting.
"Don can see you in a little while," Kerry said, stepping into the crowd around him.
"You can do this without drugs, John," Peter insisted, his face incredulous.
"They got Mr. Peterson up to Psych," Jing-Mei offered, hoping it would calm John some.
"You're looking better, Carter," Mark said, trying to be positive.
John became even more agitated at their ministrations. "This is just the first time something like this has happened since I've been back. I'll handle it," he protested to the crowd. "I know what to do."
Kerry stood aside from the crowd, looking at them, and looking at John. Then she turned and left the room.
Luka's long legs took him quickly out of the lounge where he had deposited his lab coat, and through to the bay doors, out to the street. He shoved his hands in his pockets, his face focused on the sidewalk, and kept on walking.
Kerry walked to the admit desk deep in thought, then looked at Randi. "I'll be upstairs. Page me if you need me."
Randi looked up, chewing gum, and nodded.
Kerry headed for the elevator. Getting off at on the eighth floor, she entered the personnel office and approached the clerk. "I want to see the personnel file on Luka Kovac. K-O-V-A-C."
The clerk nodded and disappeared into a door behind her desk but returned shortly with the folder. "Sign for it here," the clerk instructed.
Kerry did as asked, took the file and sat down at the desk in the reception area. Opening the file, she slowly went over each page.