CATEGORY: LKo/JC/Cast Drama
SPOILERS: This story is structured as an episode that could have taken place two months after the season six finale.
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. However, I am not a medical person and my research does not guarantee a correct interpretation.
Thanks: my appreciation to three extraordinary friends who give me constant encouragement, assistance, feedback, and inspiration.
SUMMARY: This story is structured as an episode that could have taken place two months after the season six finale. It involves John Carter's return from rehab, a new charge nurse, a new budget for the Kerry, more training for Malucci and Abby, romantic difficulties for Peter/Cleo and Mark/Elizabeth, and a tired Luka.
Uncharted Territory -- Teaser (Prologue) 6:45am
Kerry Weaver entered the automatic double doors and then the swinging doors to see Haleh moving a cart down the hallway. "You are at it bright and early," she observed with a look of approval.
Haleh looked at her and smiled. "Just getting organized. You've been busy so I just took charge."
"I'm glad the Chief of Nursing appointed you," Kerry smiled in return. "I urged them to." Then she sighed. "I'm sorry that I have been so pre-occupied with all these administrative meetings. I wanted to sit down with you and review all the SOP's, change all the signature authorities," Kerry recited her list of objectives.
"Don't worry, you know I can handle the mayhem," Haleh interrupted, trying to assure her. "You and I are used to working together."
"Yes, but it's a new relationship and we need to set new parameters," Kerry countered but then looked at her watch. "And I've got a budget meeting in forty-five minutes that I need to prepare for."
Haleh nodded and smiled. "We will. Go to your meeting. I'll page you if we need you."
Kerry appraised her. "Thank you. I'm sorry, I don't even know what the schedule is today." With that, she turned and headed towards the elevators.
"Don't worry," Haleh yelled after her, then continued pushing the supply cart towards the admit desk as the EMT radio started ringing.
Frank, the desk clerk, moved over to answer as Haleh arrived and started unloading more forms and folders.
Shortly he reported the information, reading his notes. "Multiple MVA from the beltway. ETA is seven minutes. First victim is asystole, with multiple head wounds. The second is female, with a lacerations, broken left leg, vitals stable."
Haleh turned to find Chuny and Yosh standing there. "Who are the docs on duty?" she asked.
"Malucci and Chen just arrived," Yosh answered.
"Dr. Kovac is here. I think he's sleeping in Exam Four," Frank added.
Haleh sighed. "I hate to get him up. He was at the free clinic yesterday and on duty all night."
"Especially just for a DOA and a broken leg," Chuny concurred.
Yosh looked at the chart. "Dr. Greene won't be in till eleven."
"Yeah," Chuny added. "He's picking up his daughter at the airport and Dr. Kovac is scheduled long to cover it."
Haleh shook her head. "He's the only attending here. Dr. Weaver is upstairs at a meeting. Policy is policy." She looked at Chuny but adopted a softer tone. "Get him up, but be gentle about it."
Chuny nodded, then turned down the hall that was becoming increasingly busy. At Exam Four, she carefully opened the door and looked into the darkened room.
"Dr. Kovac," she said softly, not entering too far, the light from the hallway doing so instead.
Luka jerked awake at the sound of his name.
"I'm sorry to wake you up, but we need you," she said a little louder.
He nodded, groggy from the sleep. "Okay."
Chuny waited until he started to rise and then gently backed out of the room. Soon, she heard the door open and footsteps behind her as she headed back to the admit desk, where she waited until Luka arrived.
"I'm sorry to get you up, Luka," Haleh said turning to him. "Multiple MVA coming in. You're the only attending available."
"Sure," Luka answered sleepily.
"Dr. Kovac, have you heard? Haleh is the new charge nurse," Chuny offered cheerily.
Luka took in a small breath and looked briefly away, but then looked at Haleh. "I must have missed the memo." He gave a smile that reached his eyes. "Congratulations. You'll do a wonderful job."
Haleh beamed. "Thank you." She turned to Yosh and Chuny. "Let's get the rooms set up."
The two nurses nodded and the three of them moved off down the hallway. Luka leaned on the desk and looked at the floor, still trying to wake up.
Frank, who had been hovering on the edge of the conversation, approached Luka, full of energy and a pleasant look on his face. "Dr. Kovac, I've been here two months and we've never really had a chance to get to know each other. Seems like we always have different shifts."
Luka looked up, surprised.
"Where you from, Dr. Kovac?" Frank asked with a friendly tone embedded in his police officer demeanor.
"Croatia," Luka answered with a sigh, bristling just slightly and looked down again.
"Been in the states long?"
"About two and a half years," Luka answered politely, holding his distance. He glanced at Frank. "You?"
Frank chuckled. "Touché," he said.
Luka brightened considerably. "Vous avez fait de l'escrime?"
Frank responded with a quizzical look.
"Oh, I'm sorry," Luka said, immediately chagrined. At Frank's continued puzzlement, he explained, trying to be nonchalant. "I -- asked if you had studied fencing. Touché is French, and a fencing term -- a point scored. I just thought --"
Frank laughed out loud. "No, I don't speak French. And now you got two points scored."
"Don't worry," Luka answered, his voice tired, but a small smile forming. "I'm sure you'll catch up."
A ringing phone shattered the shuttered silence of the room. Mark rolled over and grabbed the phone.
"Hullo?" he asked, rubbing the sleep from his eyes.
Elizabeth opened the bathroom door and both her hair and the light cascaded into the darkness. She waited.
"Well, alright honey," Mark sighed. "I understand. You have a good time." There was a long pause. "Yes, I love you too."
"Is Rachel not coming?" Elizabeth asked as he hung up the phone.
"A great camping opportunity," he answered rolling back into the pillow. "One of the best camps."
"I'm sorry Mark," Elizabeth said softly. "Well, at least now you don't have to go to the airport. You can sleep in." She tried to smile at him.
"I don't think I'll ever get used to her living so far away," Mark said, a father's sadness in his eyes.
"You'll find a way to keep that closeness between you," Elizabeth soothed.
"She's growing up so fast," he mused thoughtfully. He looked up at Elizabeth. "You going to that meeting?"
"Yes, at 7:30. Romano's first budget meeting in preparation for the newly seated Board of Directors."
"Have fun," Mark said. "Better you than me."
"I sincerely doubt there will be any fun." Elizabeth turned out the bathroom light and came into the room. She leaned down and gave him a quick kiss on the cheek. "Perhaps we can have lunch later?"
"Sure," Mark mumbled as he snuggled back down into the bed.
Uncharted Territory -- Act One 8am
Dr. Ken Swanson escorted John Carter, dressed once again in a suit and tie, into his office. "Well, John, you look good."
"I feel good, Ken. I've had more sleep in the past two months than I had had in all my medical training," John said, sitting down with a smile on his face.
Ken joined in the smiles but held his words.
John looked down. "But -- I am nervous about going back."
"Of course. As we agreed, I have kept Kerry Weaver up-to-date with your progress." Ken picked up a piece of paper from his desk. "She asked that you check in for a half-day of work this afternoon when you get there. She'll go over your probation and work conditions."
"And as we've discussed, and Dr. Weaver agrees, you simply tell people that you've been getting medical treatment for your injuries. No need to go into it any further."
"Yeah, but I figure everyone will know what's really up." John examined his fingers closely.
"Remember, sometimes the truth with folks is best. But you make the decision about what you tell your friends and colleagues."
"I know," John agreed.
Ken handed a piece of paper across the desk. "Here's the referral for you. Dr. Don Kyrkendall. We went to school together and he's excellent."
John took the paper and fingered it.
Ken sat back. "As luck would have it, his regular group meets tonight. You're going to have a full day."
"Good," John smiled. "Sorta like the idea of keeping busy my first day back." He folded the paper and put it in his suit coat pocket.
"You've done very well, John. I think the extra thirty days you spent here will ensure your success."
John's face became serious and he took a breath. "I know this is going to be my life's struggle, and probably not the only one." He shrugged and looked away for a moment. "It's funny saying this, but even though this is going to be a totally new thing for me, I really do feel prepared."
Ken nodded thoughtfully. "Let me tell you of a conversation I once had with a structural engineer on a long plane ride."
John looked expectantly.
"The eighty-nine earthquake in San Francisco and the eight-five earthquake in Mexico City were about the same magnitude. But there was much more damage and death in Mexico City. Do you know why?"
John shook his head. "The foundations of the building in Mexico City were inferior?" he offered.
"No," Ken answered. "Actually, the major cities of second world countries are more modern and structurally sound than most people think." He paused and narrowed his eyes. "The quake in Mexico City was about three times as long as the one in San Francisco."
John nodded as he understood the suggestion. "Anybody can come undone."
"Or undone again," Ken added.
John smiled ruefully. "I understand. I'm going to do everything you taught me." He paused with a thought and then voiced it. "I'm beginning to think everyone should have this kind of ... training."
"Perhaps that's something you might advocate when you get back," Ken said knowingly. "Stress among physicians, among all medical personnel, is very high. All of our professional organizations are beginning to recommend stress management techniques and training. Especially for emergency room personnel."
"I agree," John said nodding. "And it would give us all a foundation to talk about the stress we see everyday."
"Yes," Ken agreed. He cleared his throat. "Well, you need to get to the airport." He stood and held out his hand. "Good luck John. And keep in touch."
John reached out with both hands to shake his doctor's hand. "Thank you for everything. I will let you know how I'm doing." He smiled wistfully.
"You'll do fine," Ken said reassuringly. "Go on."
John nodded as he dropped the handshake. With one last look at his doctor, John turned and headed out the door with a determined look on his face.
Haleh left the admit desk, and amongst the crowd in the hallway, saw Luka coming from Curtain Three with Abby.
"That was the right test to order, Abby," Luka praised.
Abby looked up. "Really?" She gave a tentative smile.
"You are gaining confidence," Luka offered.
She sighed and folded her arms. "It's just that this is all harder than I thought it would be. Sometimes -- I think I'm too old to learn all there is to learn."
Luka leaned against the wall and thought for a moment. "I'd like to think that we never stop learning. You have a natural empathy with your patients. The learning part is coming along very well."
"Dr. Kovac," Haleh interrupted as she drew closer. "We've got a multiple trauma coming in, boating accident on the lake."
Luka nodded with tired eyes.
"I'm sorry, but we may need you to stay on a little bit," she continued. "Mark Greene is your relief and he's due in an hour, but Dr. Weaver is still in a budget meeting upstairs."
"How many and what's the ETA?" Luka asked.
"Two by chopper, ETA five minutes. Four by ambulance, ETA fifteen minutes."
"Page Kerry anyway as well as a neurologist," Luka instructed.
"Okay," Haleh responded, moving off. "The trauma rooms are almost ready."
Luka turned to Abby. "And what happens when fluid is aspirated into the lungs?"
Abby's mind turned. "It produces vagally-mediated pulmonary vasoconstriction and hypertension."
"Why is freshwater aspiration dangerous?"
"The alveolar-capillary membrane absorbs it quickly into the microcirculation. The surfactant destruction produces alveolar instability, atelectasis and decreased compliance with marked V/Q mismatching."
"Good," Luka said. "Watch on the major traumas, and then take one of the lesser injuries coming by ambulance." He sighed and looked down.
Abby smiled with the praise and the assignment but then watched her teacher's face. "Dr. Kovac, are you alright?" Abby asked tentatively.
"Yeah, yeah," he said looking back up at her and then straightening up. "Just tired. Let's go."
They both moved across the hall to the trauma rooms.
"Robert, we've been at this for three hours," DeRaad said, leaning in on the table. "Some of us maintain regular patients."
Kerry looked up over her glasses from a large ledger page filled with numbers at the various unit heads seated around the table.
"I want to make sure you understand the politics of the situation when members of the hospital board and the city council show up unexpectedly," Romano countered, leaning forward on the conference table. "These details are important."
"Just tell me how much I'm getting for my department for operations and for capital improvements and I'll be happy," Janet Coburn joined in the protest.
Romano read the restless mood of the room and motioned to his secretary who began distributing folders to each of the department heads in the meeting.
"Alright. In these individualized folders, you'll find my projections for your department for both operations and capital." He paused as each person opened their folder and began reading. "As you can see, we actually have some real money for capital improvements this year."
"Robert," Kerry said, surprised. "This is wonderful."
"Yes, it is," Romano beamed, proud of himself. "I need your equipment recommendations and justifications in forty-eight hours." He reached out, took a strawberry from the platter at his end of the table, and popped it in his mouth.
"Forty-eight hours?" Elizabeth asked incredulously. "I can't get an updated list done that fast. I've got two surgeries this afternoon and three tomorrow."
Kerry's pager started going off and she fished it from her pocket.
"You'll just have to," Robert countered as he swallowed. "The list goes to the board in three days and the city council next week."
"Excuse me," Kerry said, standing, "I've got to go. You'll have my list soon."
Robert seemed to smile at her as she backed out the door while objections to the short deadline rose again.
"Found unconscious in the water," the EMT said as they lifted a young man, strapped to the trauma board, to the exam gurney. "Intubated at the scene with one hundred percent O-2. Pulse is one-forty, BP is one-forty-seven over ninety-eight."
Lydia replaced the EMT's ventilation bag with the respirator while Yosh taped the victim's finger with the pulse ox lead and then began getting a new blood pressure.
Malucci began unwrapping the blankets from the victim. "I want a arterial blood gasses, complete CBC, electrolytes and coagulation profile."
"Also a urinalysis for blood alcohol level and toxicology," Luka added.
"How cold was the water?" Abby asked.
"Not bad, seventy-one degrees. Witnesses say he was thrown from the boat, landed head-first in the water beyond the boat," the EMT continued as he rolled the gurney out the door.
Luka turned towards a Lydia. "Please make sure the neurologist gets here."
"We've paged one," Lydia answered.
"Pulse ox is eighty-three," Yosh announced.
"Dr. Malucci, what else do you want?" Luka asked.
He thought for a minute. "A chest x-ray to look for aspiration or pulmonary edema." Malucci moved closer to the victim's face. "And a neck and c-spine because of how he landed in the water."
"Good," Luka answered.
"How about a nasogastric tube?" Abby asked from the back.
"Yes," Luka answered. Turning to Lydia, he continued. "Cath the urine as well."
"Pulse ox is falling some, down to 78," Yosh announced.
Luka looked expectantly at Malucci.
"Positive end-expiratory pressure," he said quickly.
"Yes," Luka said. "Do it now."
Malucci moved to the respirator and made the adjustments.
"Why do a P-E-E-P?" Luka asked.
"P-E-E-P improves the ventilation patterns in non-compliant lungs a couple of ways -- by shifting interstitial pulmonary water into the capillaries, and by increasing lung volume via prevention of expiratory airway collapse." Malucci beamed at his own response.
"Abby, what else?" Luka asked again.
"Uh," she stammered a moment. "It provides better alveolar ventilation and decreasing capillary blood flow. It increases -- the diameter of both the small and large airways to improve distribution of ventilation." Abby beamed as well.
Haleh stuck her head in the door. "Dr. Weaver has the second victim. Is everything ok in here," she asked, coming into the room.
"Yes, everything is fine," Luka answered.
"Lydia, get this paper off the floor, don't let the refuse just lie around like this."
Lydia bristled but complied immediately.
"Two ambulances are one minute out," Haleh told the room.
"Abby, you take one, Malucci the other," Luka said, moving in to replace Malucci at the bedside. "Good job, everyone," he added as they left.
Both of them nodded with a smile and quickly left the room behind Haleh.
Luka turned to Lydia. "Please call the ICU and reserve a bed."
"Right away," she answered.
"New vitals, please Yosh," Luka asked as everyone turned back to the victim.
Uncharted Territory -- Act Two 11:15 am
"We'll need to keep you for six to eight hours," Abby tried to explain to the boating accident victim.
"Oh, man, I can't stay that long," the teenager whined and squirmed on the bed. "I feel okay."
"I agree, you don't have any evidence of bronchospasm, tachypnea or dyspnea, and your pulse ox is good," Abby kept her patience.
"What's that stuff?" the girl continued to whine.
"Your breathing seems normal," Abby sighed. "But we still need to observe you."
Mark came hurrying into the room. "How are you doing, Abby?" he asked, grabbing the chart and examining it.
"Everything's under control," she answered. "Dr. Kovac has looked it over. You just coming on?"
"Yeah," Mark answered, putting the chart down.
"Good, Dr. Kovac is next door in Trauma One. I think he needs to go home and get some sleep," she said, turning towards the door and stripping her gloves.
"Thanks," Mark said, going out the door first where he almost ran into Kerry. Abby saw the urgent look on Kerry's face and backed away.
"Mark, I wanted to talk to you," Kerry said.
"Let me check on Trauma One first," Mark answered.
They began walking down the hall together towards the trauma rooms, but then Kerry paused and looked at Mark. "Did your daughter get here?"
Mark stopped and sighed, disappointed. "No, she got an opportunity to go to camp. She's not coming." They started walking again.
"I'm sorry Mark," Kerry commiserated. "I know you were looking forward to her visit."
"Yeah," Mark said, then changed the subject. "You had one of the traumas from the boating accident?"
"Yes," Kerry answered. "Not too bad, admitted to orthopedics."
"Good," Mark responded. "Does Carter come back today?"
"Yes," she answered. "Should be in after lunch."
Suddenly, Kerry stopped in the hall, unable to contain the news any longer. She turned to Mark and grabbed his elbow. "Listen, you are not going to believe this, but Romano has allocated one point three million for new equipment in the ER. We've got forty-eight hours to submit our list."
"One point three mil?" Mark repeated, incredulous. "Just for us? Doesn't have to be shared with another department?"
"Yes. I'm as surprised as you are," she answered, bewilderment in her eyes. "I can't remember when we had more than just replacement money." Kerry turned business-like. "We need to start reviewing our equipment list to make sure of our priorities and update the latest equipment information."
"Let me check on this trauma and then I'll be right with you," Mark said, smiling in anticipation.
Kerry nodded as she moved off. "Meet you in Exam One. We can work there."
Mark walked into Trauma One to see Luka and the neurosurgeon consulting x-rays on the light board.
"Doesn't look like any fractures," the doctor was saying. "Based on the physical exam and these x-rays, I think the only issue is the aspiration."
"Thanks," Luka said as the neurosurgeon left the room, dodging Mark as he went.
"How's he doing?" Mark quickly asked Luka.
"Some improvement, no apparent additional injuries," he answered. "He'll be ready to move to ICU in about thirty minutes."
"Good," Mark answered, turning to go. "Can you stay and handle it?"
Luka looked at him and nodded. "Sure," he said, trying to keep his voice positive, the tiredness showing through, but Mark was already gone. He quickly turned back towards the patient.
"Well, I hope that she doesn't let this get to her head," Lydia said sitting on the desk at the nurse's station.
"I've known her too long," Connie said, her arms folded across her chest, positive in her attitude. "She won't get power-hungry on us."
"No, the worst thing that can happen is she'll try to mother us all," Yosh laughed, looking at the rest of them. The others chuckled as well.
"That's not so bad," Malik answered. Connie reached over and playfully slapped his arm.
"But you know how it is," Chuny spoke up after the laughter subsided. "Things are going to have to be by the book for a while, and then it will settle down."
"Any change is going to be uncomfortable," Lilly added. "It's new territory." The others nodded knowingly.
"Speaking of new territory, I heard Carter is coming back today," Connie speculated.
"His name is on the schedule for this afternoon," Yosh said solemnly. "Really hope his 'vacation' went well." The others nodded knowingly as well as Luka walked up.
"Can someone to go with the boating victim up to ICU," Luka asked.
"I'll do it," Lydia answered pleasantly, standing up. She took the chart from Luka.
"Thanks," he said just as a loud commotion came from the hallway near the ambulance bay doors.
Luka and the nurses moved quickly in the direction of the noise. Frank was trying to hold onto a struggling, dirty man dressed in filthy, ragged clothes. Another man, similarly dressed, released his grip and started moving back out the doors.
"Hey, wait a minute," Frank yelled after the disappearing man. The first one continued to struggle. His long hair, streaked with gray and grime, fell into his face as he twisted in Frank's grip.
"Let go of me," the patient gurgled and struggled. "We've got to be outside."
Malik arrived grabbed the dirty man's other arm. "Relax, man, relax!" he yelled.
"Calm down," Frank instructed with his policeman's authority.
The more Malik and Frank yelled, the more the dirty man struggled.
Luka bent down to look directly into the man's eyes. "It's okay," he said gently. "It's okay. You are safe here."
The man visibly relaxed a little. Malik and Frank stopped yelling.
"Why did your friend bring you here?" Luka asked softly.
"He thinks I'm crazy," the ragged man answered, trying to point back at the door, towards the disappeared friend.
Instead, John Carter walked in the door unnoticed, everyone's attention focused on the disturbance.
"Do you think you are crazy?" Luka asked gently.
The man stopped struggling entirely. "Sure I'm crazy," he answered solemnly, looking up at Luka. "If you had seen what I've seen, you'd be crazy too."
"Come on," Malik said softly. "We can give you a bath and something to eat."
They began moving the patient towards Curtain Three as Carter looked on from the swinging doors, then walked in the lounge door.
"John," Jing-Mei said, looking up from a chart as she sat on the couch. She struggled to her feet. "Welcome back." Her voice was warm and true as she reached out to embrace him.
Carter accepted the embrace. "Thank you. It is good to be back." He searched Jing-Mei's face and then looked down. "Listen, I want to --"
"Don't even try, John," she cut in quickly. "I understand more than you know."
John looked at her with questions forming on his face.
She nodded. "Someday, we'll talk all about it." Jing-Mei patted him on the arm, then linked her arm in his. "Come on, I know folks will be glad to see you."
Together they headed out the door as Malucci saw them and joined in.
"Hey Carter," he bellowed. "Welcome back."
"Thanks, Malucci," John answered, summoning a bright face as they went through the door to the admit desk.
"Where'd you go? We missed you around here," Malucci said, looking coldly at Jing-Mei behind John's back. Connie and Yosh approached with smiles on their faces.
John also looked at Jing-Mei, tentatively, then answered Malucci. "I went for more medical attention for my injuries. I feel a lot better now."
"Good, good," Dave responded, his eyebrows raised at Jing-Mei.
The others started crowding around him, but he looked back at Frank who took up the clue on John's face. "You want Dr. Weaver?"
"Yes," John said. "Thank you. I need to see her right away."
"Sure," Frank answered. "I'll page her."
"Hey Carter," Chuny said. "Welcome back." The rest of the group expressed similar greetings.
"Thanks Chuny. I missed you all." He tried to smile at the group.
Malucci stepped in. "I gotta go but we'll talk later."
"Fine, fine," John said, the nervousness creeping into his voice just a little.
Dave headed down the hallway and into Curtain Three. He stepped around the curtain pulled on the first bed to find Luka helping Malik and Lilly who were trying to remove the patient's clothes.
"What's your name, sir?" Luka asked.
The man relaxed a little more. "Carl, Carl Milacovsky. Sergeant, U.S. Army." Carl looked at Luka and beamed. "Sixth Battalion, stationed in Da Nang, Vietnam."
Malucci looked closely at Carl. There was an oozing sore just below one of his eye and several more on his arms.
Luka nodded. "Well, sergeant, would you like a bath and a shave?"
Carl nodded. "And a hot meal. I've been out on recon for weeks."
"We'll see what we can do," Luka said. "Now it's time for you to rest. Let us take care of you for a while." He patted Carl's shoulder.
"Okay," Carl said.
Luka turned to the nurses. "Five of diazapam for now. Then try to clean him up a little, please. Dr. Malucci, I'll be back for your diagnosis."
Both Malik and Lilly nodded knowingly back. Then Luka looked at Malucci and nodded, indicating that Malucci should stay and help. Dave balked a little, but off Luka's serious look, nodded in agreement.
Jing-Mei stood at the corner of the admit desk, gazing down it's length to a Frank Bacon, standing at the opposite end. Cleo came up behind her.
"Nice," she whispered conspiratorially.
"I'll say," Jing-Mei answered.
"Kinda makes you want to go up and tear his shirt off," Cleo smiled. "Explore the environment."
"Oh, I've seen him with his shirt off," Jing-Mei answered proudly in the game of one-ups-manship.
"Oh?" Cleo responded, looking at Jing-Mei and then back at Frank. "How so?"
Jing-Mei smiled. "He was a patient here in the ER about six months ago. I treated him. He's a nurse in the ICU."
Cleo nodded. "That's where I've seen him. My, my," she said in sheer appreciation.
"He was in the Gulf War in '91," Jing-Mei said. "A real take-charge kind of guy."
"He can take charge with me anytime," Cleo said. Both residents laughed and continued their appreciative gazes.
Suddenly, Frank turned and approached the end of the desk where they were standing. "Hello Dr. Chen," he greeted her.
Both residents stood up a little straighter and smiled sweetly.
"Nurse Bacon," Jing-Mei said. She held out her hand. "What brings you to the ER?"
Frank took it and smiled. "Just working on a transfer of a patient from the ICU," he answered.
Cleo stepped in. "I hope it goes smoothly," she teased and held out her own hand. "Cleo Finch."
Frank gently released Jing-Mei's and took up Cleo's. "I'm sure it will." He grinned again. "Now if you doctors will excuse me, I have work to do." He started releasing Cleo's hand but she held on for a little longer and he did not necessarily object.
"I've got work to do as well," Jing-Mei said, her tone of voice indicating a shift in attitude. She turned and walked away.
Cleo and Frank turned to see Peter Benton striding towards them, a less than friendly look on his face. Cleo reluctantly dropped Frank's hand.
"Peter," she greeted him. "Do you know Frank Bacon?"
"Yeah," Peter smiled wanly. "I know Frank from the ICU. How you doing, man?" He held out his hand to Frank.
Frank answered the handshake. "Doing well."
Peter turned to Cleo. "Do you have time for some coffee?" he asked.
Cleo was a little surprised. "Sure, I'm waiting on two sets of labs that will take an hour." She took one more look at Frank. "See you later."
"Good," Frank smiled in return, then moved off.
Peter took Cleo's elbow to guide her around the end of the admit desk and towards the bay doors. "What was that all about," he jumped in.
"What was what?" Cleo asked. She looked up at Peter who seemed to be propelling her forward by the elbow. "Slow down. We're not off to a fire."
She wrestled her elbow from his grip when he did not respond. "Peter, what are you talking about?" she asked, confused by his actions.
"Things seemed pretty friendly there," he finally answered. "With Frank."
Cleo laughed. "We were just talking, Peter."
"Looked like more than that to me," he growled.
Cleo took a deep breath and stopped walking. "I don't think I've ever seen you like this. If you are going to be this way, we don't need to have coffee." She glared at him.
Peter was taken back by her firmness. "No, it's alright." He looked down. "Let's have some coffee."
Cleo appraised him a little longer and then relented. "Okay," she said.
Peter looked back up and smiled tentatively. "Good," he said as they both moved off through the bay doors.
Uncharted Territory -- Act Three 12:30pm
Kerry and Mark escorted John into Exam One and closed the door. Papers and files spread out over the exam table.
"Your plane was on time," Mark noted, making conversation.
John laughed. "Yeah, with all the delays and cancellations this summer, I couldn't believe mine was perfectly on time."
Kerry looked at him with concern. "How do you feel, John?"
"I feel good," John answered quickly, then paused. "I feel older, somehow." He paused again. "I've learned a lot."
"John," Kerry took a breath. "We want you to know that everything we said about supporting you is true."
"Dr. Weaver, Dr. Greene," John responded slowly, almost at a loss for words. "I can't tell you how much I appreciate what you did for me and, I'm grateful."
"Well, I think we've all learned something, John," Kerry said softly. "I've talked with Dr. Swanson, and I've consulted a number of experts about our next steps."
Kerry drew in a breath. "You will be on probation for the next twelve months. That means the following. You will submit to a drug test every week and the results will be given to me, and you will also submit proof of continuing counseling."
"I've been referred to a psychiatrist here in Chicago," John offered. "I'm even going to a group meeting tonight."
"Good," Kerry said, smiling briefly and then turning serious again. "John, I don't want you handling narcotics for the next three months."
John nodded. "I understand why, but that's going to be difficult."
"Order the nurses to administer it, or direct one of the other residents or medical students to do it. As if you are training them," Mark added. "Or call for an attending."
"Do all the attendings know the truth?" John asked.
A realization came over Kerry. "Actually, all but Dr. Kovac. He's been working nights for the last week and I haven't seen him much. I'll tell him the bare facts today."
John nodded, looking at the floor.
"Finally, John," Kerry added, "I've talked confidentially with Personnel and I don't see a way around this final item."
John looked up, concerned. "You'll have to repeat your final year of residency. And, you won't be eligible for the chief resident spot."
John was taken back and started to object, but very quickly accepted the information. He nodded again. "Of course." He took a breath. "I want to get through this, to overcome it. I'm willing to do whatever it takes."
"We both knew you could, John," Mark stepped forward. "That's why we struggled so to help you."
"And I am so grateful," John whispered, the emotion close to his face.
"Well," Mark continued, trying to avoid the emotion. "We are here for you. Please come to us whenever you need to. A bad day, a difficult patient." Mark smiled. "I'd even like to hear when you are having a great day."
John smiled as well and Kerry joined in for a moment. Then she adopted a more serious attitude.
"Good," she said, trying to be stern. "Now, get back to work."
John smiled directly at her and nodded. Then he turned and left the room.
Mark leaned against the gurney and sighed. "What do you think?"
"I think he'll have good days and bad days," she said finally. "But I think he's got the strength to do it."
"I agree," Mark said. He sighed then turned back to the papers. "I got the new fax on a communications system."
Kerry stepped towards Mark as he took a sheaf of papers from a folder. "Good, let's see." They both smiled in anticipation as they started examining the folders and papers on the gurney.
Suddenly there was a knock on the door. Kerry looked up surprised that someone would knock. "Come in."
Luka stuck his head in the door. "Haleh said you were in here, in a private meeting, but that I should knock."
"Oh, Luka," Kerry said. "Please come in, I need to speak to you about something."
Luka stepped tentatively into the room. "What?"
"John Carter is back today, from his medical leave," Kerry began. "This is for your understanding only, not for dissemination to the rest of the staff."
"For the next three months, he's on restriction with regard to handling narcotic drugs. He can order them, but not administer them. He may need to call upon you to do so if there is no other resident or nurse available."
Luka nodded again, his face impassive.
Mark looked at him. "You're not surprised?"
"No," Luka answered, shrugging his shoulders. "It was obvious what was going on." Off their surprise, he added, "I've seen it before."
Kerry looked down. "Well, of course." She looked back up at him. "I'm sorry we did not tell you before but we wanted to keep it as confidential as possible."
"Or course," Luka said. "Not a problem."
Mark shifted his weight with a little impatience. "Did you want Kerry for something?"
Luka looked at him. "Yes. My -- my shift is over."
"Oh, Luka," Kerry said in realization, but then looked at the stack of folders.
Mark spoke up. "Kerry and I are working on something here. Can you stay one more hour?"
Luka looked down and slowly nodded. "Sure. Whatever you need."
Kerry looked at Mark, a little surprised. "Thank you, Luka. Mark will come get you to let you know when we are done."
"Okay," Luka said then quickly turned and left the room.
Kerry turned back to the papers with some reluctance and then looked at Mark. "Maybe I'm being overly sensitive with John coming back today, but has Luka seemed alright to you?"
"Kovac?" Mark asked and shrugged. "Yeah. Things have been real calm since he blew up at Benton." Marked looked at her. "Did you ever do anything about that?"
"I talked separately to both of them," Kerry said. "It was a judgement call to some extent, but I reviewed the ethics of triage with both of them. I don't think there will be any more problems."
"Good," Mark said absently-mindedly, already engrossed in the equipment list.
Kerry sighed and turned her attention to the list as well.
Luka walked back to Curtain Three but stopped outside the door. He took a deep breath, straightened up to his full height, squared his shoulders, and then took another break with his eyes closed. Finally, he stepped inside.
Sergeant Carl was substantially cleaned up but once again uncooperative. Lilly and Malucci had started the oxygen by nasal cannula.
"You can't take this out," Malucci said brusquely, reaching out to keep Carl from removing the nosepiece. "Can you tell me when you last had a drink,"
"I don't drink when I'm on recon," Carl answered, almost hostile.
"Of course," Luka stepped in. "But now you have some rest coming. Do you remember?"
Carl looked bewildered. "R&R for me? Now?"
Luka looked at Malucci questioning the term. Malucci answered, not sure if he wanted to go along. "Yes, some rest and relaxation time."
"Good," Carl settled into the pillow. "Then I need a meal and then some sleep."
"We'll look into that," Luka repeated, and then motioned for Malucci to step outside with him.
The two doctors went into the hall, along with Lilly, leaving Malik to finish up the cleaning process.
"Dave?" Luka asked.
"He's gonna have the DT's. He'll throw up the food," Malucci said matter-of-factly.
"Perhaps the diazapam will calm him and his stomach enough," Luka answered. "But you are correct in that he will need more diazapam."
Dave nodded and turned to Lilly. "Okay, large-bore IV normal saline, D50, and one hundred milligrams VI of thiamine. Have more diazapam ready. Put him on a cardiac monitor.
"Also do a glaucoma test to make sure there's no interaction with the diazapam," Luka added. "And a tox screen. What about the sores?"
"I think it is erythema multiforme minor. Add a CBC and call for a dermatologist."
Luka nodded. Lilly smiled in acknowledgement and moved off to fulfill the orders.
Luka turned to Malucci. "What is the most common ECG abnormality in an alcoholic patient?"
"Atrial fibrillation," Dave answered fairly quickly. "Followed by atrial flutter, premature atrial contractions, supraventricular tachycardia, and premature ventricular beats."
Luka nodded. "Let's try a little soup. And the D50 will make him feel less hungry."
"Okay," Malucci said as Carter approached with Chuny and another nurse, pushing a young woman on a gurney. They headed into Curtain Three.
"Dave, Dr. Kovac," John spoke to both of them as he went through the door towards bed two.
They settled the gurney into place and John stepped up. "We'll just wait for your x-rays and then we'll cast your arm," he explained to the patient.
"It really hurts," she complained.
"Do you have a history of seizures, are you on antidepressants or decongestants?"
The girl shook her head. "No."
"Chuny," John said, turning to the nurse. "Start with a shot of five milligrams of morphine. Five more if she is still uncomfortable."
"We were out in the bush for thirty days," Carl told the story. "VC were everywhere but we could never see them. They mined the trails and snipers up in the trees would pick us off." He shook his head. "It was hell."
Luka stood impassively next to the bed while Malucci finished dressing the sores on Carl's right forearm and Malik did the left one. Malucci was engrossed in the story. An empty plastic bowl sat on a tray that had been pushed away from the bed.
"Then the exact day we were back in camp, they attacked in full force. Held us down for five days until our own reinforcements would come and root them out.
"What did you do?" Malucci asked as he finished and stood up.
"We didn't sleep. We ate cold food. We didn't know what to do with the dead and the injured. Sometimes the dying would cry out in the night," Carl answered, his eyes drifting to an unseen vision. "And the medics had nothing to give them."
"How long were you in Vietnam?" Dave asked.
"Back to back tours, so to speak. Drafted -- and in country for '73," Carl answered, his eyes still a little unfocused. "Second -- POW -- '73 to '75."
Carl's hands started to shake and an odd look come over his face. Suddenly he lurched to his left and threw up the soup, just missing Malik, who moved quickly out of the way. Then he wiped his face with the fresh bandage on his forearm and sat back up.
"Well, that happened the last time, too," Carl said and shook his head. "Living on the streets can make a body sore." He stared at his shaking hands.
"Five more of diazapam IV," Malucci said, looking at Malik. "And fresh gauze."
"And I'll call housekeeping," Malik answered, moving in to administer the drug.
"Why the streets, Carl? You could find a place to live," Malucci started as if lecturing a child. "The war has been over for twenty-five years."
"Most houses are too small," Carl answered sleepily. "Can't see the stars, can't hear them coming." His eyes rolled back a little then he struggled to look at Luka. "You'll watch for me, tell me if they're coming?"
Luka swallowed and stepped up to the bed. "Yes, I'll watch for you."
Carl reached out and took Luka's hand. "I was going to be an architect, build beautiful houses."
"I know," Luka said, not withdrawing his hand.
"I couldn't make the rooms big enough," Carl closed his eyes as the diazapam took effect.
"I know," Luka repeated.
"The start of the DT's?" Malik asked.
Luka nodded. "Please see if housekeeping can hurry," he asked. "The smell is a little strong." He finally put Carl's hand down.
Malik nodded and took off.
Malucci shook his head with disgust. "Such a waste. I don't understand."
Luka looked at Carl with sad eyes. "There are two ways to destroy something. Everyone just thinks of the first way -- you can shake something with a sudden force that it falls down." Luka took a breath and shrugged. "But, there's another way. If you shake something long enough, it will fall down too."
"But when the shaking stops, you get back up," Malucci countered.
"Some people do, some don't," Luka answered solemnly, still looking at Carl.
Malucci looked at Luka, raising his voice a little. "I don't understand. You get pretty bent out of shape over drug users. This man is an alcoholic in a country where there are a hundred social service agencies just waiting to help him."
Luka shrugged. "This man got shook too long." He looked at Malucci. "You had a psych rotation as a med student. You should understand."
"Yeah, but you were in a war, and you're walking and talking just fine," Malucci countered again. "What's the difference." He swept his arm out, indicating Carl.
Luka stiffened and there was silence for a moment. He looked Malucci with narrow eyes and finally spoke. "A very fine line."
He stared at Malucci a minute more, enough to make the younger man uncomfortable. Then Luka turned and walked out of the room.
Malucci stood looking at Carl for another moment, then walked about of the curtained area, not noticing Carter and Chuny standing at the next bed, listening, as John put a cast his patient's arm.
Uncharted Territory -- Act Four 3pm
Kerry came out of Exam One to see Luka putting a chart back into the rack at the admit desk. She approached him.
"Luka," she began and he turned towards her. "I'm sorry about dumping on you today."
"It's okay," he said.
"Romano has given us some extra money for new equipment, and a short deadline for submission of our request." she started explaining. "Mark and I were working a list. Tomorrow morning, I'll have that list for everyone to look at and comment on."
"That sounds really good," Luka responded, his voice tired. He tried to smile but looked at the floor.
"And I appreciate all the extra time you are taking with both Abby and Malucci. Both of them seem to be responding."
"Not a problem," he answered, "but thank you." This time the smile was a little more firm.
Kerry peered at him. "Are you all right?"
Luka looked at her for a second. "Just tired. I -- volunteered at the free clinic yesterday."
Kerry took the information in. "But you have been very quiet these past weeks," she probed.
Luka shrugged. "There's been a lot of work."
"I know. I've been swamped with meetings upstairs so much of the last two months -- new members of the Board of Directors, budget meetings, ES meetings, staffing meeting, policy meetings." She almost rolled her eyes in friendly exasperation.
A stronger hint of a smile crossed Luka's face. "You are suited for that kind of struggle -- that kind of burden. Makes it so we don't have it down here."
Kerry nodded with a small smile as well.
The smile fell from Luka's face and he took a breath. "I just had a case that reminded me of -- reminded me about compassion for everyone."
Kerry looked a little puzzled and hesitated a little. "Of all people, I don't think you need to be reminded about compassion."
Luka shook his head, his lips pressed together. "It's not important." He gave another small smile intended to convey that all was fine and lightened his tone. "Can Mark take over now?"
"Sure," Kerry answered. "See you tomorrow."
"Thank you," Luka said sincerely and then quickly walked away.
Kerry watched him go, still curious about what Luka was going to say.
John stepped from Curtain Three, wiping his hands on a towel after casting the young woman's arm. To his right, he saw Peter towards him.
"Dr. Benton," John called out just as Peter was about to turn into the elevator hallway.
"Hey, John," Peter said warmly as he turned to see the familiar voice, his face breaking into the smallest smile. "When did your flight get in?"
"About 12:30," John answered. "Dr. Weaver has me working already." He was both nervous and glad to see his mentor.
Peter nodded pleasantly. 'Good." He looked down. "Hey listen, about not answering your letters --"
John cut in. "Don't worry about it. I figured you didn't know what to say. I mean, after all, what do you say to a guy who's dripping with thanks for saving his life?" John's face was sincere.
"Well," Peter uncharacteristically stumbled, but then he found the real words. "No thanks is necessary. You are worth it." Then Peter leaned in conspiratorially, his face threatening. "But don't, I said, don't ever tell anyone I said that. I'll deny it."
John grinned broadly in contrast. "Not a word."
Chuny opened the door to Curtain Three. 'Dr. Carter, she still complaining of pain."
"Okay," John answered. He turned back towards Peter, serious once again. "Still, thanks."
Peter nodded impassively. "Later."
John turned and went back to work. Peter watched him disappear and then gave the smallest smile.
"Peter, how did the emergency pacemaker insertion go?" Elizabeth's voice rose from behind him.
He turned to see Elizabeth coming towards him and he walked to greet her. "Pretty well," he answered smiling more broadly.
"God," she sighed as they stepped into the elevator hallway. "I remember my first one. I had this supervising surgeon, Dr. Hallstead. His look could melt steel. My hands shook so hard, at least that's how I remember it." Elizabeth laughed.
Peter chuckled. "Me too. Only it was Anspaugh watching. It was pretty traumatic."
They both laughed out loud as Mark approached.
"Hi, Mark," Elizabeth greeted him warmly.
"Can we finally get a bite to eat now?" he asked, ignoring Peter.
"Sure," she said, puzzled with him cool demeanor. Elizabeth turned towards Peter. "I'll talk to you later."
"Fine," Peter answered, the smile falling from his face. He looked at the two of them, then pushed the elevator call button, shrugging.
Elizabeth turned back to Mark and they began walking back down the hall towards the ambulance day doors. "What's wrong with you."
Mark didn't answer.
Elizabeth softened. "You're missing your daughter, aren't you?"
"Maybe, some," Mark answered. "But it seems like you and Peter are --" Mark searched for the right word.
"Friends?" she offered.
"More than friends." He looked away.
Elizabeth appraised Mark and stopped walking. "I've never seen you like this. Are you jealous?"
"No," Mark argued, turning towards Elizabeth, but not meeting her eyes. He shifted his weight. "I just think, maybe it's time, that you and I got more serious."
Elizabeth was taken back. "We are serious," she answered.
"I mean something more permanent." Mark's eyebrows furled together in earnestness.
"I rather like our arrangement now," Elizabeth said, smiling and trying to cajole Mark into a better mood. She stroked his shoulder.
"Yeah, but if things were more, more permanent, then people would know where we stand with each other," Mark countered, finally looking at her.
Again, Elizabeth was surprised, then suspicious and she pulled her hand back. "You mean then I could not have good friends who were male?"
"That too." Mark shrugged.
"Mark, I think there has to be a better reason for getting married." Elizabeth whirled and stalked back towards the elevators.
Mark simply looked after her, thoroughly confused as Romano passed from behind him, also walking towards the elevators. Just beyond the corner, he saw John Carter leaving Curtain Three.
"Dr. Carter," Romano called out as he diverted towards John.
"Dr. Romano," Carter greeted him carefully.
"Welcome back," Romano continued. "How was your medical leave?"
"I feel much better from my injuries," Carter answered.
"A little unusual for a superior to grant so much leave," Romano still fished.
"Well, Dr. Weaver is a good boss," John responded. "I simply came back to work too quickly the first time. I wasn't completely healed."
Romano looked skeptically at John who kept his face as impassive as possible.
"Well, glad to have you back," he finally said.
"Thank you Dr. Romano," Carter answered. He looked at his watch. "I've got to be going."
Romano nodded silently as Carter headed down the hall, then doubled-back toward the elevators. As he got there, the doors opened. Peter and Cleo got off, deep in conversation.
"Peter, I've got things I need to do yet. I'm going to be starting my fourth year residency for the pedes specialty," Cleo said as gently as possible. "I've got more board exams coming up and I need to do my very best."
"You'll do fine on those tests," Peter countered.
"Fine isn't good enough, Peter," Cleo countered, her ire rising. "You should know that. I have to be better than perfect to get where I want to go."
"Yeah, but," he started in, suddenly was a little worried. "Where do you want to go?"
Cleo glared at him in realization. "You know, we've been dating all this time, and this is the first time you've ever asked me that."
Peter was taken back.
"In fact," she continued unabated. "You don't really know much about me, do you?"
He shrugged, embarrassed. "You don't care for jazz as much as I do, you don't play very good pool, you work out," Peter tried.
"Not enough, Peter." Cleo turned and walked away, leaving him staring after her, clearly miffed and confused.
"Luka," Steven Phillips smiled as Luka came in the door. "Good to see you."
"Hello Steven," Luka responded equally.
"You look tired," Steven said, moving Luka to the side, away from the other men who were gathering. The room was comfortable, with overstuffed chairs and a couch, and muted art on the walls.
"Work," Luka shrugged. "A lot of meetings for the others, and I had to stay late."
Steven looked appraisingly at Luka. "You let them pile a lot on you these days."
"Yeah, well," Luka shrugged again.
"Still paying your personal penance?"
Luka gave a rueful smile. "Something like that. I have also been volunteering at the free clinic, mostly on my days off. But they really needed someone yesterday, so I went in."
Steven squared his body, facing Luka. "When are you going to play some?"
"Most of the time," he answered thoughtfully, "work is my play."
Steven nodded in realization and sighed. "Come on, let's get a cup of coffee."
The two men moved off to the large coffeepot in the far corner of the room as the door cautiously opened and John Carter stuck his head in, then came in the room.
A short man in a casual polo shirt quickly moved to greet the newcomer. "I'm Don Kyrkendall," he said, sticking out his hand and smiling. "Are you John Carter?"
"Yes, Dr. Kyrkendall," John responded, pumping Don's hand with some enthusiasm.
"Good to meet you. Call me Don, everyone does," Don answered, turning his head slightly to survey the group of men milling about the room.
"Okay," John said, finally taking his eyes from the doctor and tentatively glancing around the room, immediately losing some of his enthusiasm. "Am I on time?"
"Yes, we'll get started in a few minutes." Don recognized the nervous behavior of a newcomer. "You know how the group process works, John. You'll meet everyone in time, but I understand you are apprehensive. How was your day?"
John expelled a nervous breath and smiled. "Nerve-wracking but fine," he answered, still scanning the room. John's eyes caught something and he found himself staring at the back of a man who looked familiar. At loss for words, he looked back at Don and tried to concentrate on the further instructions Don was providing.
Luka turned around with a coffee cup in his hand and recognized John across the room. After the realization sank in, he reached out and touched Steven's elbow. "I -- I know the new member of the group."
Steven turned and looked across the room at the person standing at the door next to Kyrkendall. "Don said he was a last minute addition."
"He's John Carter, a resident from County ER," Luka said numbly. He turned to Steven, concern growing on his face. "I should go. I supervise him, and it won't be good that we are in the same group."
"Yes, you're right," Steven said, nodding. "But we can get him into another group."
Luka expelled a breath. "Do it next week. He's just out of rehab, today. He needs this more than I do."
Steven looked skeptically at Luka but acquiesced. "Okay then, I'll walk with you to the door and tell him we're friends, that you were just visiting."
Luka nodded and set down his coffee cup. The two crossed the room to the door.
"Hey John," Luka said with a false cheeriness. "I was just -- visiting. You joining this group?"
Don Kyrkendall turned, surprised, but held his words.
"Yeah," John answered, the surprise still on his face, as well as a growing embarrassment about his own presence in a counseling group.
Luka took a breath. "I know both Don and Steven." Luka looked at Steven. "Oh, this is Dr. Steven Phillips."
Steven reached out to shake hands. "Nice to meet you John."
Carter returned the handshake and managed to nod politely to Steven. Don Kyrkendall watched the proceedings with a growing understanding.
"They are good people. You are in fine hands here," Luka continued, trying to smile. He turned to Steven. "I'll see you next week for coffee."
"Thanks for dropping by," Steven said.
Luka nodded one last time at John and quickly hurried out the door. John watched the door close, the implications still registering.
Sequel: Friends and Lovers