"What the hell took you so long?"
Nan LeBaron glanced up at the clock on the stark white wall of the emergency room. It showed 8:55. She raised an amused brow at the emergency physician. "I said I'd be here by 9."
"Well, we've been waiting for you," replied the impatient Dr. Winstead. He scribbled rapidly in a chart and signed his name with an illegible flourish. Without looking up at her, he grabbed another chart where he entered the time and added a note to his previous scratchings. Then he shoved the charts aside, straightened his lanky body and frowned at her. "That second year neurology resident is going to have to be a little more outspoken if he's going to get anywhere."
"I'll tell him to use you as a role model." Though her voice was tart, Nan smiled kindly at him, her hazel eyes rich with humor. Nan had only finished as chief resident in the summer, and the one year fellowship she was serving had strengthened her resolve to take very little of this kind of professional advice from other doctors as seriously as most of her contemporaries would have done.
Dr. Winstead's frown deepened. "The patient's in a coma, Dr. LeBaron, and your resident dithered around about whether to get another scan or not."
"Hey, I'm not chief resident anymore, but I'll speak with him." And I'm sure I'll find a good reason why he didn't, Nan thought. She knew the second year resident to be a perfectly capable doctor. "Shall we have a look at the patient?"
"Whenever you're ready," he said with exaggerated politeness.
Must have been a long night, Nan thought. But then Steven Winstead did not have a reputation for suffering fools gladly, or even tolerating them. She had had her own difficulties with him, but found for the most part that his virtues far outweighed his vices. He was a brilliant diagnostician, an efficient organizer, and a man with seemingly boundless energy. She had yet to see him look tired at the end of a twelve hour, or even a double, shift. Emergency physicians got an adrenalin rush from their work, and it seemed to serve Dr. Winstead well. So he was short-tempered occasionally. Nan had seen worse.
The second year resident had been called to evaluate another patient and Nan found herself alone with Winstead, a nurse she didn't know, and the patient--a male in his thirties lying on the examining table with no obvious injuries to explain the cause of his unconsciousness. She read quickly through the notes in his chart. Found in this condition, with no identification on him and no one to offer any explanation. She grimaced. That always made things more difficult. Setting aside the notes she approached the patient to begin the physical examination: level of consciousness, size and reactivity of pupils, ocular position and movement, motor response, pattern of respiration. It was all familiar ground.
"The ambulance crew gave D50 and Narcan, without response. His labs are normal. CBC is okay. Blood alcohol level is 0. Tox screen is negative." Winstead shrugged his shoulders. "Seemed likely it was a central nervous system problem. That's why I wanted the scan."
"What did it show?"
"Nothing. Even with contrast. It's on the board."
Nan turned to examine the CT scan results. Though it was true there were no obvious anomalies, her brow wrinkled in studying it. "Tell me, Dr. Winstead, do we have any idea why he didn't have identification on him?"
"He was in a jogging outfit. People don't expect to need their wallets."
She nodded and turned from the films on the lightboard. "Fresh blood can look like fresh brain tissue. It's been long enough now for it to become old blood and maybe with another scan we can pick up a subdural hematoma."
Winstead nodded. "Exactly what I suggested to your neurology resident."
"And he didn't agree?"
"He dithered." Dr. Winstead for the first time cracked a smile. "It seems to me second year residents shouldn't be intimidated by me."
"Who could help but be intimidated by you?"
There was a moment when their eyes met and they both remembered the day a year ago when Nan had disagreed with Dr. Winstead about a stroke victim. Had it been intimidation that had kept her from insisting on her viewpoint carrying the day then? Or simply her own knowledge that his experience was greater than hers, that it was a toss of the coin about which of them was right? If the patient hadn't died, it wouldn't have mattered.
"You've never been intimidated by me," he said, and nodded his head toward the nurse. "Carol hasn't either, have you, Carol?"
Carol gave him a cheeky grin and said, "No, doctor. But you do have a tendency to snap at people."
"Only at idiots," he insisted as he reached for the doorknob. "You going to take him for the scan, Dr. LeBaron?"
"Yes. I'd like to see it cleared up."
"Right." And he was gone with a flapping of his lab coat.
Carol, a short, dark-haired dynamo, helped Nan strap the John Doe to a gurney, chatting as she worked. "I hear he's rich, you know? Dr. Winstead. Comes from a wealthy old San Francisco family. Now why would someone like that go into emergency medicine?"
"Beats me." Nan wasn't paying a great deal of attention because she was adding her own notes to the patient's chart. "I guess he wanted to do something useful."
"Yeah, but he could have been a cardiologist, or a neurosurgeon. Something kind of elite. Here there's trauma, and often the dregs of the earth. All those addicts and nut cases. You kind of picture him in a quiet office, you know? Looking dignified behind a big oak desk. He'd toss back that hunk of blond hair, and blink those blue eyes, and his women patients would swoon over him."
Nan laughed and tucked the folder under her arm. "You have quite an imagination. Write fiction on the side, do you?"
"No, ma'am." The nurse grinned at her. "But I read it and Dr. Winstead just doesn't fit right where he is. Emergency medicine is fly by the seat of your pants stuff. Heady rush when everything is happening at the same time. It's the semi-wild guys who like it, and the women who especially like taking charge. Don't you think?"
"I hadn't given a lot of thought to it. Is that why you do it?"
"Well, I'm a nurse, but, sure, I like the excitement. I like having people expect me to react quickly and expertly. I've always been able to stay calm in an emergency. It's the one thing I'm really good at."
Nan regarded her thoughtfully as they pushed the gurney out of the emergency examining room. "Maybe that's why Dr. Winstead does it, too. Because he's good at it."
Carol hunched her shoulders carelessly. "Maybe. But he'd make bigger bucks at something else."
"If his family's wealthy, he probably doesn't need them."
"Yeah, I suppose. Wealthy families set up trust funds and stuff for their kids, don't they?"
Nan smiled. "You should ask Dr. Winstead."
"I wouldn't dare." But the young woman's eyes sparkled. "It would be great to have all the money you wanted, wouldn't it?"
"I don't suppose anyone ever thinks they have enough." Nan pushed the gurney through the door Carol held open for her, and out into the hall. "Thanks, Carol. I can get it from here."
When Nan had the gurney about a hundred feet down the hall she heard the door open behind her and Carol call, "Oh, Dr. LeBaron?"
Nan turned back to look questioningly at the young woman.
"Dr. Winstead said to tell you he needs to talk with you later about the malpractice suit."
)
