Another nod from Paige. “Pretty sure. We’ll need an intra-abdominal pressure check to absolutely confirm it. Hayley, can you do that? If it’s compartment syndrome, we need that done fast, then he’ll have to go right in for a laparotomy, and after that he’ll be in your team’s care. Sound good?”
Hayley opened her mouth to reply but was cut off before she could. “No,” said a voice behind them. Startled, Hayley turned to see Deborah Morales standing there, her dark eyes cool and face impassive. “Just get in there and do a percutaneous catheter decompression. Get all that fluid out and send him straight to the ICU floor. Surgery is backed up. He’s sitting up, your epi push looks like it got his pressure back to a good level, all he should need is a fluid drain and monitoring right at this moment.”
“Doctor Morales, I can’t in good conscience recommend—” Paige began, but she fell silent when Deborah, to Hayley’s absolute rage, waved a dismissive hand.
“Look at him, he’s got color back in his face. We don’t need to dump another surgery on the team right now. Nurse Milton, take him and get him drained, keep an eye on him, and let Doctor Bellows and I know if anything changes.”
Hayley blinked. “Okay, no. If it’s acute, surgical intervention is absolutely necessary. We need to do the pressure catheterization before we can rule out a need for surgery.”
“This is a catastrophic situation, Nurse Milton.” Dr. Morales shook her head. “We have to make quick triage decisions, and it’s my responsibility to keep things moving here. There are still more patients being brought in from this utter disaster; time is of the essence.”
“Yes, timeisof the essence,” Hayley said, the fragile tether she still had on her temper beginning to fray. “Especially for this patient, for whom the consequences will be catastrophic without proper diagnosis and treatment.” Done with Dr. Morales’ cavalier attitude, she turned to Dr. Bellows. “If you order it now, I’ll have the intra done in a snap. Once we know where we stand…” She turned back to Dr. Morales, looking up into her now-furious dark eyes and setting her chin firmly. “ThenI can do the PCDifthe patient doesn’t need immediate surgery based on the readings.”
Dr. Morales was visibly bristling at being dressed down and contradicted by a charge nurse. It was immensely satisfying for Hayley, especially after the whole incident in the corridor earlier. “You have no right to talk to me?—”
“Oh, but I do. Patient needs come first.” Hayley looked at Paige. “I’ll go get what I need for this.”
“Insubordination is grounds for termination, Nurse Milton,” Dr. Morales growled. Despite her fury and dislike, Hayley found that growl kind of sexy… and that was deeply, deeply annoying.
She spun on her heel and headed off to find what she needed. “Cool,” she shot back over her shoulder at the three dumbfounded doctors. “Fire me, then. I dare you.”
Oh, that feltgood.
Her triumph was short-lived.
Once Hayley had performed the diagnostic catheterization—and the man had indeed had acute compartment syndrome and had had to be whisked away for surgery immediately—she’d gone back to her ICU and realized that a great number of the patients she had helped triage and marked for admission to the ICU had had those orders overridden and been sent up to various non-critical care floors.
By whom? Deborah Morales, ofcourse. Hayley smacked her hand down on the charge desk and let out a blistering series of oaths that made a young new ICU nurse, just passing by, flinch and turn tomato red before she scurried off.How dare she?Hayley seethed, her breaths hissing through her tightly clenched teeth. Dr. Morales was why she rarely ever volunteered to work in the ER, but the scope of today’s disaster had been too big to even think about turning her back on.
And almost everything she’d done to help had been rendered moot by an ER chief on a power trip. Clearly Dr. Morales hadn’t appreciated Hayley standing up for patient needs, which was an absolutely insane stance for any doctor to take, in her opinion.
Every assignment she’d made had been made knowing she had, by some miracle of her own scheduling foresight, thenursing staff in place today to manage a higher than usual influx of critical patients into the ICU. She’d worked with other charge nurses to have patients taken off of her floor and sent up to the general care floors earlier than they’d been scheduled. A lot of delicate work had been done to make this happen so that she could lend a big helping hand to the ER team.
And now she had a fully staffed Intensive Care Unit standing idle while nearly all the patients in need that they had expected were crowded in amongst the less critical patients upstairs. The nurses up there were probably cursing her name right now, what with all the patients she’d sent up early, then all the critical patients sent up afterwards that she and her team should have been taking care of themselves.Jesus, she thought, horrified. She was going to have to run herself off her feet getting all those patients back down on her floor, not to mention all the apologizing to her colleagues she was going to have to do. How fucking embarrassing!
Closing her eyes, Hayley took in three long, slow breaths. The other nurses at the desk were studiously avoiding looking at her or even making any noises that might turn her fiery anger onto them. She did not explode often, but when she did, all the vets on her team knew what the shrapnel range was, and how intense it would be.
There was almost an audible sigh of relief when she announced, “I’m going to the ER for a moment. Please call around and see if you can get these patients here—” she pointed to a list on her tablet, then sent it around to the team. “—down here as soon as possible. Be very flexible, it’s not their fault these patients were misdirected, and we don’t want to add to their burdens if we can avoid it.” She smiled at them and hoped it was reassuring. “I’ll be back to help out as soon as I can.”
Squaring her shoulders, Hayley marched out of the ICU and headed for the ER. If only it were ethical to drink on thejob. She could really use a good tequila shot of courage before confronting the preternaturally cool-headed Dr. Morales. How someone so reckless managed to be so unruffled and coolly superior in arguments baffled Hayley. She knew she was in the right here, but Dr. Morales was about to calmly try to gaslight her, and that already had Hayley’s back right up.
She paused to re-tie her bun and take another couple of breaths.You are correct. Those patients should already be under your care. Don’t let her steamroll you.
When she entered the ER, she saw Dr. Morales sitting at the central desk with Paige Bellows, their heads bent over tablets entering notes. Hayley stalked over, making sure to nail a smile onto her face. Judging by Paige’s alarmed expression when she looked up at the sound of Hayley’s footsteps, however, it might have been less of a smile and more of a grim rictus.
Well, she’d tried.
She marched up and smacked her hands down on the desktop. “Dr. Morales, I have some concerns.”
“I thought you might.” Lazily, Dr. Morales set the tablet she was holding on the desk and looked up at Hayley, tossing her dark plume of a ponytail back over her shoulder. “I mean, I was doing your team a favor, and yet somehow I thought you’d still have a problem with it.”
“A favor?” Hayley could be nothing but aghast at the thought. “How exactly was that a favor? I had my team set and ready for all of those patients that you dumped on other floors.”
“I didn’t want to overload your team,” Dr. Morales replied. “Your ICU was full today before this all began; how could you possibly take on more patients? I had to make quick decisions. Almost all of those patients would be fine on general floors until you all got your heads above water.”
If I call her an idiot, I really will get into trouble.Hayley struggled to keep her tone neutral. “And yet if you had taken onemoment to look at current numbers before you made thatquick decision, you would have seen that I had cleared half my unit by discharging suitably healthy patients early,” she informed Dr. Morales quietly. “I sent them up to general floors for non-critical care. And then you dumped a lot of critical care patients on top of those doctors. If you were doingmea favor, it backfired like hell on those other wards.”
Dr. Morales' cat-in-the-cream smile vanished, and the news seemed to leave her speechless. “I…” she began, then fell silent.
