He leaves with a big smile on his face.
CHAPTER 30
Rhys
Hospitals arequieterat night, but the hum never stops.
The thrum of monitors, the low buzz of fluorescent lights, the soft shuffle of nurses doing rounds. Most patients say they never really sleep here. They’re right.
I badge in, exchange nods with the charge nurse, and head straight to the consult room.
They didn’t call me because the patient was crashing. They called because they wanted another set of experienced eyes. I’m not on call tonight—Paul is out of the country, and Dr. Patel is out with the flu—so they reached out. And they had already given me the update two hours earlier.
The patient was stable. Not decompensated.
“But something doesn’t feel right,” the resident saidwhen I talked to him on the phone. “We’d love your opinion—tonight, if possible.”
I asked the only question that mattered. “Is this emergent?”
“No, sir. She’s holding. Just…concerning.”
That’s the only reason I allowed myself to go to Mikaela’s floor routine first.
I would never—ever—choose anything over a crashing patient. I’ve missed birthdays, holidays, and even my own anniversary for surgery.
Tonight wasn’t that.
Tonight was a judgment call—an easy one.
The patient was monitored, stable, but trending in a direction I didn’t like.
The resident, Dr. Lewis, already has the imaging up in the consult room.
“Dr. Prescott, thanks for coming,” the resident says, relief visible in every line of his face. “We were worried it was tamponade, but the echo’s borderline. She’s not crashing. We just didn’t want to miss something.”
“You did the right thing calling,” I assure him. “Let’s take a closer look.”
Even after all these months, it’s, as they say, like riding a bicycle. Calm settles over me. An old, familiar coat.
Together, we review the echo.
Small-to-moderate effusion.
Early right atrial collapse.
Not diagnostic tamponade, but not nothing either.
“She’s not in full tamponade.” I trace the faint compression on the screen with my finger. “But she’s heading in that direction. This is tamponade in evolution.”
The resident nods, relieved to have a name for what his gut was warning him about.
I step back and pull the chart onto the resident’s tablet.
“Her vitals show subtle signs of trouble.” Tachycardia. Narrowing pulse pressure. Soft systolics.
“Her preload’s starting to disappear,” I explain. “But she’s not decompensated.”
“So…I didn’t do anything wrong by telling you not to rush here?”
