chapter 2: this could get messy
"Guessin' he's one feisty bastard."
Beth smiled at Merle's nurse for the day, Carol, who was preoccupied with attempting to apply restraints to the man's wrists. Beth had ordered for his sedation to be minimized late that morning since he was maintaining a favorable level of hemodynamic stability.
And the man had apparently come to life within moments. Carol had paged Beth and requested for her to come and assess him since he'd been so alert.
"Merle, stop moving. We're tyin' down your wrists so that we can talk to ya without ya thrashin' around." Carol spoke calmly but firmly and clearly with her face positioned directly in front of Merle's. She was a seasoned nurse, and Beth was always pleased when their paths crossed.
Merle stopped moving and his eyes, which were blue but not quite as blue as his brother's or even Beth's, stared blankly at the ceiling overhead. The ventilator seemed to let out a sigh of relief since the man had finally calmed down enough to allow the machine to function properly instead of beeping in a frenzy due to the instability of the tube that Merle had nearly-successfully dislodged from his trachea.
"Merle, I'm Dr. Greene. I'm a neurologist."
The man's eyes slid from the ceiling to Beth's face. And, apart from the tubes and wires, he appeared to be fully engaged in what she was saying. Good sign.
"We're trying to stop all of this sedation. But you have to cooperate, okay? If you do, then we can get this pesky tube out of your throat and let ya breathe on your own. Nod if you understand, please, Mr. Dixon." Beth assessed the color of his nail beds and lips and visible mucous membranes as she spoke to him.
He narrowed his eyes in a way that almost made Beth's skin crawl. In a way that almost seemed to be a silent kind of "fuck you, doctor lady." And then he nodded. Once.
"Good, you understand. Merle, can you feel me touching you?" Beth moved to the foot of the bed, lightly running the tips of her fingers across the bare, plantar surface of one of his feet and then the other. "Just nod or shake your head in response."
Merle nodded. Again, just once.
"Can you wiggle your toes?"
He nodded. Smart ass, Beth thought to herself. She grinned.
"Go ahead and do it, then, Mr. Dixon."
He wiggled the toes of both of his feet and Beth would've sworn she saw him arch an eyebrow as he did.
"That's great, Merle," Carol said, patting him gently on the shoulder. Beth watched as Merle craned his neck – to the extent that he was able – to look at Carol. He shook his head, seemingly to himself, and closed his eyes, then, letting his head fall back roughly onto the pillow behind.
"Merle, don't quit now. We're almost done."
His eyes remained closed. Beth nudged at and wiggled his feet. And, very slightly, she felt Merle kick back at her.
"Think he's done for now," Beth sighed with a shrug. "Just keep the sedation to a minimum. Ya'll can try removing the restraints in an hour and see how he does. Re-apply them if he tries to pull at anything or won't calm down and give me a call. I've got to go do rounds on the other floors and then I'll stop by again."
"Thanks, Dr. Greene," Carol said cheerily as she pressed a few buttons on the IV.
Xxx
Three hours later, Beth was mentally exhausted. Grady Memorial was the largest hospital at which she'd been employed. It was a multi-specialty facility and recognized across the region for the various high-quality services that it provided, including its excellence in neurology practice. And though that was intimidating for any relatively new physician, Beth had always thrived under the weight of expectation and pressure.
"Dr. Greene. Stunning, as always."
Beth reluctantly looked up from the computer in front of her. She recognized his voice as well as the way it caused an uncomfortable twisting in her gut.
"Dr. Walsh," she responded, briefly lifting her eyes to the man's before dropping them back down to the monitor.
Shane Walsh was a hospitalist physician who worked exclusively for Grady Memorial. He was a general practitioner and generally a well-respected physician. His personality, however, was an entirely different story. He was notorious for flirting shamelessly with the nursing staff and other physicians on staff. He was in his mid-30s and, were Beth being honest, not terrible on the eyes. He was built like a stout athlete and jumped at any opportunity to remove his lab coat to reveal his signature form-fitting dress shirts. His complexion was dark as were his eyes, and his thick black hair was always perfectly combed and arranged to appear as if he hadn't combed it at all. As a hospitalist, Dr. Walsh could essentially consult with any physician he chose or preferred for any given specialty – and Beth was not exactly thrilled that she was apparently his favorite neurologist.
"Did anyone call you regarding the consultation I placed for Mr. Grimes on the fourth floor? Young guy, early-40s. Came in with unilateral arm weakness and slurred speech after workin' outside all damn day."
Shane lazily leaned his upper body over the counter that surrounded the small documentation area, at which Beth was sitting, adjacent to the main nurse's station of this particular unit. He slowly trailed a finger along the top of the computer monitor in front of her. And, though to anyone else it likely appeared like an unintentional action, it caught her attention and, truthfully, caused a prickle of discomfort to run up her spine. She squinted her eyes as she followed the path created by his finger.
"No one called. I just saw the consult in the system. Don't know if I'll have time to examine him today, but I'll put in orders for stroke work-up if there's no obvious trauma." She didn't meet his eyes as she spoke.
"Thanks, sweetheart," he drawled. She swallowed the bile that had risen up and into her esophagus.
"No problem. I'll see him first thing tomorrow morning if I don't get back to his unit tonight."
Beth returned her attention to her charting and sighed in irritation when, moments later, Shane still hadn't budged or removed himself from her personal space.
"Got plans tonight?"
"Really?" She shook her head. She'd normally kept her mouth shut when he made any sort of advancement towards her, but, for whatever reason, today she didn't feel that she possessed the capability to tolerate it or even the thought of it.
"Damn, 's just a question, girl. Ya need to get laid. Go crazy if ya let this be your life, Beth." She shuddered internally at the way he seemed to wrap his tongue around the phonetics of her name.
"Thanks for the advice. Have a nice night." She logged off of the computer work station abruptly and shoved her weight forcefully backward, causing the wheeled chair in which she'd been sitting to roll backwards and away from Shane.
She saw his shit-eating smirk from the corner of her eye as she stalked off towards the elevators. She wished she could've taken a picture of it or videotaped the entire exchange that'd just occurred so that she could send it to her older sister, Maggie, who constantly questioned her about her relationship status – or lack thereof. This was why Beth had no interest whatsoever in relationships.
Xxx
Beth returned to the critical care unit. It was nearly five in the afternoon.
"Oh, Dr. Greene!" Carol waved at Beth from where she stood several feet further down the slightly curved hallway that separated the patients' rooms from the narrow nurse's station on the opposite wall.
"How's Mr. Dixon?"
"He's like a new man. Almost had to restrain him again until this visitor arrived. He just got here about twenty minutes ago, and Merle's been alert and fairly calm and cooperative since then." Carol spoke softly, as the two women were conversing just outside of Merle's room.
"Must be his brother." Beth smiled, and she felt happy that Merle had some kind of support system – despite his brother's obscurity the previous evening.
"I don't know – they don't look anythin' alike. Well – okay, not true. I guess they're both a little rough 'round the edges. But this guy - one that's here visiting him Merle – well, he's what we used to call - way back in my day - a looker." Carol nudged Beth with her elbow and smiled mischievously.
"Well, I'm gonna go ahead and check in with 'em."
"Update me with the plan, Doctor." Carol patted Beth on the shoulder as she walked passed and toward another one of her patients' rooms. It had been strange, initially, to give orders to people – nurses, other physicians, respiratory therapists, physical therapists, pharmacists – who were legitimately old enough to be a parent to Beth. To give orders to people whose years of experience in the medical profession were greater than the number of years Beth had been alive. It and she had gotten more comfortable as the time passed and as she developed relationships built upon mutual respect with her peers.
Beth knocked on the door, which was partially ajar, to Merle's room.
Both Dixon men turned their heads toward the door as she entered and flashed them a smile before washing her hands.
"There she is. 'S the doctor I was tellin' ya 'bout," Daryl said. Beth wondered what exactly he'd been telling Merle.
Beth stepped closer to the bed and stood opposite Daryl, who was sitting in chair directly bedside. Beth smiled to herself at the small but insistent feeling of pleasant surprise she felt when she noticed that one of Merle's hands was tightly gripping one of Daryl's. The head of Merle's bed was elevated to the most upright position Beth had seen it. Curtains were open and the rays from the descending sun were shining into the room.
"You bein' here is such a good thing for him," she said, looking at Daryl. And she probably would have normally waited until she and Daryl were alone to say anything like that because she didn't want to upset or bias the patient in any way – but it wasn't the patient who appeared to experience some kind of discomfort at her comment.
Daryl did, however. His eyes lifted quickly and briefly locked with Beth's before he – just as quickly – directed them towards the floor and then tersely unclasped his hand from his brother's.
Beth furrowed her eyebrows at Daryl's nonverbal reaction to her encouragement, but she decided to brush it off for now in favor of updating them both on Merle's progress and the plan of care.
"It's been a good day for Merle. He's been without sedation since mid-morning today. He was able to follow commands and to wiggle his toes and respond appropriately to the questions that I asked."
Daryl nodded. "'S good. Can he get outta here soon, then?"
Beth wasn't surprised at that particular question – she'd have enough money to pay off her medical school debt and buy a fucking mansion if she had a quarter for every time that question had been asked much too early.
"He's still on the ventilator for now – he will remain in the critical care unit until it can be successfully removed and he shows us that he's able to breathe efficiently on his own. We're going to attempt to wean him off later this evening. The next step is moving him off of this floor and up to the general neurology unit if he's stable medically. We will likely monitor him for a few more days after he transfers to the other unit. In the meantime, after we get the ventilator removed, I'll put in orders for physical and occupational therapy – we need to see how he's doing mobility- and safety-wise so that we can determine the best course after he discharges from the hospital. At best, we're probably looking at another three to four days." Beth spoke confidently but slowly and to both Daryl and Merle, and she was pleased to see that she had been able to maintain the attention of both of the brothers.
"What d'ya mean, best course?" Daryl leaned his torso into the back of the chair and brought a thumb up to his mouth.
"There are different options for rehabilitation following a hospital stay. It all depends on how much he's able to do on his own and how much assistance he needs and how much help he has available to him. If he's not safe to return home at the time of discharge, we can get him into a rehabilitation facility for a few weeks to regain his strength."
Beth watched as Merle's head whipped around toward his brother's. She wasn't oblivious to the fact that conversations including anything in addition to or besides going home were often shocking to patients and families.
"'S okay," Daryl said quietly, and his voice was that rough, grainy sound that Beth recalled from the previous night. "Ain't gonna be decidin' nothin' yet, Merle. One step at a time, a'right?"
"No need to stress about it now, either of you. I only mentioned it to give you an idea of the overall plan for Merle while he's here and plant some seeds in your heads." Beth listened to Merle's chest and lungs and bowels with her stethoscope before turning away from the bed and returning to the sink to wash her hands.
"I'll be back tomorrow, Merle. Just keep doin' what you're doin'. Cooperation and patience are half the battle."
Beth flashed both of the men a smile before exiting the room. She hadn't gotten very far, as she was searching for Carol to give her an update on Merle's care, when she heard a breathless voice from behind her.
"'Fore ya go, can I just ask ya a couple things, Dr. Greene? Er - talk to ya for a second?"
Beth turned around and nearly directly into Daryl, who was breathing a little heavily and not quite making consistent eye contact with her.
"Of course, Daryl. Do you wanna talk here? If not, we do have a private counseling room."
"Yeah, let's go to that room. Bastard can hear better'n ya'll think."
She led them down the hallway, out of the unit, and into the small conference room that was next to the family waiting area. As he sat down in one of the three chairs that surrounded the small wooden table, Beth closed the door tightly behind her.
She sat down in the chair across from Daryl.
Daryl stared down at the table, at his thumbs that were twitching outside of his palms. Every time he opened his mouth in preparation to speak, he ended up closing it again and remaining silent.
"You can say anything, Daryl," Beth assured him, sensing his discomfort.
He cleared his throat and, though his head remained oriented downward, his eyes met hers from under the several strands of hair that hung down and into his face.
And she kept her eyes on his. And a strange, full moment passed between them. She sensed fear there, behind his eyes; a search for some kind of trust from her – for some kind of salvation in a stranger.
All of a sudden, she was curious. So curious. More curious than she remembered ever feeling, at least when it came to a patient. And Daryl wasn't even the patient. She wondered why he was the way he was, what his and Merle's relationship had been like before Merle had been hospitalized, how old they were when their mother had passed away, what either of them did for work.
She blinked and sucked in a deep breath.
"Guessin' Merle wasn't real honest. 'Bout his – I'unno what ya'd call it – 'bout his history, I guess."
"Said he had his appendix removed when he was a child," Beth responded.
Daryl nodded but, somehow, Beth sensed some kind of disappointment or reluctant understanding somewhere in his silence.
"Ain't lyin', but he didn't tell ya 'bout everythin' else."
"What exactly are we talkin' about here, Daryl?" Beth leaned forward slightly.
"I'unno if I can even be tellin' ya this legally."
"You can. You're his next-of-kin and power of attorney. And, besides that, if you know something that we don't – like a disease or illness – then it could dramatically affect his recovery. Limit it. If you don't feel comfortable, I can ask him more firmly to give me a complete history."
Daryl shook his head. "Nah, don't want ya to have to do that. Plus, Merle's the type that'll either close up for good or retaliate if ya try to control him or manipulate him and he catches on to ya."
"Understood," Beth responded, folding her arms across her chest. She wondered if Daryl had always been the keeper of his older brother's secrets.
Daryl sighed heavily. She could see the force with which he was pushing his elbows into the table, and she watched in silence as he scrubbed his hands, which were large and stained by blackish scatters and streaks, over his face.
"He's not all bad, but he uses drugs. Has since we were kids. Abuses 'em. Sells 'em. Steals 'em." Beth could detect the effort required for Daryl to speak the words. She could sense the invisible air of helplessness and anger and disappointment and resigned acceptance that surrounded them.
"What's his drug of choice?" She urged him on with a gentle kind of professionalism and encouragement.
"Hell, hard to say now. Ain't hung around him in months, not 'til now – 'til this happened, at least."
"What has he been known to use?"
He removed a hand from his face and kept the other near his chin and ran the tip of his thumb along his lower lip. Beth refrained from her instinct to suggest to him that he wash his hands. They were in a hospital, for fuck's sake, but she didn't want to scare him off when he was opening up. And, for some reason, she felt like that was a significant thing for him to do. And, of course, he was providing her with information that was important to the care of her patient. Of his brother.
"Meth, mostly. Dabbles in coke. Prescription pills, painkillers I'm guessin'. Weed – pro'ly the least of his worries, though. Talked to a few of his - " he paused in thought for a moment before continuing, "associates. Since he's been in here. Was tryin' to figure out what might'a caused this. Guess he was in the middle of some kind of meth deal when he just collapsed. Tweakers stole all his shit and left him in some alley."
Daryl's tone was hard and icy and edged with anger, but she could hear the faint shaking in his voice. And she knew, in that moment, that Daryl had likely spent the majority of his life trying to save his brother.
And that thought made her think longingly of her own sister and the bond that they'd once shared. And it caused a sharp pain in her chest that drove her to reach her hand out, almost unconsciously, and place it over one of his.
The small shock she felt where her flesh and his touched startled her, and she almost jerked her hand away. The spark of electric current, which her logical mind attributed solely to the contrast between the coolness of her skin and the radiating warmth of his, shot up her arm and into her chest. And she inhaled a few uneven breaths to redirect her mind and her thoughts to Merle. To her patient. To what they were discussing and what the brother of her patient had just revealed.
"Are you or Merle in any kind of trouble?"
His eyes danced along a non-linear path to hers, and he abruptly yet deliberately flipped his hand so that their palms were pressed together, mismatched but aligned, and curled his fingers slightly into her skin.
He shook his head. "None that I know 'bout. But I'm keepin' myself pretty hidden just to be safe. Stayin' in some old hotel on the west side of the city. Ain't lived here in a few years but could pro'ly paint a damn picture from memory of all the places where I know his tweaker friends might be."
Beth nodded and felt a wave of relief. She could certainly involve social work and even the police department if she needed to and if she felt that Merle's safety could be at risk. But she was getting the distinct feeling that the best thing to do would be to maintain a low profile until Merle was at least somewhat more medically stable.
"Thank you, Daryl. For tellin' me. Know ya probably feel a little bit guilty about it or maybe like you're betrayin' him. But – I promise you – you're doin' the right thing for him." And she punctuated her statement by gently squeezing her hand around his.
"Pro'ly should'a told someone sooner. Was gonna tell that nurse, but – I'unno – didn't feel right. Didn't feel like she'd get it. But you do. An' I'm glad you're his doctor."
Beth smiled. "C'mon, I'll walk ya back to his room."
Xxx
Beth was finishing up her charting at the computer station behind the area of the nurse's station that was positioned just across the hall from Merle's room. She'd heard Daryl speaking softly every now and then and the soft, muffled noise from the television.
She was packing up her things and preparing to leave the second floor and – finally – head toward the parking garage when she heard his voice again. And it was a bit lighter than when they'd last spoken. The tone of it was different somehow – it was difficult to dissect the difference, but it was almost like earlier he'd spoken to her like an acquaintance, which was, in fact, basically all she was to him, and now he spoke to her like one would speak to a long-time, trusted friend.
"What time ya gonna be comin' 'round tomorrow, Dr. Greene?"
And if she listened closely, which she wasn't – not really – she'd likely have recognized the change in her own tone.
"What time you gonna be here?" She flung the strap of her messenger bag over her shoulder and walked around the counter that bordered the nurse's station to stand directly in front of him.
"Got one more day off'a work 'fore they fire me." He smirked a little, rolling a shoulder. "Pro'ly come 'round ten in the mornin' or so."
She lifted her eyes from his feet, which she'd been studying with a fair amount of intent as he'd spoken, to his eyes. And they were on her face – not static, but slowly raking from side to side and top to bottom as though he were trying to etch the lines of its structure into his memory. And she almost felt like squirming a little under his regard.
"I'll see ya then," she said quietly.
She didn't miss the subtle bloom of crimson that formed at the angle of his jaw, nor did she miss the tingling heat that she felt inexplicably creeping up her throat.
She smiled and quickly turned to leave the unit and the hospital for the night. At least she'd have several hours between then and when she'd return the following day to reiterate to herself that blushing in front of one of her patient's family members was not something she learned in medical school.