Chapter 4: Esme (Part 2)
"Explain."
That was the first word out of Dr. Stewart's mouth when he entered the small post-op doctor duty room. Carlisle exchanged a look with Dr. Huang. The hospital superintendent did not look angry. Just exhausted. Himself clad in wrinkled scrubs, for once he looked all of the seventy years he had under his belt. As kind hearted and mild mannered as he usually was, neither of his two juniors wished to tell him exactly how many rules they had broken in that OT.
With a hesitantly raised eyebrow Chloe answered. "We were short staffed. There was an emergency. We improvised."
"Did someone die?" He asked.
"Not yet." Chloe's answer was weak and with a resigned sigh Dr. Stewart sank into an empty chair.
The room was small but clean and well lit. A table ran the length of the three walls with chairs that faced away from it more often than towards it. The room was monopolized by the senior surgeons and physicians. With the interns and residents usually left to slog over the post-op paperwork, this room was mostly used by Carlisle and his peers to sit and chat between or after surgeries.
Today, however, both he and Chloe meticulously filled out the post surgery notes themselves. A fact not missed in the least by their superior.
"Where are your interns?"
Himself free of any responsibility right away, a small smile played at Dr. Stewart's lips. He might not be quick to take disciplinary actions against people but he never missed a chance to rib someone either.
"A patient came in with acute kidney injury and a plethora of other issues. I managed it the best I could, then sent him up to the ICU and told Eva to watch his urine output."
Dr. Stewart's eyes shone with mirth. "A heart doctor is managing a kidney patient. Do you mean to start an interdepartmental crusade in my hospital?"
Carlisle stifled a chuckle. This wouldn't be his first argument with the visiting nephrologist. The crux of the issue being 'visiting.'
Their hospital did not have a full time nephrologist. Just a doctor who visited twice a week and was supposed to be available for any queries over call the rest of the days. Except that if you could not physically corner him in the hospital, it was impossible to reach him. He never answered the calls. That meant if an emergency came up with any of the patients, the nurses had taken to contacting Carlisle instead.
He had studied nephrology, even though the rest of the staff were not aware of it, and had never prescribed the patients anything that would harm them. But their visiting nephrologist disagreed with him, almost as if on principle. If he saw Carlisle's signature on any of the patient's case sheets, he would start shouting at whoever was the unfortunate nurse in front of him and change the medications. Sometimes just switching the brand without changing the composition or dose at all.
He riled up Carlisle more than anyone ever had before. To the point where Carlisle too had snapped at him a couple of times during their interdepartmental seminars.
Once, on a rare, sunny afternoon a couple of years ago, Alice had sat down and scripted their entire argument that would happen the next day. She would say the sentence from the nephrologist that would push Carlisle, and his other children came up with comebacks. They'd pick the best one and repeat the cycle of back and forth till they'd charted out the entire argument. Then they'd place bets on how long the script would be followed the next day before going astray by either of the parties.
Carlisle was loath to admit, he lost his cool enough to switch from the scripted witty retort Jasper had come up with and spew the downright vitriol he'd heard Rosalie suggest the day before. He was written up for it but Rosalie did not stop smiling for two days straight after that.
"Maybe if you hired a full time kidney doctor, the heart doctor would stay in his lane," Carlisle answered their superintendent who rolled his eyes.
"If I had the funds to hire another doctor, I'd hire a whole set of nurses. They're ten times as useful. And I know you all "manage" things among yourself."
"So you are okay with us dabbling into other specialities?" Chloe asked amused. They all did it. But they'd breathe a bit better if they knew Dr. Stewart was going to look the other way. There truly was no point in calling a medicine consult to the OBG department just because a pregnant woman got the flu. Dr. Huang could manage that herself even if the rules said otherwise.
Dr. Stewart shrugged. "As long as you are not asking an Ortho to read an ECG, I'm alright with it."
Carlisle narrowed his eyes. "You are the only orthopaedic surgeon in this hospital."
"Yeah," Dr. Stewart snorted. "Don't ask me to do that. I don't remember what any of those things mean anymore."
His phone buzzed and the older man glanced at it. A heavy sigh and all mirth was gone from his face. "Cullen, while you were resuscitating the baby, did the nurse not know how to turn on the suction machine or did the machine not work?"
Carlisle spent just a moment pretending to think back before he answered. "The machine did not work. The nurse was inexperienced, yes, but in all honesty, so was I."
Dr. Stewart cussed some Smith under his breath and Carlisle gave a questioning glance at Chloe.
"That's Dr. Stewart's nemesis." She leaned back into her seat. "Dr. Stewart has been trying to get more funding for the hospital from the Trust. But this Smith person has some kind of veto there and redirects all the funds to either the bigger hospital in Seattle or towards the private clinics run by him or his buddies."
Carlisle's forehead wrinkled in confusion. "Can he do that?"
"Legally, no," Dr. Stewart sighed. "But these people refer enough patients to the Seattle hospital that the higher ups look the other way when I reach out. It's going to take something big for them to do something about it. Let's just pray this place isn't rubble by then."
With that, he pushed himself off the chair and headed out. Just when he reached the door, he turned back and looked at Carlisle again. "I went to see the baby in the NICU."
"How is he?" Carlisle couldn't help but ask, the contrite clear in his voice. He could still hear the crackling of the broken ribs and the silence of the unresponsive child.
"If he dies, it wouldn't be because of anything you did or didn't do. That's all the nurse told me."
With that, the old doctor left the room, leaving Carlisle and Chloe under a heavy silence.
"Gods, Jennifer needs to survive this," she sighed and Carlisle stared at the paper in his hand again.
A lot of things needed to happen. Jennifer had to survive. Her family had to understand why the C-Section was necessary at such an early stage. They had to understand why they had to perform the emergency surgery and remove her uterus after the delivery. The people in the OT needed to keep their mouths shut about everything that happened there.
And David. David had to survive.
That is why Dr. Huang had initiated a pre-term emergency C-Section. David was dying and it was the only way to give him a chance at survival. But after the delivery, Jennifer would not stop bleeding. They tried giving her the IV medicine. They tried to put pressure on the uterus. Chloe, for a moment, was elbow deep into Jennifer's uterus trying to put pressure from the inside. They tried to tie the artery supplying the blood to the organ and stop the flow entirely. All to no avail.
In the end, Jennifer had lost too much blood and the only way to make her stop bleeding to death was to remove the organ that was bleeding, that is, her uterus.
A tough decision indeed, especially for a woman with a precious pregnancy whose only child might not survive at all. But neither the OBG in that OT nor the Cardiothoracic Vascular Surgeon in that room could see any other way of keeping the patient alive. So they did it.
And now, both of them sat in that small post op room filling the paperworks as diligently as possible, bending the truth where required and forging signatures where necessary. They could not risk leaving it all to the interns. The chances of a possible litigation was too high.
Even now Carlisle could faintly hear Jennifer's husband fuming somewhere in the hospital. He was already sore about not being allowed into the room. This was just more ammunition for him.
They stayed at it till the post-op work was done and then parted ways. Dr. Huang went to check up on Jennifer who was receiving a blood transfusion and Carlisle went off to sleep. Or at least pretend to do so.
Instead, he went to the doctor's room in the ICU complex and laid down.
Just a couple of hours, he told himself. Then he'd be free to get back to work for the next twenty or so hours.
Unlike the other duty doctor's room, this one was neither clean nor well lit. It was small and crammed with two thin beds covered in flimsy, unmade bed sheets. Far too many people used it. And most people who used it, left the room when an emergency was called. So they did not make the bed after themselves.
That late at night, or rather, early in the morning, the beds were well used, the dustbin was overflowing with trash and the lights were out. The room smelled heavily of Eva. She seemed to have been the last person who used the room.
Carlisle left the door slightly ajar to let a little light shine through, and more importantly, to let the people see he was in bed. There was no point 'resting' if nobody saw him. A couple of nurses passing by did see him. But they were taking turns getting some rest as well.
It was through this crack he left that he saw her. A cabinet outside gave a distorted reflection of the corridor connecting this room to the ICU.
She was typing on her phone furiously, occasionally letting a cuss slip out loud. She would look up towards the door to the room at times and then spin away, getting back to her phone. When there was a short buzz on her phone, she turned on her heels and ran off, away from the room.
Eva was…entertaining.
To watch at least.
He could call Esme and talk to her to pass time. But then again, he needed to be asleep to any passerby. It was much easier to close his eyes than break off mid conversation and hide his phone if someone approached him. So, instead of calling his wife, he lay on his side and watched his intern's shenanigans through a distorted reflection.
Minutes passed by and a few more groggy voices joined the soft whispers from the ICU. The machines in the room beeped its usual, rhythmic tone and most patients were sound asleep, under the influence of medicines or otherwise.
He could hear every word of the hushed conversations outside between the new arrivals and his flustered intern. Still, he held his place on the bed. Any hint that he was awake would make life easier for Eva. That, he could not allow. Not in this particular situation.
The worry in her voice as she explained the situation to the new arrivals in the ICU almost broke his resolve. He could go and sort it all out in under half a minute. Yet, he stayed in bed.
It was a good thing he had practice doing so. Ignoring the silent suffering of a woman.
Edward's discouraging glares from almost a century ago were fresh in his mind. Even then Carlisle had sat in his office, ignoring the nervous pacing around the house.
No, Edward had said resolutely. You need to stop getting her everything she needs. Let her ask you for it!
Esme needed that. The confidence to walk up to them and ask them for things, demand it of them. It was her right as a part of their family. But she had been a nervous wreck, terrified of approaching them for anything.
It had taken time, and effort, on part of not just Esme but also Carlisle and Edward to bring Esme out of that shell. But it worked.
And the same century-old resolve held him in place that stormy night in the hospital.
"Your intern is one step away from a nervous breakdown," Dr. Huang announced, closing the door behind her as she entered. In two short strides, she sank into the other bed. The air in the room was quickly infused with the scent of blood and Carlisle took a couple of deep swallows to fight off the flow of the venom in his mouth.
"I know," he muttered, throwing a sheepish smile her way that he knew she couldn't see in the now-dark room.
He, on the other hand, clearly saw her raised eyebrow. "And you are not going to help her? That's new, Dr. Cullen."
"I am helping her," he declared, turning to lay on his back and stare at the ceiling so that Chloe could have whatever shred of privacy she could in this box of a room.
"How?" Carlisle could hear genuine curiosity in her voice despite the exhaustion. "She has the entire dialysis team standing outside the ICU right now. And is almost turning catatonic every time she looks at this door. How are you helping her by staying here?"
"Well, I told her to watch how much urine the kidney injury patient was passing. If it was sufficient, that means the treatment was working. If it was less than what we expected, the medicines would have to be adjusted. But she fell asleep here. And when she went to check on him, a few minutes before I got here, the patient's urine bag was still completely empty."
Chloe shot up from the bed and turned to look at him. Carlisle glanced at her too. Her eyes were huge, the sleep and exhaustion alarmed out of her body. "Dr. Cullen, if the patient hasn't passed any urine at all, he might be in kidney failure! He could be in very bad shape by morning! We can't have so many patients turning critical in one night."
"Oh relax," he waved a hand at her worries. "He's fine. He passed enough urine that one of the nurses had the urine bag changed and made a note on the nursing chart. That nurse is asleep right now and Eva just hasn't checked the nursing chart."
Chloe was still frowning. Carlisle understood her concern. Perhaps better than most of their colleagues. He had more reasons to fear an investigation than anyone else in the hospital given the trail of falsified documents he and his family used on the regular.
"She doesn't get it but this is an important moment in her career," he continued. "Eva is terrified right now. And I want her to suffer a bit more before I step in. Anything she does and feels before I go, will teach her to be more thorough in going through the patient's file. It will teach her to look at the nursing chart as well, not just the doctor's note before coming to a conclusion. But once she 'wakes' me up, any reprimand will just make her scared of disturbing seniors or asking for guidance."
Chloe let out an exasperated breath, shaking her head. "You coddle them too much. Back in my college, a good, old, verbal thrashing taught the interns whatever was needed."
Carlisle chuckled but said nothing. He never got the chance to.
With a hammering heart, Eva approached the room. And at last, there was a timid knock on the door.
A/N:
I am sorry for putting this story on hold. Other things took a bit of a priority and I really wanted to finish Dear Lady. But I'm back to this one now and will try to keep either at least a weekly or biweekly update.
I wanted to cover all the different aspects of a hospital that Carlisle works with, instead of just the patients. So, just a tiny glimpse into his relationship with different colleagues. Bureaucracy and insurance too will make an appearance in the story!
Hoping you enjoyed the chapter! Do let me know what you think, or if there is any particular scenario you want to see explored in one of the chapters!
-ZQ