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Fever Pitch

Fever Pitch by Elizabeth Neff Walker
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Fielding Medical Center is San Francisco’s most prestigious hospital complex. So when emergency room physician Steve Winstead and neurologist Nan LeBaron are sued for malpractice when a patient dies, it’s a major event.

Tension mounts between them because Steve fears Nan won’t handle the crisis well, and Nan offers Steve the hard truth about his bedside manner—which could be improved.

Then tension turns to fever—and it’s a different game.

Women's Fiction by Elizabeth Neff Walker

3rd of the Fielding Medical Center Quartet

Belgrave House; August 1995
186 pages; ISBN 9780451404725
Read online, or download in secure PDF format
Title: Fever Pitch
Author: Elizabeth Neff Walker
 
Excerpt

"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."

~ ~ ~

Nan had learned to live with uncertainty in her chosen profession. It was delightful to be able to pin a diagnosis on a patient quickly and skillfully, but a number of the diseases neurologists worked with were more a process of elimination than a simple matter of reading elevated lab values or seeing distortions on X-rays. More than that, a lot of a neurologist’s patients had diseases for which there was very little treatment. Which made it very important that Nan could be supportive to those patients. She had learned to discuss their diseases with them in a clear and helpful way that said a patient was more than just his or her disease. She was level-headed and, as the nurse Carol would have said, “good at what she did.”

One of the first things she’d learned to do was leave the hospital behind her. Not that the hospital didn’t follow her home, with constant calls and pagings, but she had managed to reach a place where she could separate herself from the doctor part of her. Which was why she didn’t understand Peter’s insistence that she let medicine take over her life.

It seemed to her as she trundled the gurney down the hall that Peter was looking for an excuse to withdraw from her life, not that medicine was crowding him out. He had, after all, known from the start that she was expected to put in long hours. Hadn’t he insisted that he didn’t want any woman sitting in his pocket? Well, she certainly wasn’t.

The scan room was expecting her patient, since Carol had efficiently called ahead. Nan moved into the control room while a nurse and technician moved her patient onto the bed of the machine. Dr. Woo nodded pleasantly to her as he readied the equipment for a new scan. Comatose patients had to be handled differently than ones who could obey instructions. On the other hand, their unconsciousness rendered it unnecessary to make all the explanations that got repeated over and over in the course of a day. Nan enjoyed watching the video screens show the computerized images of a patient’s brain, but she would never have  wished to train as a radiologist. Her rewards in medicine came directly from patient contact, something radiology as a specialty couldn’t provide.

Slice after slice of brain image appeared on the screen. Eventually Dr. Woo said, “There. Do you see the hypodense region? Interesting that it’s so clear now. The hematoma must have been really recent when he was brought in earlier. Better get the neurosurgeons in, Dr. LeBaron. This guy needs help.”

“Thanks, Dr. Woo. I’ll put in a page.”

She glanced once more at the John Doe, silently wished him luck, and left to make her call.

~ ~ ~

Ever since Angel Crawford had gotten married, Nan had had the flat to herself. The three unit building was a Victorian with a three-color paint job that emphasized in burgundy and navy the detail around the doors and windows and under the eaves, against a dark gray wood background. The flat itself had high ceilings, hardwood floors and dark stained wainscoting in the entry and dining room. Nan’s bedroom, the larger of two, was spacious but with windows that looked out only on two light wells.

Because it had been a busy day at the hospital, and because she couldn’t quite believe she’d agreed to it, she had entirely forgotten that Roger was moving in. When she arrived at the flat, only two blocks from the hospital, she had been alarmed to see the downstairs door standing open. Only for a moment, of course. There was a car parked in the driveway with its doors open and a pile of clothing on hangers in the back seat. Men’s clothes. How could she have forgotten he’d said he would be moving in today? And why had she agreed that he could?

Roger came loping down the stairs and out onto the vestibule where he noticed Nan standing by his car. He seemed to take in her skeptical expression and his face fell. “You’ve changed your mind, haven’t you?”

“Of course not! I was just wondering if I had the energy to help you get these upstairs.” Nan forced a welcoming smile. “It’ll be great to hear someone else moving around the flat.”

“I probably make more noise than Angel did,” he confessed, coming slowly down the stairs to stand a few feet from her. He began tugging at his belt. “It would be all right, if you’d rather I didn’t move in, Nan. I don’t know what made Jerry come up with the idea.”

“I’m glad you’re moving in,” she insisted, stooping down to grab a handful of hangers. “It’ll help with the rent and it’ll provide companionship. When I’m here. I spend a fair amount of time with my boyfriend Peter.”

Roger lugged a cardboard box full of shoes, belts and ties out of the car. It looked like he’d just tossed them in at will. “I didn’t bring any cooking stuff.”

“I have everything we’ll need.”

Nan followed him up the stairs with an inward sigh. She remembered how she’d once told Angel that he was a nice enough guy, but that his nervous mannerisms would drive her crazy. Would they? Not if she kept in mind that the poor fellow had just lost his wife. He’d married Kerri knowing that she was dying, of course, but he was taking it very hard, Jerry said. Couldn’t seem to sleep in his own house right now. Nan would be doing a good deed in letting him share her flat. Well, who wouldn’t take a poor, suffering, depressed, fidgety anesthesiologist into her home like a lost puppy? Certainly Nan had found it too difficult to say no.

Trooping up the three flights of stairs, Nan realized she’d begun counting on the exercise just the walk home and climb to the flat gave her, especially on days when she didn’t get a run in. It would be handy for Roger, too. He was thin but rather pale. Probably hadn’t been outside exercising in the sun enough. As she followed him into his room, Nan thought chances were that he wouldn’t want to stay long. Just until the worst of his depression retreated and his insomnia got better. Pretty soon he’d want to be back in his own house, his own bed. He’d lived there for years before his marriage, and he’d be able to live there again soon, she felt sure.

“Doesn’t anyone use the back yard?” he asked, staring down into the wasteland of weeds. “Would they mind if I sort of cleaned it up?”

Nan deposited the loaded hangers on the stripped bed that had come with the flat. “I’m sure we’d all be delighted. But it’s almost December. Is there anything worth planting at this time of year?”

He shrugged. “I’ll find out. It just looks so depressing out there.”

“Well, yes.” Nan came to stand beside him at the bow windows. “I guess no one’s tackled it because it’s a lot of work.”

“I don’t mind. Anything to keep me busy.”

She would have liked to ask him if there wasn’t something at home, something he’d benefit from eventually. But of course she knew better. “Maybe you could paint this room.”

“I hate painting,” he admitted. He tugged at his ear lobe and sighed. “I appreciate you letting me stay here. I’ll try not to be a pest.”

“You’re not going to be a pest, Roger. I’m glad to have you.” And suddenly she was. “I miss my brothers sometimes. And my friend Peter isn’t at all like anyone in my family. You’d probably fit in with them, though if you ever meet them you probably won’t think that’s a compliment.”

“Why not?”

“Oh, they’re rowdy, and a little bit redneck, and unsophisticated.”

“Sounds just like me,” he said ruefully.

Nan laughed. “Hardly. But I think you’d like them. They’re salt of the earth people.”

“I hope I get to meet them sometime.”

“You probably will. They’re coming for Christmas.”

~ ~ ~

Christmas was still several weeks away, but Steve Winstead had already bought himself a Christmas present, of sorts. For years he had lived in the five unit building in Pacific Heights that he’d inherited as his share of his grandmother’s estate. It was an elegant building with spectacular views of the bay. It was also next door to his parents’ mansion. They might refer to it as their house, but it was a mansion. Steve had grown up in a kind of luxury that tended to spoil one for the simpler things of life.

By the time he reached college age he was sated with a social life that included cotillions and week-ends at Lake Tahoe. His parents had expected him to go to college, of course, and even have a career, something refined like the law or architecture. They had even accepted with good grace his decision to go into pre-med. But they were not so sanguine about the direction his career had taken since then. Though they would never have said so to any but their closest friends, emergency medicine struck them as rather crass and unrefined. His mother, Bitty Winstead, had recently remarked to him when they were seated on the deck off their summer home that she supposed he frequently got blood on his clothes.

God almighty! Blood on his clothes! Steve revved the engine of his British racing green MG as he waited to pull out of the parking garage at Fielding Medical Center. He’d done two twelve- hour shifts back to back, finally getting out of the emergency room just after seven. Daylight had long since vanished, but it was reasonably warm and he felt no need to put the top up on his car. He was not unaware to the picture he made in his MG, his fine blond hair blown wild by the wind, his eyes narrowed against the whipping strands.

But it was Steve’s impression that people liked seeing someone enjoy the good life. Oh, they might be envious, momentarily, of the money it took to support a luxurious lifestyle, but mainly they got a vicarious pleasure from seeing someone race along in a sports car, or glide across the waves of the bay in a stunning sailboat. If this was a slightly I view, Steve was so accustomed to his wealth and the world he had grown up in that he was unaware of it.

Fielding Medical Center was only a short drive from the Golden Gate Bridge. For years Steve had driven across the city to Pacific Heights, not a particularly inspiring drive most days. Now, with the key to his new home attached to his key ring, he aimed across the bridge to the north. At night in an open car the Golden Gate Bridge was a particularly fascinating sight. In stopped traffic Steve could look up at the lighted towers and see stars beyond. He found it particularly energizing to be leaving the city, leaving behind the hospital, and Pacific Heights, and his family. No one he knew lived in Belvedere.

Highway 101 wound quickly north and Steve took the turn-off to the Tiburon peninsula. Tiburon, an exclusive community, was still a little newer and more developed than Belvedere, its sister community comprised of one hill around which narrow roads wove their way to the top and back. In nooks and crannies of the hill extravagant homes boasted astonishing views of the bay and San Francisco. Not all of the homes were large or extravagant, but all of them felt special—hidden away, like some cherished secret. His new house was like that, a surprise you came on at the bend in the road, shingled, wrapped around by ivy and jasmine.

True, it was a fixer-upper, but Steve intended to enjoy himself making it into the perfect place for him. Hell, the flat in Pacific Heights still mainly had his grandparents’ furnishings, so old and heavy and worthy. The management company would find decent tenants for it, probably someone of his parents’ generation who wanted something smaller than the house they’d lived in for years. Steve’s new house—which was all of sixty years old—needed a new roof, and the interior painted, and a kitchen and bath remodeling, and the floors sanded. Everything, really. It had been neglected as an elderly man grew more and more incapacitated, until he finally was forced to leave for a nursing home. To Steve it seemed like the perfect opportunity to get his hands on something that he could make into his own. And be out of the social pull of San Francisco at the same time.

Turning onto Belvedere Avenue he noticed for the first time how the lights from houses scattered round the hill shone like bulbs on a Christmas tree. A fanciful thought, for one of his skeptical disposition. But he smiled slightly, nonetheless. Certainly the whole endeavor—buying the house, planning its restoration—felt like a celebration of freedom. It was just one more step away from the stifling atmosphere of being the only child of wealthy, prominent parents. Even becoming a doctor and having a life of his own hadn’t entirely severed that tie. Not that he wished to disown his parents, but he did wish to disown that sticky trap of belonging to the social register, the ingrown pettiness of a small, privileged group. There were more important things in life, and that particular group didn’t even seem to know it.

Steve wound the MG up twisting Madrona Avenue past his house hanging over the road, until he doubled back and came on the garage behind it. The garage was too full of ancient relics from the previous owner to allow a car to be parked in it, so Steve pulled off to the side of the road and turned off his engine. For a long moment it seemed like perfect silence, and then the sound of wind in the trees, the faraway murmur of another car, the scraping of a vine on wood, whispered on the night air. Steve combed back his straight hair with long fingers and took a deep breath. This would be the first night he spent in his new house.

He had cadged a foam pad from one of the nursing floors, and stuffed a sleeping bag in the car that morning, knowing that he was coming over. It didn’t matter if there was no furniture. The electricity and plumbing worked. What more could he ask?

Well, probably it would have been smart to bring some food, he thought as he stood in front of the empty refrigerator. This appliance was so old the term “ice box” came forcibly to mind, with its rounded edges and its tiny freezer section overflowing with ice. Steve grunted and decided to unplug the refrigerator so the ice would melt. It did not occur to him, because he’d never defrosted a refrigerator, that the melting ice would collect in water on the bottom shelf, to await his next opening of the door.

From his briefcase he withdrew a yellow legal pad which he had purposely brought with him to begin a list of the projects he wanted to get started on. Wandering from room to room he scratched down all the details he became aware of, floors needing sanding, every room needing paint and most needing curtains or blinds as well, ugly light fixtures that needed replacing. The list grew longer as he climbed the stairs to the second story. The carpet on the stairs was a downright hazard, there was no bulb in the overhead light, the shower curtain was in tatters. He hadn’t realized how much was needed for a whole house. Beds and tables and chairs and lamps and sofas and towels and bedding and kitchen utensils. On principle he refused to bring anything from the Pacific Heights flat. Everything here would be different and exactly his taste.

When the phone rang he was startled. It seemed so unlikely that anyone knew his number. And he’d forgotten that he’d asked the real estate agent to be here for the phone service installation. She’d seemed a little annoyed about that, come to think of it, but had refused his offer to pay her. Well, who was supposed to do that sort of thing? He couldn’t very well take time off from the emergency room to be here, could he? The call would be from his mother. She was the only one to whom he’d given his new number, and then with the rebellious thought that he wished he didn’t need to give it out to anyone, at least not yet.

“Hello.”

“Steve? Hi, it’s Ruth Ann.”

Now how the hell had she gotten his number? Though he’d dated her off and on over the last year, he’d been relieved when she told him recently that she was seeing someone “seriously.” There had been that quality to her voice that told him she was rebuking him, that she could just as easily have been seeing him “seriously.” Heaven forbid! “Ruth Ann. How’d you get my number?”

“From your mom. I saw her at the club today and she said you’d moved. Was I astonished! To Belvedere! I had no idea!”

“Well, I haven’t even really moved in yet. The place is empty.” Steve knew he wasn’t being encouraging, but he didn’t want to encourage Ruth Ann. She was part of the set he was trying to draw back from.

“I’m having a party, Steve. And I hope you’ll come.” Her voice became coyly playful. “It’s an important party. We’re going to make an announcement.”

“Well, that’s wonderful,” he said heartily, preparing an excuse in his mind. “When’s the party?”

“December 12th. It’s the only day most of the family could make it. I hope you can.”

“Oh, I’m sorry, Ruth Ann. I work that night.” Did he? He had no idea.

“Really? Oh, that’s too bad. It’s a week-end. Do you work week-ends?”

“Sometimes. Three days and one night a week, twelve-hour shifts. We take turns on the week-ends, you know, especially in a holiday month like this.” He found himself pacing restlessly, ready to end the conversation. “Anyhow, I wish you all the best, Ruth Ann. You certainly deserve it.”

“Thanks, Steve.” Her voice had dropped to a soft register that sounded almost sad to him. “He’s a nice guy, Jeff is. I know you’d like him. But you’ll meet him some other time.”

“Sure I will. Well, thanks for calling, Ruth Ann. Take care.”

He stood for a long moment staring down at the instrument after he’d hung up. It occurred to him, though dimly, that he had not treated Ruth Ann well. Not tonight, on the phone. That had been all right, if perhaps he’d rushed her a bit. But over the course of the last year. He’d used her, in a way. Not exactly purposely, and certainly with her willing acquiescence, but at no time had he intended a lasting relationship between them, and the whole time he knew that’s what Ruth Ann was hoping for.

That was the trouble with two people having different expectations. Steve had told himself that he’d been perfectly straightforward with Ruth Ann, told her right up front that he wasn’t interested in marriage. And she’d said that was fine with her, they’d just have fun together. But he had known that wasn’t what she wanted. And he’d continued to see her. Was that using her? At the time he’d refused to believe that it was, but tonight he saw it differently.

Tonight it made him annoyed with himself. And with her. Why couldn’t she just say what she really wanted? Of course if she had he would have been gone. Her only hope was to ingratiate herself into his life and into his emotions. That’s how it worked, wasn’t it? Steve had never been struck by lightning, falling in love at first sight. He didn’t believe such a thing existed. So obviously love grew with acquaintance and proximity and intimacy, didn’t it? So was she right to hang in there? And was he wrong for letting her? He might have changed his mind, too.

He wished she hadn’t called. But he was good at putting things out of his mind. Steve decided to drive back down the hill and pick up a bite to eat in Tiburon, maybe have a beer, think about what he was going to do with the house. This was a clean slate for him. He was starting over, and this time he was going to do it right.