KIRSTEN NADIF WAS LOST.
Damn. She’d been at the hospital for almost a month now, and she still couldn’t seem to find her way around some of the floors. NYC Memorial was massive. Her previous hospital, where she’d started her career, was a quarter of the size of this hospital. So it was understandable that she might feel a bit discombobulated.
She laughed. Discombobulated. One of those fun English words she’d learned years ago in her ESL class in Lebanon. She tended to use that word. A lot. Just for that reason. It helped tie her to her roots and reminded her of her purpose for remaining here in America, even after her father had moved back home.
Not for the first time, she questioned her decision to transfer from Ohio to New York. But it had been for the right reasons. Lately, she’d begun thinking of moving back home to be near her father, and to do that, she would need all the experience she could get. And NYC Memorial was on the cutting edge of pulmonary treatments, including transplantation, a stage her mom had never reached before her death ten years ago. Her dad’s decision to move back to Lebanon last year had not been an easy one, and she found she missed him terribly. Never had she felt more alone and out of place than she did right now with people streaming around her.
Just give it time, Kirsten.
She’d already made one friend. Nicola Sabat had seen her wandering down a hallway on her first day at the hospital and had stopped to help, and then invited her to lunch, since she said her husband was at home on “daddy duty”—thanks to a sick babysitter—and Nicola could use the company.
They were on their way to becoming fast friends.
Only today, Nicola was nowhere to be found, and she was late for an appointment with a patient and the hospital’s head of transplant surgery.
She spied a sign on the corner of the wide hallway. Critical Care. Finally! Glancing at her cell phone, she saw she was ten minutes late, and now there was a missed-call notification. Her phone had been on silent. Perfect.
Heading in the direction of the arrows, she pressed redial to call the number. It rang once.
“Tangredi.”
She blinked at the unfamiliar name before realizing it was the doctor she was supposed to meet. “Hi, this is Dr. Nadif. I’ll be there in a minute or two. I got lost. Sorry about that.”
There was silence for a few seconds, and Kirsten’s chest tightened. Had he hung up on her? She pulled the phone away from her ear to look just as his voice came back through. “Then I guess I’ll see you in a minute or two.”
Then the phone went dead.
Oh, Lord. Despite the softness of his tone, she sensed he was irritated. Rightfully so. She should have probably called, but figured the process of finding out how to get in touch with him would make her even more tardy. And she’d had an emergency case in Pediatrics that she’d needed to see to. The ten-year-old had had persistent bronchitis, and after a troubling X-ray she’d ordered an MRI of her lungs that was scheduled for next week. She was probably overreacting, but after her mom...
She shook her head, dropping her cell phone back into her pocket. That was the last thing she needed to think about right now. This was her first time meeting this particular doctor, and their brief interaction on the phone did not bode well for their developing a chummy relationship.
Not that she was looking for “chummy.” Or a relationship of any kind, for that matter. Been there, done that and it didn’t bear repeating. Then there was the huge move she was contemplating in the next year or two.
She quickened her pace, looking toward the U-shaped bank of white laminated desks, which meant there was a nurses’ station just ahead. Faster to ask than to try to find the patient’s room on her own.
She approached a male nurse who was standing on the outside of the desk talking to one of the other nurses and stopped. “Excuse me, can either of you tell me where Tanya Latimer’s room is?”
The man’s head turned toward her, revealing eyes the color of blue, chipped ice. They perched over cheekbones that were just as hard and severe. She suppressed a shiver.
The nurse behind the desk glanced at her lanyard and spoke to the man. “I think this is who you were waiting for, isn’t it, Dr. Tangredi?”
Dr. Tangredi.
Ya ilahi! He wasn’t a nurse. He was the doctor she was supposed to meet. Having this embarrassing introduction done in front of an audience was not how she’d envisioned this happening. “Oh, um, hello.” She stretched out her hand. “I’m Dr. Nadif.”
When his skin connected with hers, it was not what she’d expected. At all. Unlike the rest of his forbidding demeanor, his fingers were warm as they curled around hers. Goose bumps—having nothing to do with the overly cool temperature of the hospital—broke out along her arms.
“I know who you are.”
That comment startled her before she realized the nurse wasn’t the only one who’d glanced at the lanyard hanging at chest level. Swift heat washed into her cheeks, and she wasn’t sure why.
“I’m sorry again for being late.”
“I let the medical students go on to lunch.”
“Medical...oh, right.” This was even worse. It hadn’t been just the doctor who’d been kept waiting by her lateness—there had also been a group of students. She could explain that she’d had an emergency, and that she hadn’t simply been caught up in some romance novel for the last fifteen minutes.
Not that this man knew anything about romance, if the empty ring finger and his chilly tone were anything to go by.
Unfair, Kirsten. He probably has a girlfriend waiting somewhere. After all, he was gorgeous, despite his less than winning personality. She forged on ahead, deciding she was not going to let him intimidate her. “I can always come back, if that’s more convenient for you.”
“No, the patient is waiting. I’d rather get your assessment now, before we make any other decisions about her treatment.”
“Of course.” She straightened her back. “Lead the way.”
He nodded a goodbye at the nurse behind the desk, and Kirsten threw the woman a quick smile before following Dr. Tangredi down the hallway, catching up to him in a few strides. “So can you tell me a little more about the patient?”
“Tanya Latimer, female, midtwenties. Primary pulmonary hypertension. Her condition degraded until she was placed on the transplant list. Yesterday, she got a new pair of lungs.”
He made it sound like something that happened every day. Like you simply went to some parts superstore and picked out what you wanted. In the real world, lungs and livers and hearts were not so easy to come by. It took time—and, often, another family’s tragedy—to make it happen.
And that time sometimes ran out before a donor organ became available. She knew that firsthand.
“How’s she doing?”
“Blood oxygen is better than it was before the transplant, but not quite where we would like it to be at this point.”
“Any signs of rejection?”
His eyes focused on her again. “No. And we’re hoping there won’t be.”
Hoping there wouldn’t be signs? Or that the lungs wouldn’t be rejected?
The latter, of course.
“Once the inflammation from surgery settles down, that should improve as long as the donor had no underlying health conditions.”
“I screened him myself.”
Meaning what? That he was infallible? Well, she hated to break it to him, but even the finest doctors in the world couldn’t always halt the progression of disease. Her mom was a case in point of that.
“Okay, but I’d like to read your notes, if that’s possible, just so I can see if there’s...”
She was going to say “to see if there was something you missed,” but something stopped her. And that was crazy. Since when had she been afraid to speak her mind? She wasn’t. She was just being cautious.
“I’ll have them sent to you. But right now I’d like to have you put eyes on her and actually look at her, and not just go by a set of notes or give her a cursory glance.”
Kirsten stiffened. She always looked at her patients—really looked. Why was she feeling so defensive all of a sudden? Maybe because he’d gotten prickly when she’d questioned him, and now he was doing the same to her.
“That’s why I came down here.”
They stared at each other for a long moment before Dr. Tangredi did something that shocked her. He smiled. It was a smile that floored her with its sudden infusion of warmth. Even his eyes had been transformed into a deeper hue of blue. She struggled to catch her breath for a moment.
“Call me Snow. Please. Most people do.”
It wasn’t just the change in his demeanor that threw her, but the abrupt change in topic did, too. She felt... Don’t say it.
Her mind filled the blank, anyway. She felt discombobulated.
You really are going to have to find a new favorite word.
Snow. Man, the name fit him. But as long he didn’t try to launch any more ice spears at her, she could deal with the name.
“I’m Kirsten.”
“All right, Kirsten, let’s go see our patient, then.”
He pushed through the door of the room, and the first thing that met Kirsten’s ears was...noise. Lots of it. During her pulmonary workups she was used to listening closely, whether it was to note subtle changes in lung function through her stethoscope, or to ask a patient to blow through a peak-flow meter. She was used to an asthmatic wheeze and other sounds of oxygen being moved, but the cacophony of an ICU room was always startling to her senses. Cardiac monitors beeped and ventilators hissed, along with the sound of other machines.
The patient’s eyes were open, watching them. She followed Snow over to the bed.
“Hello, Ms. Latimer, I’m Dr. Nadif. I’m one of Dr. Tangredi’s, er, colleagues. I’m a pulmonologist. And I’d like to check to see how you’re doing, if that’s okay.”
The woman nodded. It had to be a frightening experience to not be able to control your respiration, or speak...to be totally at the mercy of the machines and caregivers. A wave of compassion went through her.
Kirsten went over to the dispenser on the wall and sanitized her hands, then snapped on gloves. Next, she took the woman’s hand in her own. “Dr. Tangredi is going to help me examine you, but if anything hurts unbearably in the process, I want you to squeeze my hand, okay?”
Another nod.
She glanced at Snow. “Can you put my stethoscope in my ears so I don’t contaminate anything? I can’t do it one-handed. It’s in my pocket.”
Snow’s head tilted, but he did as she asked, coming closer and sliding his gloved hand into her pocket. A wave of some weird emotion slid over her as his fingers curled around the instrument, sliding across her hip for a second. But before that emotion had fully registered, he’d pulled out her listening device, uncoiled it and stood in front of her to slide the earpieces in place. He was so close, she could smell the light tangy scent of his aftershave. His hands brushed over her cheekbones as he adjusted the fit. For once she was glad for the noise in the room. It would help mask any changes in her own breathing. And she knew there was a change. She could feel it. Feel it in the sudden heat that flared in her face, in the pulse that thumped in her neck.
“Thanks, that’s good.” She should have tried to do it herself, rather than risking having him come so close. But, after her breakup with Dave, she’d thought she was immune to men, and had no idea she was going to react to Tangredi the way she had.
Fortunately, he moved back several steps, eyes clipping hers, before he glanced again at the patient.
She took a second to compose herself, then addressed Tanya. “I’m going to listen to your lungs. This might be a little chilly.” Still holding the woman’s hand, she adjusted the hospital gown so that she had enough room. She wouldn’t be able to listen through the patient’s back unless they sat her upright, and Kirsten didn’t want to do that unless absolutely necessary. She was pretty sure they had already moved her around a lot. Tanya didn’t need yet another set of hands causing her pain.
Avoiding the drain tubes and the incision down the middle of her chest, she gently placed her stethoscope on the patient’s sides and under her collarbone, listening to bronchial sounds and the inflation of the lungs themselves.
She didn’t detect any crackling, which was good. The patient’s heart sounded good and strong, as well, and the sides of her neck indicated she had good blood flow to the brain. “Everything sounds the way it should. What’s your pain level on a scale of one to ten? You can either squeeze my hand that many times or hold up fingers.”
There was a pause and then she lifted her other hand and held up four fingers. So her pain level was a four. She glanced at Snow. “Is that what you’d expect at this point? Or does she need something more?”
Snow checked the chart, then looked at Tanya. “You have another dose of meds coming in just a few minutes. Are you okay until then?”
The woman nodded.
“Good,” Kirsten said. “It won’t be long, okay?” She gently palpated the woman’s belly and then let go of her hand in order to move to her ankles. “No peripheral edema that I can see.”
“Yes, I noted that, as well.”
“I think she looks good. Good color. So my opinion would be to monitor to make sure her oxygen levels don’t drop further, and I would expect to see an improvement tomorrow or the next day.” She glanced at Tanya. “And some of your pain should start subsiding a bit in a week or so. Once your incision starts to heal, it will go a long way toward making you more comfortable.”
Tanya nodded again. Something pulled at her, though. Something in the woman’s eyes that made her want to stay here with her. But she couldn’t. Kirsten gave her a smile and then checked her IV bags, noting the medications and the drip. “Can I come back to see how you’re doing tomorrow?”
The woman seemed to relax into herself, and her eyes closed, almost as if she was relieved. Kirsten had been right. When she looked at Snow, however, he didn’t look nearly as pleased. Afraid she was hijacking his patient? Not likely. He was the transplant expert, not her. She just knew lungs. And from the sounds of them working, this woman had gained a good set of them. But there just seemed to be something...more. Something she couldn’t quite put her finger on. Her instincts weren’t often wrong.
“Can I see you outside?” Snow smiled at the patient, but the chill was back in his eyes. “I’ll check in with you later this afternoon, Ms. Latimer.”
Kirsten stripped off her gloves, dropping them into the waste receptacle as she went outside, then coiled her stethoscope again and stuffed it back in her pocket.
Before Snow could lay into her—which is what she suspected he might do—she decided to explain first and leave her uneasy feelings out of the mix, since those were harder to explain. “Seeing her today gave me a baseline of comparison for what’s going on. I’d like to check for improvement over the next twenty-four hours in order to predict how she’s going to do. That’s why you called for the consult, right?”
“Yes. I just didn’t realize it would take more than once to satisfy you.”
She shot him a glance, then realized he’d meant nothing by those words. It was her own weird reaction to him that was putting thoughts in her head. Time to get back to her reasons for coming to New York. “Is pulse oxygen normally higher than the eighties when you first perform a lung transplant?”
“Pretty much. There’s usually a dramatic improvement right away, but considering where most of them start, almost anything is better than where they were before surgery. Over the next couple of days, there should be a steady climb. But these patients are normally in a hypoxic state by the time they’re approved for transplantation. And then there’s the wait time.”
“So why were you concerned with this particular patient?”
He paused before answering. “I’ve noticed what I think is some apathy, lately, about the process. Transplant candidates go through a rigorous screening process before they’re placed on the list. She passed it, but...” He shrugged. “I would say it’s a gut feeling more than anything, but my gut’s track record has been known to have its weak spots.”
She couldn’t imagine Snowden Trangredi being anything less than totally self-assured and confident with his decisions. But she guessed anyone could have a bad day and get something wrong. But to admit it? That surprised her, after his attitude earlier.
So what had he been wrong about? A patient? Something else?
“What makes you think she’s not fully on board?” She’d had an odd feeling about Tanya, too, so it helped knowing she wasn’t the only one.
“Not sure. Like I said, it’s just a gut feeling, but she’s shown neither excitement nor fear in the hours leading up to surgery. Something just didn’t feel right, but since she’d already been approved, it was almost too late to send a concern up the chain to the transplant board. And if I sounded the alarm and was wrong, then a person who desperately needed a transplant might end up overlooked. Or worse, die. And I didn’t want that to happen.”
Snowden’s light hair was just a little too long, the natural curliness very much in evidence at the ends and across the top. It fell down over his forehead in a way that made her tummy heat. And those eyes seemed to see everything. It unnerved her. And it also made her take a mental step back.
Leaning a shoulder against the wall beside her, he glanced at her. “So you’ve been at NYC Memorial how long now? I know Dr. Billings retired, but I wasn’t sure who’d taken his place.”
She’d arrived two days before Billings officially left, so there’d been almost no time for him to show her the ropes. They’d been too busy going over his patient files and explaining the rationale behind his treatment methods. They’d been very different from what she’d done at her former hospital.
“I’ve been here almost a month. I guess it took them longer than they expected to find someone who was qualified to take Dr. Billings’s place, although I’m not quite sure why I beat out the other applicants. So I’d barely skidded in before he left. It left me feeling kind of discombobulated.”
He blinked. “Discombobulated.”
Too late, she realized she’d actually used the word in a sentence. That’s what she got for reciting it in her head one too many times. She rushed to cover her blunder.
“It means—”
“I know what the word means. I just don’t think I’ve ever heard someone say it. Out loud.”
One side of his mouth curved up in that same smile he’d given her earlier, and that mental step back she’d taken earlier all but disappeared. The problem was, while his smile relieved one kind of tension, it caused another to sprout up in its place. And this one was a bit wilder, a bit more unpredictable.
She did not need wild and unpredictable. Not at this point in her life.
She cleared her throat. “Well, it’s just one of those fun words. It helps me not take myself too seriously. I think the world has a habit of doing just that. Being too serious. Too...distant. We don’t make the connections we need to.”
Connections? What the hell was she talking about?
Snow must have wondered the same thing because his smile faded, and he seemed to stiffen. “As a doctor, I’ve found it’s better to maintain a certain distance with my patients.”
This sounded like an argument he’d had before. The explanation seemed to come too quickly. Maybe she wasn’t the only one who’d thought his name fit the man. Except she’d seen a crack or two in icy coating. “Yes, of course.”
He shoved back that stray lock of hair, dragging his fingers through it as if making an effort to keep it back.
Was he used to it being shorter? She hoped not. She kind of like it that length. It was the only thing about him that didn’t seem to be under some kind of tight control. It was wild and unpredictable.
Ya ilahi! The curse rolled through her head as she clamped down on that observation. Those were the exact words she’d come up with moments earlier.
She certainly didn’t need to stand here thinking about the length of his hair or how much self-control the man had. “Well, thanks for asking me to come see Ms. Latimer. You’re sure you’re okay with me coming back tomorrow? I can come while you’re doing rounds if you’d prefer.”
“Not necessary. And I think she’d like it if you visited again. She seemed to perk up when you stood beside her. Held her hand. I don’t usually get that kind of reception during her appointments.”
“It’s probably a programmed response.” She didn’t want him to get back on the subject of maintaining a professional distance, since she was having a little trouble doing that with him right now.
“A what?”
She shrugged. “She probably associates you with pain or discomfort...or fear. I’m not there to do a procedure on her, so she doesn’t view me as threatening.”
“Threatening.” The way he said the word was ominous and not at all what she’d meant.
She was digging herself in deeper. Time to back out of the hole. “I don’t mean in a physical way. It has nothing to do with you personally, I’m sure. It’s kind of like some people being afraid of the dentist. It doesn’t matter how nice they are, sometimes it’s associated with something unpleasant, even though it’s necessary.”
“And you’re not associated with that.”
“Nope. I’m only there to examine. Not to perform any kind of procedure, and subconsciously Tanya knows it.”
“Guess I never thought of it like that.”
“I’m sure she’s grateful for what you’re doing.” She hesitated. “Would you mind if I tried talking to her about the surgery and what it means for her? Maybe what you’re seeing as apathy really is fear.”
“Fear. Hell. Not what I wanted.” He took a deep breath and blew it back out. “Okay. I want to be kept in the loop, though. So no secrets, even if she asks you not to tell me something. This is her life we’re talking about. I don’t want there to be any misunderstandings or hiding of information.”
That stung. “Of course. I realize she’s your patient, not mine. If she says something I think is important, I’ll let you know. You have my word.”
“Thank you. I appreciate that.”
He paused. “Could you give me a call as soon as you see her? I’ll schedule her in my afternoon rounds rather than morning, so I can check any areas of concern you may have. My number should be in your phone, since I called you.”
“Yes. I’ll add you to my contacts.” Did she really need to do that? It’s not like they were going to work together on a daily basis, but if she didn’t, she’d have to guess which one of the numbers was his. Sure, Kirsten. That’s the reason. She gave an internal eye roll.
“Sounds good.” With that he pushed away from the wall and walked down the hallway. It wasn’t quite a swagger, but his lithe body had a loose-limbed way of going that made him seem completely at ease with himself. And why wouldn’t he be? He had everything in the world going for him. Looks, skill, personality... She paused at that last one. Well, maybe he had a winning personality. If he chose to show that side of himself. She had a feeling he could be a formidable enemy, though, if provoked.
Well then, she would do her best not to provoke him on purpose, but if he got his feathers ruffled over nothing, she was certainly not going to apologize for the sake of mollifying him.
Kirsten was pretty strong-willed herself, so that could go both ways. Hopefully neither of them would see fit to test the other’s limits.
Because she was pretty sure neither she nor Snow would like the outcome, if that happened.