Flirting With Dr Off-Limits

CHAPTER ONE

KATHERINE PAPPAS HOPED with all her heart that she’d been abducted by aliens. And that an extraterrestrial scientific experiment had sucked her brain dry.

After all, she’d much rather believe that the blankness of her mind throughout the night had been due to interplanetary interference and not because she’d just plain forgotten everything she’d ever learned in medical school. Exactly three weeks after she’d graduated. With a new job as a first-year intern at the same well-respected hospital as her hotshot surgeon brother.

Katy sucked in a calming breath. You know this stuff. Just quit with the nerves and do the job you’ve been dreaming of doing forever. She moved into a corner so no one, hopefully, would notice her until she felt ready to head to the first patient’s room for morning rounds. After wiping her sweaty hands on her scrubs, she began to organize cards on each patient she’d be seeing that morning,

The shrill sound of her phone made her nearly jump out of her skin, and her stomach somehow both sank and knotted as she answered. The words that had been so wonderful to say just a week ago seemed to stick in her throat and choke her. Dr. Pappas.

Paging Dr. Katherine Pappas, world’s best surgical intern on her way to becoming world’s best family practice physician. Is she available?

Hearing the voice of her closest friend in med school, Rachel Egan, made Katy relax and even conjure a small grin. Dr. Pappas is available, except more likely she’s on her way to becoming the first intern booted out of Oceancrest Community Hospital only hours after arriving.

Uh-oh, Rachel said. Bad night on call?

The nurses are probably referring to me as Dr. Dolittle. As in do very little. She sighed. All night when they asked me questions, the right answer seemed to take a minute to percolate in my brain. I was sure I could do this, but now I’m worried.

You’re being ridiculous. Who had a straight four-point GPA in both undergrad and med school, like any human can do that? Who got the Alpha Omega Alpha award when we graduated? You’re brilliant, Katy, and you’re the only one who doesn’t realize it.

Then why doesn’t the perfect answer pop instantly into my ‘brilliant’ brain?

Because we’re nervous newbies, that’s why. We crossed that med-school finish line, and all of a sudden we have the word ‘Doctor’ in front of our names and have to answer to it. Who wouldn’t be scared? I know I am.

Really? You are? Rachel had always been the calm and confident student, the one who’d earned smiles and praise from professors and attending physicians for her cool and collected demeanor. In stark contrast to Katy’s often ruffled one.

Heck, yes, I am! I wish we’d ended up training at the same hospital. Maybe we’d both feel less freaked out if we had each other to lean on.

I know. But you’re happy to be back in your hometown, and I’m thrilled to be in San Diego. Plus I think it’s good that I moved in with Nick. He’s going through a hard time right now.

Still pretty depressed about his divorce, huh?

Actually, the divorce isn’t final yet. But, yeah, he’s very glum compared to his usual self. Katy didn’t know what had gone wrong in her brother’s marriage, but it was sad that, after just a year, it hadn’t worked out. She wished she could blame his wife, Meredith, except Katy had always liked her a lot—and, as the saying went, it took two to tango. Whatever their problems, both of them had probably contributed to them.

It’ll be good for him to have you there, I’m sure, though I hope nobody gossips about favoritism since you’re his sister.

Favoritism? Katy hadn’t even thought about that, and hopefully no one else would either.

So, tell me—

Katy’s hospital call system buzzed and her belly tightened. Gotta go, Rachel. She punched the button and swallowed hard before she tried to talk. Dr. Pappas.

Mrs. Patterson’s potassium is at three point zero, and I need to know what you want me to do.

Okay, so that was low. She should order a potassium IV—probably four mil. No, wait. Maybe she should give it orally? A nervous laugh bubbled up in her throat as she wondered how the nurse would react if she prescribed a banana to bring up the patient’s potassium.

She swallowed. You know, I’ll have to call you right back.

Are you serious? the nurse said in an annoyed and condescending tone. Fine. I’ll be waiting.

Okay. Katy’s face burned as she turned off her phone and wiped her hands, which were somehow sweaty and icy cold at the same time, on her scrubs again. She fumbled in her pocket for her Scut Monkey book. Rachel made fun of her that she infinitely preferred using it over trying to look things up on the internet. But her little book had helped her more than once, and she was determined to get this right.

Katy gnawed her lip and studied the little book. Based on the patient’s age, weight, and kidney function, it looked like she was right. Four ml potassium to drink would be the safest, most effective approach. Okay, good. As she tried to call the nurse back she dropped her phone on the hard floor, sending the plastic cover soaring across the room.

She groaned as she grabbed up the phone, relieved to see it was still working. Klutzy Katy. Why had she been plagued with some pitiful clumsiness gene, and why did it get worse when she was nervous? Graceful under fire she was not.

She called the nurses’ station, surprised that a different nurse answered to take the oral potassium order. How many staff worked in this hospital? The number must be mind-boggling.

Right, time to get to rounds!

The patient card on the top of her pile read Angela Roberts, Room 1073. She went to knock on the door, pausing to inhale a deep breath. This was it! Seeing her very first patient in person as a real doctor! Yes, she’d inherited all of them from the resident who’d already seen them, but still. The thought was nerve-racking but thrilling, too, and a big, spontaneous smile came on her face.

Hello, Mrs. Roberts. I’m Dr. Pappas, your intern. How are you feeling?

I’m all right, dear. Wishing they could figure out my spells so I can get the gall-bladder surgery over with.

We’re working hard to figure that out. She warmed her stethoscope against her palm before examining the woman. We’re in the process of ruling out things like seizures or transient ischemic attacks, which are little mini-strokes.

Strokes? I’m sure I would know if I’d had a stroke, dear.

TIAs are so tiny you might not notice. Katy smiled, her chest a little buoyant as she thought about this puzzle they were solving.

Well, Mrs. Roberts said, waving her hand, I trust Dr. Armstrong to know what he’s doing. Whatever he figures out is right, I’m sure. He’s a lovely man.

Katy felt her smile slip and she forced it back up, at the same time avoiding rolling her eyes. No doubt Dr. Armstrong is an excellent surgeon.

And excellent at other things, too. Like giving fake excuses for not being with someone—breaking hearts in the process—then turning around and doing exactly that with someone else. Like having inappropriate hospital affairs that got other people fired. Fooling everyone who used to think he was wonderful in every way.

The old embarrassment and anger filled her chest again when she thought of how many years she’d hero-worshipped the man who didn’t deserve it.

And handsome! So good looking, like a doctor on TV. I’m sure a young thing like you can hardly resist a handsome surgeon like Dr. Armstrong.

He’s my superior here at the hospital, Mrs. Roberts. Long ago, she’d agreed. She’d thought everything about him gorgeous—his football-player physique, his warm amber eyes, his thick dark hair. Funny and smart, with a teasing grin that was irresistible.

But no more. A man had to be beautiful on the inside as well as the outside to appeal to her. Not that she appealed to him anyway, which he’d made abundantly clear.

I’m feeling a little tired. The woman snuggled down into her bed as Katy continued her examination. Can you come back later?

I’m almost done for now, Mrs. Roberts. May I pull your sheet down a little? I just want to take a listen to your belly.

Katy glanced up when she didn’t respond and was startled to see that her head had lolled to one side of the pillow, her mouth slack and her eyes closed. Had she fallen asleep, just like that?

Mrs. Roberts? Katy’s heart sped up and she spoke louder, shaking the woman’s shoulder. Mrs. Roberts?

The monitor the patient was hooked up to began to screech and Katy looked at the screen. Her oxygen level was dangerously low, but there was no change in her heart rate. That couldn’t be right, could it? Quickly, she rubbed her knuckles against Mrs. Roberts’s sternum.

Nothing. No response. Katy put shaky fingers against the woman’s carotid artery. Her pulse was so slow and faint Katy knew this was beyond serious. Heart pounding in her ears now, she leaped up and smacked the red code button on the wall then ran back to the bedside.

Okay, Katy, you’ve got this, she said out loud to herself as her mind spun through the advanced cardiac life support protocol she’d finished during orientation just yesterday. It’s as easy as ABC, right? Airway, breathing, circulation.

Her own breath seriously short and choppy, she shoved the pillows from the bed to get Mrs. Roberts lying flat and lifted her chin to open her airway. The woman’s chest still barely moved.

Damn it! Katy knew she had to get a bag valve mask on her immediately, then noticed the EKG wires had been disconnected, probably when she’d gone to the bathroom. Stay calm here, you know what to do, she reminded herself, sucking in a deep breath to keep from fainting along with Mrs. Roberts.

Fumbling with the equipment, she managed to stay focused as two nurses ran into the room. We need to get her back on the monitor. I need to bag her. Can you get me a bag valve mask? And another IV. She could practically smell their alarm and forced down her own. Do not panic, Katy. This woman’s life could depend on you.

The loud sound of a cart rumbling down the hall and into the room made Katy sag in relief. The cavalry had arrived.

Give me the patient’s history, a guy said, as he moved from the crash cart to the head of the bed, quickly getting a bag on Mrs. Roberts to provide the oxygen she desperately needed. He was probably from the ICU team, but Katy wasn’t about to waste time asking questions.

Patient is eighty-two, with cholecystitis, her surgery is on hold until she’s medically cleared by Cardiology. Katy gulped as she stared at the still-unresponsive Mrs. Roberts and forged on. She was talking to me and just kind of collapsed. She has fainting spells and we’re trying to figure out why.

She stared at the monitor as the ICU guy attached the last EKG lead. Involuntarily, Katy let out a little stressed cry when she saw the heart rate was alarmingly slow at only thirty-five beats per minute. Sinus bradycardia, she said. Atropine point five milligrams and we need pads for transcutaneous pacing.

Had all that really come right out of her mouth? No time to give herself a pat on the back as the ICU guy barked to the nurse, Get Cardiology on the line. You, Doctor, get her paced as I intubate.

Katy blinked and a touch of panic welled in her chest that she resolutely tamped down. He’d just called her Doctor. She was part of this team, which would hopefully save this woman’s life. Concentrating intently on getting the pads placed amid a flurry of activity by the nurses, she didn’t even notice the tall, broad form that came to stand next to her.

I’ll take over now, a familiar deep voice said. Good job, Dr. Pappas.

Alec Armstrong brushed past her as she moved to one side, allowing him to deliver the electricity to Mrs. Roberts’s heart. Katy stood there, stunned, her hands now shaking like a tambourine. Beyond glad it wasn’t her trying to get the pacing finished and giving orders to the nurses.

Which wasn’t the right attitude, she scolded herself, since she wanted to be a doctor—was a doctor. But, dang it, how many newbies had to deal with their very first patient coding on them?

She watched Alec work, and couldn’t help but notice how different he was, and yet somehow the same as when she’d known him years ago. As a boy and teen, he’d practically lived in their house as Nick’s best friend. While he’d been as fun and adventurous as anybody she’d known, he’d always become calm and focused when there had been an important task at hand, his eyes intent, just like they were now. His hands moved swiftly and efficiently, as they had during all the crazy science experiments they’d done together. All the times he and Nick had worked on projects with her, teasing about her endless quest to learn new things and solve weird problems.

Her hero-worship of Alec was over. But the moment that thought came into her head, as she watched him work, she knew it wasn’t true. How could she not admire how capably he dealt with a critical situation? But she didn’t have to like him as a person to admire how good he was as a doctor and doubtless as a surgeon.

In a short time the frantic flurry of activity was over and the ICU guy began to wheel Mrs. Roberts from the room. As he left, he said over his shoulder, I’ll dictate my procedure note. You got the code note?

I’ve got it, Katy and Alec said at the same time. Their eyes met, his the amused, warm amber she remembered so well, and she felt her face flush. How could she have thought the guy was talking to her when attending surgeon extraordinaire Alec Armstrong had taken over?

So, Katy-Did. His lips curved as he folded his arms across his chest. What the hell did you do to my patient to make her code like that?

Please call me Katherine or Katy. I’m not a kid anymore, she said with dignity. Which he should know after her ill-advised behavior at her brother James’s wedding five years ago. Her cheeks burned hotter at the memory.

Fine, Dr. Katherine Pappas. His smile broadened, showing his white teeth. How did you almost kill her?

I didn’t almost kill her, and you know it. I didn’t do anything. Katy’s voice rose to practically a squeak on the last word and she cleared her throat, forcing herself to sound somewhat professional. "I was talking with her and giving her an exam, and she just fainted. I think she probably has sick sinus syndrome, which is