Merry Christmas to you, Officer Greca
- 1 -
Dr. Sarah Bonheur headed for the hospital cafeteria, desperate for some rational company. Normally the little blonde loved her work in the Emergency Department of the Fossil Creek Community Hospital. Fossil Creek, named for the creek along whose banks the town was originally sited, was located at the base of the mountains south of Denver. It had grown from an old mining supply town and now boasted a population of about 120,000. That was big enough to support a full-service 200 bed hospital, but small enough not to be as impersonal as a larger city. But though she was on only her second day of precepting a pair of 3rd year medical students in their Emergency Medicine rotation at the hospital, she already was contemplating homicide. Medical education was like an apprenticeship. Students were given more autonomy as they progressed and learned more. By the third year of medical school students should be capable of getting a history, doing an exam, and formulating an assessment and a plan about how to proceed. They couldn't be expected to get it all right, which is why attending supervision was so important, but she shouldn't have to baby-sit them. With this pair, however, she was afraid to let them loose on patients by themselves. She almost wondered whether Matt was some sort of plant, so tenuous was his grasp of medicine. Meanwhile Jeff knew it all, but had no common sense - he seemed unable to differentiate between likely and bizarrely exotic diagnoses. Her quirky imagination threw up an image - They're like xenoliths: the other med students who are progressing normally are the magma, and these two are the foreign chunks swept along with the eruption of the magma from 2nd year to 3rd year - and unfortunately, landing in my ED! And they keep calling it the 'Emergency Room' rather than 'Emergency Department,' she ended her rumination with the pet peeve of ED workers.
As she entered the cafeteria, she saw a fellow attending, Kees van Eyck, and her favorite ED charge nurse, Nancy Cassat. She aimed for their table, with the students trailing behind like a small flock of ducklings.
". . .. I think it was a circle, not a triangle," Kees said as Sarah and the students walked up.
"Why are you talking about geometry?" Sarah wondered.
"No, we're just talking about that scandal up on the Peds floor, with Dr. Escher and the three nurses," Nancy told her.
"If you can surface from your speculations for a moment, let me introduce my students. You've already met Nancy," Sarah said, And boy, is she not impressed so far, she thought, then continued aloud, "And this is Dr. van Eyck. You'll work with him some too."
"Hi, I'm Kees," he smiled at the two young men, who looked at him somewhat askance. Sarah hid a smile. Kees was a flaming queen with a penchant for frou-frou touches like wearing pink scrubs, but she'd trust him with her life.
"Case?" Matt asked with what Sarah was beginning to recognize as his characteristically furrowed brow.
"Spelled 'K-e-e-s.' It's Dutch. Kees is the nickname for 'Cornelius'," he explained.
"And this is Matt Corot and Jeff Giacometti," she introduced.
Sarah sat and pulled out her sandwich and apple, then looked at Nancy's plate. Her nose wrinkled. "How can you stand eating knockwurst? You know what they make it from!"
"Well, at least I'm leading an adventurous life. You have the same boring peanut butter and jelly every day," Nancy pointed out.
- 2 -
"It sucks having to work Christmas Eve and Christmas, and swing shift means we miss the evenings too," Ed Hogarth grumbled to his partner as he looked out of the patrol car at the snowy scene. They'd had a few snowstorms earlier in December, leaving piles of snow on the ground. It had warmed up some in the last few days so that by now the streets were messy with slush and icicles hung from the eaves of buildings.
"Yeah," Lee agreed. "But at least we're not standing out there," she added as they passed by a Salvation Army band huddled on the street corner, hoping for some last Christmas donations. "Playing a tambourine or trumpet in this weather must be terrible." Lee noticed a dispirited horse pulling a carriage, little bells on the harness jingling. "And I bet that poor horse isn't too happy either."
The car mike crackled and dispatch stated, "We have a report of a stranded motorist at 1st and Elm." Lee reached for the mike. "Dispatch, this is car 54, we're only a block from there, so we'll take the call." As they rolled up behind the car and stopped Lee could see that the left rear tire was flat. The occupant seemed to be an elderly woman. She still approached cautiously, but relaxed when she saw the woman was alone. "Do you need some help, Ma'am?" she asked.
"Oh, my, yes. I felt the car thumping so I pulled over and stopped since I didn't know what was wrong," she quavered.
"Well, it looks like a flat tire. We can help you with that, if you have a spare tire," Lee replied. "Can you open your trunk for me?" She looked in the trunk after the woman hit the release and found a spare which seemed to be in good shape, and even a jack and tire iron. She returned to the patrol car and said, "Just a flat."
"It's your turn," Ed pointed out. "I changed the last one."
She grumbled, "Well, this should count for two - you got to change the tire on a nice, sunny day."
"Those are the breaks, Greca," Ed smirked.
She gave him a fierce glare but went to the woman's car and prepared to change the tire. She put the tire iron on a lug nut and pushed. No response. They must have used a pneumatic torque wrench to put these on, she thought as she strained against the stubborn nut. It finally gave, almost pitching her to the ground as it made a sudden revolution. With similar struggles the other lug nuts gave up, and she lifted the flat tire off the wheel. As she turned to take it to the woman's trunk, a car drove down the street, kicking up a spray of dirty slush. Given her position, even as nimble as she was, there was no way to avoid it and she got an icy drenching across her right side. "Son-of-a-. . ..." she yelped.
Once the tire was changed and they were on their way again, Ed snickered. "Xena, Warrior Tire-buster to the rescue."
She scowled. "I don't know why you always have to call me "Xena, Warrior-something."
"Oh, I don't know - maybe because you're like a Xena reincarnation: six feet tall, black hair, indigo eyes, with a grumpy kick-ass attitude . . .." he listed.
- 3 -
Lee headed up the highway which climbed through the canyon carved by Fossil Creek. The city limit was a mile further up and she intended to check for trouble along the road then turn around. The snowplows had been by and both sides of the road had snowbanks. The highway was largely dry but at intervals was damp with water which had melted from the snow. The road wound with the creek and she noted that areas which were more shaded had ice starting to form as the air cooled in the late afternoon. She reached the town limit and saw a Sheriff's Patrol car already in the turn around marking the boundary between the city and the unincorporated county. She turned left and pulled up beside the sheriff's deputy in order to chat for a moment. Ed snorted and muttered, "County boy! Should leave the policing to us."
"Now, Ed," she chided. "That's xenophobia."
"Is that one of your fancy soc-i-ol-ogic words for saying I think we're better than they are?" he drawled innocently.
She merely shook her head and rolled her window down. Just then they heard the sound of a motorcycle engine echoing off the canyon walls and a bike passed them headed up the highway. Though he was going the speed limit, Lee frowned - if he hit a patch of ice he'd be in trouble. The deputy obviously thought the same thing, as he said, "I'd better stop him and get him to slow down." Before the deputy could move, however, the bike did slip on some ice, throwing the rider off. He rolled across the asphalt, fetching up against the snowbank lining the outer edge of the highway.
"Call for an ambulance," Lee instructed Ed, then slipped out of the car and ran to the motorcyclist, joined by the sheriff's deputy. "Don't try to move," she told the helmeted biker, who was trying to sit up. "An ambulance is on the way and you need to lie still until they get here." The ambulance arrived shortly and the paramedics efficiently bundled him up for transport, removing his helmet, placing him in a rigid neck collar and then strapping him to a backboard. "We have to go back down into the town anyway, so we could check his status at the hospital and let you know," Lee offered to the deputy.
"I'd appreciate that," he replied, looking over the accident scene glumly. "It'll take me a while to finish up with the work here."
- 4 -
Once they reached the emergency entrance to Fossil Creek Community Hospital they parked and then walked in. Lee looked around the waiting room automatically scanning for possible problems or anyone she knew the police were looking for, as Ed explained to the clerk what they wanted. She didn't see anyone of interest to them but was impressed by how full the room seemed to be. A man whose dreadlocks made him look like a Rastafarian sat next to a young mother holding a weeping toddler; an elderly man stared silently at the floor while next to him a young man talked into his cell phone as he cradled his other arm to his chest; a derelict appearing man coughed without covering his mouth, causing the people around him to surreptitiously vacate his immediate vicinity.
Ed called for her attention, "She says we can go back." She followed him into the emergency department, which consisted of a number of cubicles arranged around a central nurses' station. The paramedics stood by the stretcher with the motorcycle accident victim, talking with a young blonde woman in a white coat and scrubs with a stethoscope slung around her neck. Lee squinted at her ID badge - 'Dr. Bonheur' seems to be her name; and she's cute, she thought. As one paramedic continued reporting to the doctor the other noticed Lee and Ed and waved them over.
"Did anyone witness the accident?" Sarah asked the paramedics. They motioned to the cops who now stood nearby. Sarah turned to them and after peering at their nameplates she queried, "Well, Officers Greca and Hogarth?"
"It was a wipeout," Lee offered. "He was traveling too fast for road conditions and couldn't control his motorcycle when he hit a patch of ice. He flew off it and rolled several times. Luckily he hit a snowbank that stopped him. I think that's when he broke his arm."
Sarah raised her eyebrow at the cop's confident diagnosis, but had to agree that his arm probably was broken given a bit of an unnatural angle to the end of it, visible despite the air cast the paramedics had placed. "Then he might have been better off with a few more rolls and a less abrupt stop," Sarah challenged.
"Well, not really, since he was on the road above Fossil Creek. He would have rolled a couple hundred feet down if that snowbank hadn't been there," Lee returned with a sparkle in her blue eyes.
"Point taken," green eyes sparkled back.
Sarah examined the patient, finding that he complained of numbness in his first two fingers as well as pain in the arm. He also complained loudly about the rigid backboard and the uncomfortable hard cervical collar. She did a quick survey but found no other obvious injuries, and sent him off to get an x-ray of the arm. Given the mechanism of injury she ordered cervical spine films also, but didn't really expect to find a problem. She did anticipate a fracture of the arm and had already asked the nurse assisting her to page Dr. Morisot, the hand surgeon on call.
She turned back to the police officers and noticed then that the tall woman seemed to be wet just on her right side and was plucking at the clinging leg of her dark blue uniform when she thought no one was looking. Well, that's unique, she thought. "Do we need to hold him for you?" she asked. Greca hastily let loose of her pants leg and replied, "Ahh, no, he got a ticket for his driving but he just has to appear in court rather than being booked into the jail."
"Ok," Sarah said. "Thanks for the business." She turned back to the nurses' station but watched over her shoulder as Greca went out, admiring the cop's athletic build. She noticed she carried her gun on the left. Must be a lefty. The patient returned from x-ray and Sarah removed the collar after finding no fractures in his neck. She put the x-ray of his arm and wrist up on the x-ray viewbox and saw as expected that he had a fracture of both the radius and ulna. "What could be causing his hand numbness?" she asked the students.
Matt looked blank but Jeff launched into speech, "It could be a stroke or a brain tumor or an arteriovenous malformation . . .."
Sarah stopped him. "We like to refer to 'Occam's razor' in medicine - that is, a single process causing all the symptoms is more likely than multiple co-existing diagnoses causing symptoms. You should be striving for unity as you formulate your diagnosis." She pointed to the x-ray of his arm. "So, in this case, it's probably related to his injuries from the accident. It's not likely he has another central nervous system cause of his findings. In the accident he fractured the heads of the bones helping to form the carpal tunnel. And what runs in the carpal tunnel?"
"Umm, the ulnar artery?" hazarded Matt.
"No," she sighed. "The median nerve. So probably his median nerve was also damaged when the bones were fractured, and that could give him numbness in exactly this distribution." As she finished her explanation a brunette about her height walked up. "Hi, Jane, these are my 3rd year med students, Matt and Jeff. This is Dr. Jane Morisot," she made introductions.
She reported on her findings and the hand surgeon nodded. "It certainly sounds like median nerve damage is probable - if so I'll want to take him directly to surgery."
Sarah nodded in turn and motioned to one of the nurses. "Alex, would you assist Dr. Morisot with anything she needs?"
"You got it, doc."
- 5 -
Lee and Ed got a call from dispatch asking if they could help transport a suspect from the scene of a brawl, while the officers who originally responded transported the other party. They pulled up and the officers handed over a man with a scraggly beard and worn clothing. They put him in the back of the cruiser and started for the jail. Soon they heard scratching sounds from the back seat. Ed looked back and asked, "What's wrong?"
"My skin's all itchy," their passenger replied. "I've got this rash that's killing me."
Ed sighed. "We need to get him cleared - the jail won't be happy if he has something contagious."
Lee gave a resigned nod and turned down a street that would take them to the hospital. If I get bugs from him! she thought as her skin started to crawl.
They explained the situation to the triage nurse, who quickly put them in a cubicle with the suspect. "Can't you take these things off? I can't get a good scratch going," he complained while raising his handcuffed wrists."
Dr. Bonheur walked into the cubicle with the two students just then. "It's probably a bad idea to scratch it anyway," she pointed out. She looked at his visible skin, then raised his shirt and pants legs to see more of the rash. Classic psoriasis, she thought upon seeing the red plaques with silvery scale on them. Pretty extensive - no wonder he's itchy. Aloud she said to the students, "This is pretty classic - do you recognize what the rash is?"
"Well, it could be leprosy," Jeff enthused.
Leprosy? she thought incredulously, Where does this kid get these ideas?
The patient and officers alike looked worried at this suggestion, so Sarah quickly corrected him, "No, Jeff. This is the classic appearance of psoriasis." To the patient she said, "They should be able to give you a cream at the jail to help the itch," and added to the officers, "This isn't contagious - you don't need to worry about taking him in."
Oh, good, Lee thought, feeling her sympathetically itchy skin settle down now that she knew no bugs were involved.
- 6 -
Sarah turned back to the desk and asked Mark, the triage nurse, "Ok, what's next?"
"You've got two ready to be seen - a homeless guy with a cough, temp of 102o and an O2 sat on room air of 85%, and a woman complaining of chest pain. We already got an EKG on her for you," Mark reported.
"Ok; Linda - would you hook the first one up to oxygen to try to get his saturation up to at least 90%, get a chest film, and get the standard bloods," she ordered, "while I look at the woman with chest pain." She looked at the EKG on the way to the woman's cubicle. Uh-oh. This shows sinus tach at 120 with a right ventricular strain pattern - could be a PE. She stepped into the cubicle with the young woman. "Hi, Ms. Kahlo, I'm Dr. Bonheur and these are two medical students working with me. Do you mind if they observe?"
"No, that's fine," the woman replied.
"Tell me about your chest pain," Sarah invited.
"It just suddenly started hurting today right here," she pointed to her left side. "Every breath I take it gives me a sharp pain, and I feel short of breath. I just got back from a trip to Europe - do you suppose I picked something up there?"
"We'll check for the possibility of pneumonia with a chest x-ray," Sarah assured her, "as well as looking for other possible causes of chest pain." She established there had been no trauma the patient recalled, then asked, "Are you on any medications?"
"Well, I take the birth control pill but otherwise no - I'm pretty healthy."
"You mentioned a trip to Europe - how long were the flights?" Sarah asked.
"We got a direct flight from Denver to Rome, and the same on the return, which took about 11 hours," the patient responded.
"Ms. Kahlo, the thing I'm most worried about is a pulmonary embolism," Sarah told her. "That happens when a clot breaks off from somewhere in the venous system, travels to the right side of the heart, and then gets pumped out into the lungs, where it lodges. It can give you chest pain and the sorts of changes I'm seeing on your EKG. Your heartrate is fast and it looks like the right side of the heart is working harder than usual."
"A clot?" Ms. Kahlo was bewildered. "How would I get a clot?"
"The estrogen in the birth control pill makes your blood more likely to clot, and then a prolonged period of immobility, like your lengthy flights, can start the process of a clot forming in your calf," Sarah explained. "She needs a V/Q scan as well as a chest film," she told Matt and Jeff. The familiar blank look spread across Matt's face. "Do you know how they do one, and what it tells us?" she asked.
"The patient inhales radioactive xenon-133," said Jeff, "and a detector can identify where in the lungs the air goes. Then they inject radioactive technetium into the veins to see where the blood flow goes in the lung. If there is a mismatch it suggests a blockage in the pulmonary arterial system."
"Right!" replied Sarah. Seeing Matt's puzzled expression she clarified further, "The pulmonary embolism cuts off blood flow to the vessels beyond that point and we see a V/Q mismatch because no blood is flowing there but air can still reach that part of the lung when the patient inhales." To the patient, looking alarmed at the word 'radioactive,' she added, "Don't worry; it's a very low level of radiation, just enough to show up on the detector, but not enough to harm you."
I need to get away from these guys for a while. What would be some simple tasks to set them? Sarah wondered. Ahh - "You can go with her to radiology to watch how they do it," she suggested to Jeff. "Matt, you come with me." They went to the next cubicle where the nurse was finishing drawing blood on the derelict appearing man with the cough. His x-ray was up on the viewbox and showed a clear right lower lobe infiltrate. "What do you see on the x-ray, Matt?" she asked.
This is not a subtle finding! she thought in frustration. "Okaay. See this area that's solid white?" she gestured to the x-ray.
"Does anything else in the lungs look that way?" she prodded.
"That's an infiltrate, probably due to pneumonia. Have him try to give you a sputum sample," she instructed Matt.
"How do I do that?" he asked.
She looked at Matt and by a heroic effort held back a snarky reply. Is this willful ignorance, she wondered, or is the boy really this dumb? "You give him a sputum cup, he expectorates in it, and it gets sent to the lab," she spelled out for him. She reviewed her statement for a moment then added, "You do know that 'expectorate' means he coughs sputum out, right? And once you have it, make sure you put a label - one of his, of course - on the cup, then hand it to the nurse. She'll take it from there." She turned to leave and caught a sympathetic glance from Linda; they shared a mutual eye-roll at the denseness of the medical student.
"Don't worry," Linda advised, "I'll make sure he does it correctly."
- 7 -
Now that she had the students temporarily occupied, she went to the ED nurses' lounge to get a cup of coffee. Nancy and Kees were there already, chatting as they did paperwork. "Are you still on the same scandal?" she asked as she poured herself a cup and added a large dollop of cream and a heaping spoon of sugar.
"No, we're talking about the cover-up of that affair at the old monastery site that's up for development. Don't tell me that bunch of licentious politicians and their secretaries were there for just a 'planning meeting,'" as he made quote marks in the air. "The report in the newspaper was a total whitewash if you ask me."
"You may be right," Nancy remarked reflectively. "The project certainly seems to have been in limbo since then."
Sarah shook her head - another of Kees' penchants was looking for sex-based conspiracies everywhere; but she had to admit conversation with him was amusing, if a little one-sided. She sighed again as she sat and rubbed her temples - working with Matt and Jeff on this everlasting shift was slowly giving her a killer headache. "I'm going to strangle them before the evening is out," she swore to Nancy and Kees.
"Now Sarah - go to your happy place," Nancy advised.
"What? Happy place? Are you nuts?"
Nancy elaborated in a sing-song, "I have a happy place to go to in my head, where I'm the viceroy of a land of magical creatures like unicorns."
"Ok, you are nuts." Sarah considered the idea though - Hmm. I could be a sixteenth century witchfinder and burn them at the stake. Since she was essentially a non-violent person she visualized burning them in effigy rather than alive, but it was still satisfying. "You're nuts, but that does help," she confided to Nancy.
- 8 -
"Car 54, where are you? Can you respond to assist another unit on a possible robbery?" dispatch enquired. Ed told dispatch they could, and they were directed to a jewelry store on the south side of town. They parked beside another cruiser and conferred with its crew, agreeing that Lee and Ed would go to the back of the store while the first officers watched the front door. As they made their way back, Lee tried to look into the store through the windows on the side, but they were too opaque for her to see through. They could see the door was ajar as they rounded the corner and saw a man just exiting with a bag in his hand.
"Police! Drop the bag and put your hands up!" Lee yelled. Instead, the man bolted across the open area behind the store, with Lee in pursuit. Too late she remembered that the vacant lot resembled a bombed-out no-man's land, with holes and junk scattered across it. She found herself hopping like a kangaroo trying to avoid the pitfalls. Despite her efforts her left foot went into a hole and a splash of icy water soaked that leg to the knee. Fortunately, the robber had also forgotten about the state of the lot, and went head over heels after catching his foot by happenstance on a piece of junk hidden beneath the snow. Lee pounded up to him with Ed arriving a moment later. Once they had the man up he complained of knee pain, and limped conspicuously on the way back to the cruiser. "Alright," Lee told him. "We'll stop by the hospital on the way to the jail, and they can look at your knee."
They parked by the ambulance entrance and Ed went in while Lee waited in the car. He came back with a nurse pushing a wheelchair and they returned to the ED with the suspect in it. The nurse assessed him and told them, "Let's take him over to x-ray." After the trip to radiology they settled him on a gurney in a cubicle and stood by it, Lee's soaked left shoe occasionally squeaking as she shifted her weight.
Sarah heard the squeaking sound as she stood by the nurses' station desk writing a note on the man with pneumonia and thought vaguely, That's onomatopoeia. 'Squeak' sounds just like the sound it describes. Her brow furrowed and she looked up. "What's squeaking?"
"Oh, that's probably the cop in 8," Nancy replied.
"Cop in 8?"
"Yeah - they brought in a guy who twisted his knee trying to run from them. We already got an x-ray of his knee per protocol."
"Ahh," Sarah said, "let's see it." She saw no fracture and went into the cubicle to look at the patient. "Officer Greca - more business for us?" Sarah enquired.
"Yeah - he complained of knee pain after a fall so we wanted to get it checked before taking him to the jail," Lee responded.
Sarah nodded, then examined the manacled suspect's knee. She looked up and caught Officer Greca's eye. "It's just a sprain - we'll put him in a knee immobilizer and you can take him away."
After strapping on the immobilizer the nurse helped wheel him out, with Lee and Ed flanking him carefully. Sarah's eyes followed them. Now her left leg is soaking, too. Sarah mentally scratched her head as she watched the cop squelch out the door.
- 9 -
"We've got a probable appy in 6," Mark told Sarah, handing her the chart.
After reviewing the nurse's intake, Sarah walked into the cubicle. "Hi, Mr. Rossetti. I'm Dr. Bonheur, and these are two medical students working with me. Do you mind if they observe?"
"No, that's ok," he said through gritted teeth.
"Tell me how this started," she invited.
"Well," he grunted, "I felt queasy and then I started vomiting, and it started hurting all around here," he pointed to his navel. "Then later it started hurting more low on the right side here. It really hurt every bump we hit driving over here."
She palpated his abdomen, eliciting a gasp when she reached his right lower quadrant, and she noted involuntary guarding. "I'm sorry," she apologized, "I know this hurts, but we have to examine you like this in order to figure out exactly what's wrong with you. Does it hurt just when I press in, or when I release the pressure too?"
He gave a yelp as she removed her hand, and said, "They both hurt like hell!"
She motioned Jeff and Matt over and told them, "He has right lower quadrant pain with involuntary guarding and rebound tenderness. What would be a reasonable differential diagnosis?"
Matt looked blank then asked, "What's involuntary guarding and rebound mean?"
Sarah closed her eyes momentarily at Matt's lack of basic medical knowledge but replied, "Involuntary guarding means that the muscles underlying the area I press on are tight without conscious effort on the patient's part; you can also have voluntary guarding, when the patient consciously tightens up in anticipation of pain. Rebound tenderness means that the patient has pain with release of pressure. What causes that?"
Matt still looked blank but Jeff chimed in, "It means the peritoneum is inflamed."
Mr. Rossetti had been trying to follow the conversation and Sarah interpreted for him, "The peritoneum is the lining on the inside surface of your abdominal wall. When it gets inflamed it hurts, which is why you're in so much pain. When you hit those bumps it jiggled the lining, just like when I suddenly took pressure off it, and that's why it hurt more." She then asked the students again, "And what would the differential be?"
"Well, it could be Crohn's disease, or mesenteric adenitis, or a ruptured ovarian cyst . . .." Jeff burbled.
She pinned the hapless student with a green glare. "Yesss, Jeff, in a woman this presentation could be from a ruptured ovarian cyst. What are the odds this guy has an ovary, though? The first thing you should consider in a male is that this could be appendicitis. How should he be worked up further?"
"A CBC to see if he has an elevated white count, and an abdominal CT scan with rectal contrast."
The patient looked hopefully at Sarah, expecting her to correct the student again, and his face fell when she said, "exactly."
"You mean he's right?" he protested. "I have to get contrast that way?"
"Yes, sir, I'm afraid we do have to do the CT with rectal contrast - it helps pinpoint whether the appendix is inflamed, and that will let the surgeon know whether you actually need an appendectomy."
- 10 -
"What's next Mark?" Sarah asked the triage nurse.
"Mary's been looking at a guy in 10 and wants your opinion," Mark gestured to the physician's assistant standing at the desk.
"Ok, Mary, what's the story on this one?" she asked as she picked up the chart.
"Well, after a liberal internal application of brandy, he apparently mouthed off to a debutante-type and got punched by her escort. He has a broken nose, I think, and a lac to the cheek from the escort's ring."
She stepped into the cubicle, noting without surprise by now that Officer Greca was standing there.
She's looking less thrilled to see me all the time, Lee thought. "Ahh, hi," she waggled her fingers at Dr. Bonheur. "He's not under arrest but I thought I better stay here because he's a little excitable."
Sarah nodded and said to the patient, "Is it alright if she stays while we talk? You have a right to privacy if you want, but then you have to behave."
"I don't care if she's here . . .. I just said 'bodacious tatas' as a compliment to her, and he hauls off and slugs me!" he complained.
Sarah raised her eyebrow. "Well, I wouldn't consider that a compliment if you said it to me, so I can see that he might not appreciate your saying that to his girlfriend," she pointed out. He looked befuddled by her comment so she shook her head and proceeded to examine him. She stepped out of the cubicle and told Mary, "I agree with your assessment. Go ahead and stitch him up and splint his nose, and we can give him an ENT referral for follow-up."
"Alright," Mary agreed.
- 11 -
"Now, this one is a guy from the homeless shelter. He's having diarrhea and they say he can't stay there until he's better," Mark reported next.
Sarah shook her head. She understood the shelter's point of view, but now that meant the ED needed to keep him around all night, since they couldn't in good conscience send him out into the cold with nowhere to go. She went into the cubicle with her mini-flock of maddening students and talked with him, then examined him. Once they returned to the nurses' station she asked the students, "What do you think is likely causing his problem?"
"It could be infection with an amoeba," Jeff suggested.
She rubbed her temples again. "Yesss, Jeff, you can get diarrhea from amebic colitis - but how likely is it that this guy who lives in a homeless shelter has traveled somewhere where he can pick up a tropical parasite? It's not like we're in the Amazon here." She added, "Jeff, there's a truism in medicine that I think you need to pay more attention to: 'If you hear hoof beats, look for a horse not a zebra.'"
He simply looked confused.
She sighed and continued, "What that means is that common things are common and you're much more likely to see them than the unusual things. So we call those rare, exotic diagnoses zebras - and you've been giving me zebras rather than horses all evening! And for you I think we could extend the metaphor - you've tossed in a few wombats as well." She continued, "From the history it's most likely viral - most episodes of diarrhea probably are and we don't routinely test for viral pathogens because there aren't any simple tests available and because they cause self-limited illness. But we should send a stool culture in case he's picked up one of the bacterial pathogens. Which ones do we test for?"
Matt looked blank yet again but Jeff contributed, "Shigella, Salmonella, Campylobacter and E. coli."
Sarah nodded and suggested to the students, "Why don't you write this up and fill out the lab sheets?" Sarah saw Nancy beckoning her furtively from the door of the nurses' lounge and she sidled over, careful not to attract the attention of the medical students. She went in and said, "What's up, Nancy?"
"I can't help but notice your expression get more sour after every time you talk to those students. Would ice cream help?"
"Ice cream would play hell with my girlish figure, but if I have to talk to Matt-and-Jeff the wonder-students right now, I might be the one led away in manacles, after I kill them," she vented to Nancy.
"Aw, poor baby. And you're such a hippo! I bet you could eat a gallon of ice cream and not gain an ounce. We could gossip while we eat the ice cream," Nancy inveigled.
Sarah brightened. "Any juicy tidbits making the rounds?"
"Well, enquiring minds want to know - who's the luscious butch cop who's been coming in all evening? And have you asked her out yet?" Nancy smirked mischievously.
"Nancy!" Sarah sputtered. "Anyway, I don't even know that she's a lesbian." And my gaydar may say she is, but I've been wrong before, she added to herself.
"Puh-lease! I bet you anything she is."
- 12 -
They scanned both sides of the street as they drove along it, alert for anything out of place. "Look there," Ed pointed. "I think that's a guy on the porch of the Montessori school."
Lee glanced over and nodded. "Yeah, I think you're right."
They pulled over and got out. The man was lying down but managed to sit up as they approached. "Waassh you wann?" he slurred. A noxious cloud of alcohol seemed to hover over him.
"Ok, buddy, let's get you up - can't leave you here to freeze to death. How's a nice warm jail cell sound?" Ed heaved and the drunk staggered to his feet.
He was able to make it to the car with help and didn't seem to be injured, so Lee thought with relief, Oh, good, at least here's one we don't have to take to the Emergency Room. They headed for the jail after settling him in the back seat, where he mumbled quietly to himself. As they passed the hospital Lee looked over wistfully, wishing she and the cute doc had hit it off better that evening.
Two blocks from the jail their passenger suddenly roused. "El Diablo! He is here!" the man shrieked as he edged to one side of the seat.
Lee and Ed looked at each other then she put on the left turn signal and made a U-turn. "Back to the hospital," she groaned. "We can't take a hallucinating guy to the jail."
"No," Ed agreed. "They have no sense of humor about guys seeing pink elephants in the corner."
They pulled up at the ambulance entrance and Ed went in to get a nurse, the actions old hat by now. They got settled in a cubicle with the drunk and before long Dr. Bonheur came in.
"Officers," she sighed.
"Ahh, we were going to take him to the jail," Lee rushed to explain, "but then he started hallucinating . . .."
Sarah nodded as she looked at the patient. He appeared to be intoxicated and old alcohol fumes wafted off him; it might all just be alcoholic hallucinosis, one of the stages of withdrawal, but it would be smart to be sure nothing else was going on. I could sic the wonder-students on him, she realized. They really can't do any harm - or at least much harm, she amended to herself - while we're waiting on the labs to be sure he didn't ingest anything else. She found the thought cheering and set her plan in motion. "Ok. We'll look him over. If you need to get back out on patrol our security can stand by," she told the police officers. She then told the students to get as much of a history from him as they could and to perform an exam. She returned to the nurses' station and caught up on her paperwork while waiting for the labs.
"Uh-oh," said Nancy when she checked the computer to see whether anything was back yet, "he's got oxalic acid crystals in his urine."
They shared a glance. "Why don't you see whether the pharmacy has any fomepizole in stock, so we're ready if the rest of his labs look like he needs it?" suggested Sarah. The bloodwork took a little longer, but soon she had it all, and knew the guy was in serious trouble. Metabolic acidosis with a high anion gap and an osmolar gap. He's been drinking anti-freeze. And he's starting to have renal damage already - probably he's been drinking it since yesterday. "Yep," she said to Nancy," he needs the fomepizole. Give him 15 mg/kg IV please."
The students were back at the desk by now listening. She showed them the labs and then asked, "So, why does he have oxalic acid in his urine?"
"It's what makes rhubarb leaves poisonous, so you could get a high oxalic acid level by eating them," Jeff responded.
"Yesss," she said slowly, "oxalic acid is what makes rhubarb leaves poisonous - but since it's the frigging end of December, Jeff, how likely do you think it is that he ate rhubarb leaves today?"
Matt had been silent, and chose this moment to ask what an osmolar gap was.
With iron self control Sarah merely said, "Look it up in your 'Washington Manual'," referring to the pocket guide that was the medical student's bible, rather than suggesting that he give up on the thought of becoming a doctor.
She returned to the question of the oxalic acid and explained, "It is an end metabolite in the pathway from ethylene glycol, which is found in anti-freeze. Lots of really down-and-out alcoholics will drink other alcohols if they can't get their hands on ethanol. They get inebriated from the ethylene glycol, but as the body metabolizes it several very toxic intermediates form. If the ethylene glycol level is high enough, enough toxins form to cause renal failure and death. So, we're going to give him fomepizole to halt the metabolism into those toxic intermediates."
"Don't we want to check an ethylene glycol level," Jeff queried, "to be sure he needs it?"
"It would be optimum to have a level to guide therapy," Sarah agreed. "Unfortunately, it takes about six hours to get a level back. We can't wait that long because his kidneys are being trashed as we speak by the metabolites of the ethylene glycol. We're already seeing a bump in his creatinine. So we need to treat without a level."
- 13 -
"Go ahead, dispatch," Ed said.
"We have a call from an elderly woman worried about her kitten," dispatch advised them.
"Ok," Ed said as he took down the details. He glanced at Lee and said, "Well, at least we shouldn't have to drop by the hospital because of this call, unless it turns out she's hallucinating kittens."
Lee laughed then concentrated on finding the right address. It was in the older part of town, where there were a number of stone and brick buildings dating to Fossil Creek's early days. The one they were looking for turned out to be a four story building separated from its neighbors by narrow alleyways. The apartment they wanted was on the fourth floor. Lee balked at going up when she realized that the elevator appeared to date to Fossil Creek's early days as well but gave in when Ed threatened to tell everyone at the station she was afraid of elevators. "Ok," she pouted, "but you have to do the talking once we get there." Despite her dislike of the creaky little confined space they arrived safely and found the apartment door.
Ed banged the knocker on the door. "Ma'am? Police. Did you call about your kitten?"
They heard a shuffling, then the door opened to reveal a bent elderly woman who said, "Yes. It was so pleasant this afternoon that I opened the window to air the place out a little. I didn't realize the screen had a tear in it and he slipped out onto the ledge before I could stop him. I'm so afraid he'll fall into the alley and be hurt."
As they stepped in Lee saw that the small living room was simply furnished but neat and clean. A window overlooking the alleyway was open. She went over and saw the torn screen, which she raised so she could look out the window. She saw the building had a wide ledge at the height of the windowsill, with a sheet of water dripping down on its edge from the gutters above. She looked to the left and saw a little kitten huddled on the ledge a few feet away, partially protected from the water by a large ivy vine that had crept up the wall. She thought she could probably reach him if she stretched out far enough - and didn't mind getting even more wet. She sighed and resigned herself to her fate. She leaned further forward as she reached to the left, gripping the windowsill tightly with her right hand to keep her balance. Cold water soaked her head, neck and shoulders. The kitten shrank back but she grabbed it before it could move away on the ledge. She congratulated herself for a moment, until the kitten squalled, planted all its claws in her hand, and sank its bitty but very sharp fangs into the space between her thumb and first finger. Lee squalled too but managed not to fling it reflexively into the abyss below. Instead, she let out a stream of invective as she inched back in through the window, kitten firmly attached. As she swung fully back into the room, the kitten let go and ran to his owner, who picked him up while scolding Lee reproachfully for her language.
Once they were back at the car, Ed started razzing her. "Young lady, my late husband was a Naval man, and even he wouldn't use language like that!" he mimicked Mrs. Eakins.
"Yeah, real funny, you hillbilly," she fumed as she ransacked the car's small first aid kit for enough bandaids to cover all her wounds.
"No, no!" Ed laughed, "I'm from Texas. That makes me a redneck, not a hillbilly."
"And it didn't need to be effusive, but a 'thank-you' from her would have been nice," she continued grumbling.
- 14 -
"Doc, the ambulance crew is bringing in a guy with a head injury now," Nancy reported. "They didn't think he needed to come in but apparently the cop insisted."
Sarah watched the stretcher roll by, with its occupant handcuffed to its rails and flanked by two hospital security guards. She turned to see Greca following behind. "Officer. So we meet again," she deadpanned. "Now what?"
Lee gave a bright smile to Dr. Bonheur, in hopes of soothing the irascible little doctor. "It was a beer-fueled donnybrook," she explained, "and this guy got hit in the gourd with a beer-bottle. Since he was on the losing side of the encounter, we thought we better bring him by here before booking him in the jail."
Once the stretcher was in a cubicle, Sarah examined the patient's head and saw a large bruise centered over his left temple. "Do you know whether he lost consciousness at the scene?" she demanded of the closest paramedic.
"Uh, I, I'm not sure," stuttered the paramedic.
Sarah looked up, displeasure showing plainly on her face.
"Well, he was down and not moving when we got there," Lee chimed in, feeling sympathy for the paramedic, "then he opened his eyes and sat up. So it looked to me like he had been knocked out."
Sarah gave her a moderately friendly look for the information then asked the hovering students, "What do you have to worry about with a scenario like that?"
Even Jeff looked blank, and the look of displeasure crept back on Sarah's face. "Well, what's the problem with the bone in the temple? . . .. Anyone?"
Lee found herself anxiously chiming in again, "It's thin there and easily broken."
Sarah raised an eyebrow at this unexpected contribution but said, "Well, boys, the cop is right. And what happens if the bone is broken?"
No one replied this time, as Lee realized that Dr. Bonheur probably didn't really consider her part of the team who needed to answer; so Sarah explained, "The artery passing through the bone can be torn and an epidural hematoma can form. The classic presentation is someone hit in the temple who initially loses consciousness but then wakes up and appears fine for a few hours, before collapsing again. So what do we need to do?"
"Get an MRI?" suggested Matt.
Well, Sarah thought, at least he did suggest an imaging study, even if it's the wrong one. "Close," she said. "A head CT shows blood collections very well and shows the bones better than an MRI, so we'll order a non-contrast head CT." She turned to Officer Greca and said a tad waspishly, "This will take some time, Officer, so you may want to go see what else you can dig up for us. Our security guards can stand by meanwhile."
"Ahh, ok," Lee replied. "I'll just be going then . . .." she edged out of the cubicle.
Sarah watched her go, regretting her sharp tone. Now her head and shoulders seem to be wet, she thought. What is going on out there, I wonder?
I need coffee, Lee thought after leaving the cubicle. She fished in her pocket for some quarters to use in the coffee machine, if she could find one. She saw a nurse nearby and asked her where one might be.
"Why don't you come in here? We've got some coffee that's a lot better than that sludge they sell," Nancy offered as she opened the door to the nurses' lounge.
Lee nodded, pathetically grateful for the favor. She followed Nancy into the lounge and went to the table with the coffee. As Lee stirred a little cream and sugar into her coffee, Nancy said, "I've got a bet with Dr. Bonheur - you're a lesbian, right?"
Lee nearly dropped her cup, but said, "Errr, well, yes. Why are you and Dr. Bonheur betting on that?" she frowned.
"I saw her checking you out earlier but when I asked her whether she'd asked you out yet she said she wasn't sure you were a lesbian," Nancy explained.
"Oh," was the best reply Lee could manage. Checking me out? Ask me out? Somehow I doubt it after our last interaction, she concluded sadly to herself.
- 15 -
"Sarah, I'm worried about this 75 year old guy we've got in 4," Nancy told her. "Something just doesn't seem right."
"Ok," she said. "What brought him in?"
"Fatigue - he said he just couldn't take it anymore. His vitals are ok but his color isn't good, and he's awfully thin," Nancy said.
Sarah nodded and stepped into the cubicle to see Mr. Dore. He was a wizened little gnome of a man.
"How are you doing tonight, sir?" she enquired.
"Oh, just fair-to-middling, miss," he replied.
"Well, can you tell me more about what's not doing so well?" she coaxed.
"I'm just tired."
"Anything else? Any pains, or fevers, or problems with your appetite?" Sarah pressed.
"No, no pains. I get sweats some nights but I don't have a thermometer so I don't know whether I've had fevers. I haven't been real hungry for a few months now," he revealed.
She examined him and found some enlarged lymph nodes in his neck, but nothing else helpful. She agreed with Nancy about the weight though - he was really cachectic. "I'm going to ask the nurse to draw some blood, Mr. Dore, so we can see if we can find a reason for your fatigue."
Sarah moved onto another case while waiting for the labs to return, suturing a laceration a man inflicted on his finger while trying to carve a turkey. She checked the desk when she was done and saw she had some results. She reviewed them: he was a little anemic, and had a little renal insufficiency, and had slightly elevated liver function tests. None of them by themselves, or even taken all together, seemed bad enough to make him feel so tired. It was a conundrum - normally she liked the challenge of figuring out an unusual case, but tonight she cringed at the thought of what fantastical doozy of a diagnosis Jeff would come up with next. She suspected that Mr. Dore had something seriously wrong with him given the overall picture, even if she didn't have a firm diagnosis, and that the best thing would be to admit him so that an internist could continue evaluating him.
She went back into his cubicle and reviewed the findings, and suggested that he should stay. "I know it's Christmas tomorrow but I think we should get started trying to figure out what's wrong and what we can do to help you feel better."
He agreed without much protest, and because he didn't have a regular doctor, she returned to the nurses' station to talk to an on-call internist about accepting the admission.
The students had listened to her presentation and when she hung up Jeff said, "But you haven't figured out yet what's wrong with him. Shouldn't you be doing more testing?"
"You don't always figure it out in the ED," she explained. "We make a diagnosis when we can, but sometimes our role is just to recognize that something is really wrong and get someone into the hospital where that can be sorted out."
- 16 -
As Lee paused at a stop sign a car roared past on the cross street. She hit the lights and siren and went after him. Fortunately, he pulled over and there were no problems as Ed ticketed him for speeding. They returned to the cruiser and settled in their places again. Lee's left hand had been getting more sore as the evening wore on, but she had been too busy to pay much attention to it. Now, however, it hurt to try to grip the steering wheel and she impatiently flipped on the dome light to look at it. Her hand was red and swollen. She stared at it, flabbergasted by its appearance. Ed whistled when he saw it and said seriously, "We better get back over to the hospital - that doesn't look good. And you better let me drive."
She nodded numbly, and silently got out of the driver's side and switched to the passenger side. As Ed settled in he said, "You must be feeling bad. The cantankerous dragon-lady we all know and fear would never let me drive."
She was too worried even to take umbrage at Ed's words. "That doctor's going to inflict grievous bodily harm on me," she whined. "She hates me!"
"Supercalifragilisticexpialidocious," Sarah muttered sarcastically as she saw Officer Greca walk into the ED yet again. "I can't wait to see what she's bringing me this time." She gave herself a mental slap. Don't snap at her again - it's not her fault you're stuck with Matt-and-Jeff the wonder-students, after all, and everyone she brought in did need to be evaluated. She summoned up a smile and asked, "What are you bringing us now?"
Lee was relieved at Dr. Bonheur's milder tone, but still was apprehensive as she sheepishly pulled her left hand out of her pocket and held it out for inspection. "Ahh, this time it's me. A kitten bit me earlier and now it's done this."
Sarah frowned with worry as she saw the swollen, red hand. "Cat bites get infected easily. We always give prophylactic antibiotics when we know someone's been bitten to try to prevent something like this." She took Lee's hand and turned it over, then unbuttoned her sleeve and pushed it back.
Lee was amazed to see a half inch wide red line extending halfway up her forearm. She looked up to ask Dr. Bonheur what it meant and her eyes widened as she caught sight of a vision in pink waltzing down the corridor behind the doctor. Sarah caught her expression and looked to see what was causing it. "Oh good," she exclaimed, "Kees is here - he can take care of you."
Lee felt an immediate pang at these words. She must really dislike me if she doesn't even want to take care of me she thought dejectedly.
"Kees," Sarah said, "this is Officer Greca. She got bitten by a cat earlier and now has cellulitis and lymphangitis. Will you take care of her, please?"
He looked at Lee's hand and arm in turn and told her, "Well, Officer, you'll need to be admitted for IV antibiotics. We'll have the hand surgeon look at you too."
"Surgeon! Admitted!" Lee growled in alarm. "Can't you just give me pills?"
"I don't think the surgeon will need to do anything, but we always involve them to be on the safe side," Kees soothed. "And the infection is too serious to treat with oral antibiotics at first. That red streak is lymphangitis, which means the infection is already in your lymph system. It can advance very rapidly. But if the infection responds well to the IV antibiotics you might even be able to go home in the morning."
After a flurry of activity involving numerous personnel, some armed with needles, Lee found herself in a hospital bed, her left hand supported from a pole by a sort of sling, with antibiotics dripping into an IV in her right hand. Ed had informed the station of her admission and the sergeant had come by to check on her. He told her not to turn up at work the next day, even if she was out of the hospital, and left her with a wry, "Merry Christmas, Greca. Tough luck this happened."
Lee blinked back a few tears as she looked at her hand in its support, and thought about her disastrous shift. It had been one calamity after another, ending with the fiasco with her hand. Way to impress the girl, Stud. She thinks you're a pest and then you go and let your stupid hand get infected. She thinks you're nothing but a big dumb cop. She looked at her watch and realized that at 10 after midnight it was now officially Christmas. Yeah - a real Merry Christmas to me.
- 17 -
Lee opened her eyes, at first puzzled about why her hand felt so odd. She saw the support and the whole horrible evening rolled back over her. Oh, yeah, she sighed to herself, that. Her hand felt and looked much better, though, so she thought, Maybe I can get out of here.
Dr. Morisot came in soon after that and agreed to release her. "I'll have the nurse come unhook you from all this. I want you to take these antibiotics twice a day for the next week," she instructed as she wrote a script.
Lee waited impatiently for the nurse; she finally heard a sound and looked towards the door - Dr. Bonheur was standing there. To Lee's surprise, once the doctor saw Lee looking at her, she blushed and looked at the floor. Then she raised her eyes and rushed into speech. "I heard you're being released and, I thought, or wondered, if maybe, um, if you'd like - since that's your dominant hand, and you can't use it well, at least not right now, and it's Christmas so no place will be open - maybe you'd like me to make you some breakfast? It wouldn't be anything fancy - just an omelet and tater tots or something . . .." she trailed off, and looked at the floor again.
"That sounds like a little bit of paradise compared to last night," Lee smiled. "But are you sure? I mean, you didn't seem too fond of me by the time I came in for the seventh time, and then you didn't seem to want to take care of me . . .." she trailed off in turn.
Sarah blushed again. "I'm sorry," she apologized. "I wanted the chance to try to get to know you outside of this place and thought it would be best if I wasn't the one who took care of your infection. And, I wasn't really mad at you but those two students were just driving me crazy, so it wasn't the best night to have a busy shift. But I guess you had a busy shift too, huh? And I guess I should have asked whether you already had plans, since it's Christmas."
"Busy is an understatement," Lee agreed. " And I didn't have any plans - my family's all in Minnesota and I was supposed to work today's swing shift too, so I was just going to putter around my place until it was time to go back to work." She frowned. "I really need a shower and a change of clothes - my uniform got trashed last night."
"I noticed that. How about this - we could stop by your place and you could pick up what you need and then take a shower at my place while I make breakfast. Consider it restitution for my grumpy behavior last night," suggested Sarah hopefully.
"Ok - sounds great!" Lee happily agreed.
- 18 -
Lee directed Sarah to her apartment building and said, "You better come up while I get my things - it's kinda cold out here."
She paused by her mailbox in the lobby and Sarah realized when she saw 'L.A. Greca' written on it that she didn't know the officer's first name. "Umm. What's your name?" she queried.
Lee gave her a puzzled look then realized what she meant. "It's Lee. What's your name?"
"Well, pleased to meet you, Sarah," Lee grinned as she let them into her apartment.
As Lee disappeared into her bedroom, Sarah looked around the living room. A telescope stood in one corner, next to a large bookcase. She wandered over to look at it, and then turned to the bookcase. She scanned the titles, excited when she saw some lesbian fiction. Yes! she thought as she gave a victorious arm pump, the old gaydar seems to be working! She scanned the rest of the shelves, seeing an eclectic selection of books. She supposed 'Criminal Justice: Introductory Concepts'; 'Case Studies in Criminal Justice'; 'Philosophy of Law: An Introductory Textbook of Jurisprudence'; and 'A Brief History of American Jurisprudence' all related to her work as a police officer. But she also had 'Backyard Astronomy'; 'Basic Astronomy'; 'The Ancient Astronomers'; and 'Black Holes, Quasars & Pulsars'. There was an even larger selection of titles relating to sociology and anthropology, including 'Essentials of Sociology'; 'Sociology of the Family'; and 'Xenia: Gift Giving and the Sociology of Hospitality'. Anthropology seemed to have simpler titles, with books on cultural, forensic, linguistic, physical and business anthropology all present. Sarah thought, Ahh - she's studied physical anthropology - that explains how she knew about the thin bone of the temple, I bet.
A framed picture over the telescope caught her eye - it seemed to be of a comet, with some red and blue stars to one side. She was still staring at it thoughtfully when Lee re-entered the room carrying a gym bag. Sarah looked over and asked, "Is this a photo?"
"Yeah, I took that picture on top of Guanella Pass one night when Hale-Bopp was passing by, with a long exposure time. It was tough to get because it turns out that airplanes fly over that area of the mountains all the time. It was hard to time it to get a picture without plane lights in it. That's the constellation 'Cassiopeia' next to the comet."
"So it looks like you're interested in astronomy," Sarah waved at the telescope and books.
"I was a Sociology/Anthropology major in college, and to help meet my science distribution requirement I took a course called 'Physics and Astronomy for Poets.' It turned out to be really interesting. I still remember how amazing it seemed to me that a photon of light can have both particle and wave properties. Anyway, it got me interested so I ended up taking an Intro Astronomy course too. I don't pretend to understand astrophysics at all, but I still like to read and follow what I can. I figure at least I know what they're talking about when they say an asteroid could hit and wipe us all out. And the pictures from both the big optical and the radio-telescopes are just beautiful."
- 19 -
Sarah lived in a small Victorian house in the older section of town. She let them in and showed Lee to the bathroom, then went to start breakfast.
Hmm; I could do cheese and veggie omelets - better wait till she's out of shower to make sure which veggies she wants, but I can chop things up now. She rooted around in the fridge some more, then pulled out a bowl with cantaloupe chunks in it. She sniffed it cautiously then smiled. Yes! It's still good! So omelets, tater tots, toast, cantaloupe - and orange juice and coffee to drink. Sounds like a plan. Now for some music. Sarah selected a CD of Haydn String Quartets and put it on. Even though it wasn't Christmas music, exactly, the Baroque music seemed to suit the day.
She was busy in the kitchen when Lee appeared in the doorway, looking much more comfortable in jeans and a sweatshirt. Sarah explained the breakfast plan and asked what she wanted in the omelet.
"Yeah, that sound's good. I'd just like a plain cheese omelet; I'm not big on veggies in things like that," she admitted. "Can I do anything to help?"
"You could set silverware out," Sarah suggested and showed her where to find it.
Lee looked to be sure Sarah was busy at the stove again then opened her backpack and pulled out a small package with Christmas wrapping. She set the silverware out and then put the package on the table. She looked at the centerpiece on the table as she set it down. It had a rock in it that looked like lava but had lighter colored chunks mixed in. That's really different. She looked up as Sarah entered carrying a pitcher of orange juice and two glasses. "What is this rock? I've never seen anything like it."
Sarah said, "It is unusual, isn't it? A friend who's a geologist gave that to me. He said those are xenoliths in the lava - another type of rock carried along when the lava erupted." Sarah's eyes zeroed in on the package - "Hey, what's that?"
"Xenia," smiled Lee. In response to Sarah's questioning look she elaborated, "My mother would call it a hostess gift, but it's an old concept - guest gifts in thanks for the gift of hospitality. I'll confess I was going to take it to the station today, but since I'm here instead, I'm giving it to you."
"Can I open it?"
"Of course - it's yours."
Sarah picked the package up and eagerly tore the wrapping off, revealing a box of Enstrom's Almond Toffee. "Oh, cool - this is the world's best candy! Thank-you!" she said happily. "Let's eat so we can have some for dessert!"
"Ok," Lee laughed, and followed Sarah back to the kitchen to pick up their plates.
They set the food on the table and Sarah poured them orange juice then raised her glass; Lee followed suit.
"Merry Christmas to you, Officer Greca," Sarah toasted as they clinked their orange juice glasses together.
"Merry Christmas, indeed, Dr. Bonheur," Lee smiled.
Final word count: 120
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