Irregular Heartbeat Read online

  Table Of Contents

  Acknowledgments

  Dedication

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Epilogue

  About Chris Zett

  Other Books from Ylva Publishing

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  www.ylva-publishing.com

  Acknowledgments

  This book has evolved during the years of writing from a vague idea to a final version I’m happy and proud to share. I wouldn’t have been able to create it without the help of many friends and strangers:

  The nameless drummer who played so enthusiastically during a concert that I couldn’t stop staring.

  The friendly staff at my two favorite cafés: November and Stockholm. You have the best tea, coffee, and cinnamon rolls to fuel a writer.

  My teachers and fellow students of the GCLS Writing Academy 2016/17. You inspired me to write better and finally finish the book.

  My invaluable beta readers who read all or parts of my story and often provided feedback I didn’t want to hear but needed to: Bianca, Isa, Jon, Katja, Melanie, Simone, and Trish.

  My GCLS mentor, editor, and friend Sandra for teaching and encouraging me. More often than not you knew better than I what I wanted to say and expressed it more eloquently than I could.

  The team at Ylva Publishing, especially Astrid, who are not only professional, but super nice too, and published the book in record time with a wonderful cover.

  And last, but not least, my wife, Bianca. Thank you for not only tolerating but supporting my mental and physical disappearances into the realm of writing.

  Dedication

  To Bianca—my real-life workplace romance.

  Chapter 1

  Diana stepped up to the glass wall and discreetly tried to get a look at her reflection between the large, red letters spelling Emergency Department. Neat hair, boring clothes. Not even close to the rock star look she’d sported last year.

  She clutched her extra large mocha for a second longer, then tossed the empty paper cup into the wastebasket and wiped her damp hands on her slacks. A glance at her cell phone confirmed she was twenty minutes early. Well, better early than late. This was her last chance at a career in medicine, and if she blew it by making a bad impression…

  She swallowed. I won’t.

  The electronic door opened with a hiss. Immediately, the clean smell of disinfectant reminded her of her father’s practice and calmed her. The entrance area was an empty space designed in imposing granite like a bank, and her echoing steps reinforced that impression. She tried to look confident and at ease as she addressed the woman behind the glass wall at the admission desk.

  “Good morning. I’m Diana Petrell, the new resident. I’m looking for Dr. Emily Barnes, if she’s here already.”

  “Hi, Dr. Petrell. We’ve been expecting you. Here’s your paperwork and your ID card. It gets you through here,” she pointed to the door in the glass wall, “and into the locker room, cafeteria, and so on.” When Diana needed two tries to swipe the card in the right direction, the woman laughed softly. “I’m Stacy. Welcome to Seattle General Hospital.”

  Diana laughed with her but couldn’t say more than “thank you” as Stacy rapidly gave her directions to the locker room.

  “Get changed and then find Tony, the day-shift charge nurse.” Stacy pointed toward a lanky guy in blue scrubs at the far end of the counter, who smiled and waved. “He’ll find Dr. Barnes for you,” she added with a grimace.

  What’s that about? New arrivals demanded Stacy’s attention before Diana could find out more about Dr. Barnes.

  She headed toward the locker room. As soon as she stepped into the drab beige corridor, a low-level background noise of hurried steps, beeps in various rhythms, and the screech of an uneven set of wheels enveloped her like the hug of a long-lost friend. She hurried past wheelchairs, IV poles, and supply carts to the staff-only area of the ED. When she located the women’s locker room, she managed to swipe her ID correctly on the first try and entered the windowless room.

  Several of the dented metal lockers stood empty. The walls were painted puke green, but she supposed it might have been a friendly spring color a few years ago. Or probably decades.

  A shelf next to the door held neatly folded blue scrub shirts and pants. Diana grabbed a comfortable size to accommodate her white, long-sleeved T-shirt that she planned to keep on underneath. She picked an unused locker and quickly changed. The soft cotton was perfect; she’d missed this.

  She removed well-used white running shoes from her backpack and slipped them on. Still comfortable. They had survived the nine years in storage surprisingly well. She had rediscovered them in the same box that held her medical texts, her lab coats, and the dark red stethoscope Henry, her favorite brother, had given her for graduation.

  Diana distributed a pen, a penlight, her smartphone, and a black notepad to the various pockets of her scrub shirt. Finally, she slung her ID badge and the stethoscope around her neck. The ritual reminded her of donning armor before a battle, but she wouldn’t go so far as to compare herself to a valiant knight. The unaccustomed weight pulled on her shoulders, and she would need several days to get used to it again.

  She put on her much-rehearsed confident and friendly smile and went to find Tony. Showtime.

  “And here is the staff lounge and Dr. Barnes. Good luck.” Tony finished the short tour of the ED. He opened the door for her and left with a wink.

  Was he hitting on her, or was this just his normal way of communication? She shrugged it off and turned her attention to the staff lounge.

  The middle of the room was dominated by two dark leather couches flanking a large coffee table. Small circular burn marks indicated that it had been here longer than the no-smoking regulations. Mismatched desks with computer terminals lined two walls. Diana was happy to see a kitchenette with an industrial-sized coffee urn, a microwave, and a fridge. All the essentials to surviving a twelve-hour shift.

  Diana’s focus shifted to Dr. Barnes, the attending who would be her supervisor. She had been unable to learn anything substantial about her from her new colleagues. Everyone had either twitched or frowned whenever Emily Barnes’s name had come up.

  The slender, pale woman sent out don’t-talk-to-me vibes. She was sitting on one of the couches, typing on a laptop. Her strict posture screamed either ballet dancer or military. Or maybe librarian. The neat bun that imprisoned every strand of her light brown hair reinforced this impression.

  Should she wait to be acknowledged? That wasn’t really Diana’s style. A polite greeting had never hurt anyone. “Good morning. Dr. Barnes?”

  She looked up, nodded, and studied Diana for a moment with hard gray eyes. “New resident?”

  What an unusual eye color and hair combination. “Yes. Hi, I’m Diana Petrell. I was told to meet you here.” Diana moved closer and offered her hand.

  Dr. Barnes gave it a short, hard squeeze. She didn’t stand, and even though she looked up at Diana, she managed to make her feel sma
ller.

  Impressive.

  “You’re late.”

  “I thought I was early.” A quick look at the clock on the wall confirmed her statement. Five to eight.

  “You’re not. The morning shift started an hour ago.”

  Diana bit the inside of her cheek to stop herself from reacting to the cold tone. Instead, she focused on the content of the statement. “I’m sorry. I was told to be here at eight. I’ll be on time from now on.” She struggled not to ball her hands into fists.

  Dr. Barnes took her time moving the laptop to the side. It probably wasn’t a coincidence that it aligned precisely with the edge of the table. “I expect punctuality, hard work, and preparation. If you can’t commit to our schedule, this residency won’t work. It’s very unusual to begin your work here halfway through the program and in the middle of the year.” She frowned, but the lines were barely visible in her immaculate makeup.

  It was difficult to guess her age. Everything between twenty-five and fifty seemed possible. She was probably close to Diana’s own thirty-seven.

  “I’ll evaluate your performance and supervise you until we decide what you can do on your own.” Dr. Barnes pointed to the other couch. “Sit. Dr. Wallace emailed me your résumé. What kind of work did you really do?”

  Dr. Barnes had a long list of procedures, both diagnostic and therapeutic, to go through. After fifteen minutes, Diana was sweating. This was worse than her job interview last week. Dr. Wallace, the chief of staff, had at least been civil.

  Just when Diana thought they were finished, Dr. Barnes presented her a case. “A thirty-year-old male with chest pain. He’s pale and a bit short of breath. Vitals are stable. What do you think?”

  Was this like a board examination? Diana decided to address the question as if it were. “First, I’d introduce myself to the patient and ask him about the pain and the situation he was in when it started. Then I’d interview him about his history, and then—”

  “Skip it. Three differential diagnoses. Now.” The tone was sharp enough to make Diana flinch.

  Diana bit down any rebellious instincts to answer in the same manner. “Pneumothorax, pneumonia, and intercostal neuralgia. Without further information it’s impossible to—”

  “Pneumothorax. What do you do?” Dr. Barnes took a sip from her mug.

  “If the X-ray confirms it, I’d put in a chest tube.” Diana wished she could drink something too. She’d already used up the caffeine from her way to work and her mouth was dry. But she wouldn’t give Dr. Barnes the satisfaction of appearing weak by asking for coffee. “Do you want me to explain how it’s done?”

  Dr. Barnes shook her head. “We’ll save that for later. So, did you put in one before?”

  “Many. We regularly treated gunshot and knife wounds in LA.” Diana wanted to slap herself for bringing up the one topic she wanted to avoid: her last residency.

  “Is that the reason you quit? Too much violence?” Dr. Barnes leaned forward. Her gray eyes seemed like lasers, ready to cut through any defense Diana could think of.

  Diana squared her shoulders and forced herself to hold her gaze. Yes, she had something to hide, but she hadn’t done anything wrong. “During my final year, I had to interrupt my residency for personal reasons. The patients in the ED had nothing to do with it.” She had to take control of the discussion and tell Dr. Barnes something about the nine-year gap in her résumé before she asked too many questions. “I couldn’t work in the medical field after that, but I regularly read medical journals and visited conferences to stay up-to-date with current standards and new medications.” Diana tried to gauge Dr. Barnes’s reaction, but her features hadn’t moved out of the slightly displeased expression they had been in from the beginning. She continued before Dr. Barnes could interrupt her again. “You’ll see that I know how to evaluate patients, treat most of the standard problems, and, most importantly, I know when to ask for help.”

  Dr. Barnes studied her for a moment, and Diana forced herself not to fidget. If she could bluff her way through contract negotiations with business sharks, she could appear confident now.

  Finally, Dr. Barnes leaned back on the couch, but the deliberate movement didn’t seem relaxed. “Journals? Conferences? Commendable, but they can’t replace real experience. Today we’ll work all cases together and see how you’re doing. Without my approval, you won’t touch anyone or give any orders.” She waited for Diana to nod before she continued. “Just pretend you’re a medical student, and we’ll get along fine.”

  Student? Was that some kind of a joke? Diana ground her teeth. Her return to medicine after a long absence was highly unusual, but she was no student. She had treated patients on her own before and knew her limits. She fought the urge to tell Dr. Barnes exactly that. It hurt to be on the bottom of the food chain again, but her ego wasn’t important today. She unclenched her jaws and faked a smile. “No problem. I’ll follow you. Let me know what you want me to do.” She would be the perfect demure medical student until she earned Dr. Barnes’s trust, and she damn well would be all adult about it.

  Just when she thought the worst was over, Dr. Barnes fired more questions. “So, what does personal reasons mean? Housewife? Kids? Jail? Drugs?”

  Diana laughed until she realized that the last bit hadn’t been a joke. Did Dr. Barnes really think she could keep her medical license after nine years in jail? Unfortunately, the chief of staff had forbidden her to talk about the real reason she had spent the last few years out of a hospital. She hoped the story she had come up with didn’t sound too weak, but the truth wasn’t helpful if she wanted to gain respect as a physician. “No, nothing like that. I…um…I had other obligations. I worked with a friend and had no time for a full-time residency. We lived far from the next hospital…on a farm.” Diana suppressed a wince. That sounded even less convincing when she said it out loud than in rehearsal.

  She shifted on the couch and tried to think of an alternative direction of this discussion. Her gaze fell on the laptop. “I guess you’re doing your charts electronically now. I hope that’s an improvement to carrying around the high stacks, like we used to. How many patients have you got this morning? What can I do to help?”

  From the look Dr. Barnes gave her, she had seen right through the feeble attempt at deflection, but instead of asking more questions, she hit a few keys on her laptop, then turned it around. “Here, take this one: female, twenty-one years, abdominal pain for five hours in the lower right quadrant, no emesis or diarrhea.”

  Diana grinned. Appendicitis was an easy enough start. Even her grandma would be able to make a diagnosis. Or was Dr. Barnes tricking her?

  Dr. Barnes led the way through another corridor stuffed with medical paraphernalia to a large room where several examination bays were separated by curtains. She pointed to the patient’s chart in a metal holder at the entrance of one cubicle. “That’s all the paper that’s left; the rest is digital. Go inside and examine her. I’ll watch, and we’ll discuss the case outside before you recommend further diagnostics or treatment. Don’t promise anything you can’t keep.”

  Diana swallowed a comeback. Everyone learned in their first week of internship to avoid promises. Convinced that her face muscles would ache terribly in the evening, she resumed her smile and entered the examination room.

  As soon as she saw the patient, Diana’s heartbeat quickened. Finally back at work. She quickly disinfected her hands, using the bottle next to the door. The alcohol helped to hide her clammy palms.

  “Ms. Miller? I’m Dr. Petrell. You’re here because of abdominal pain, is that correct?”

  The young woman nodded and grimaced at the same time. Fear emanated from her in waves.

  Diana sat on a stool to bring herself to eye level with the patient. This time her smile wasn’t forced as she tried to project calm. “Can you tell me more about it?”

  Ms. Miller recounted her pr
oblems, and Diana listened intently, asking her to clarify some points and then questioned her about her prior illnesses, medications, and allergies. The familiar ritual helped her to overcome her nervousness.

  “You don’t take any medication? Not even occasionally over-the-counter pain meds or the pill?” Most patients forgot about those, and Diana had learned the hard way to never take anything for granted.

  Ms. Miller shook her head and blushed. “We’re careful,” she mumbled.

  Diana mentally added pregnancy to her internal checklist. Warming her stethoscope in one hand, she stood. “I need to examine you now. Tell me if anything hurts, okay?”

  She hadn’t done this in years, but the routine was still intact after thousands of patients. She worked her way down until she reached the abdomen.

  When Diana pulled up the gown, the patient tensed and put both hands in front of her lower abdomen.

  Diana looked up and met her gaze.

  Ms. Miller’s dark brown eyes were large and gleamed with unshed tears. Her lips trembled, but she didn’t say anything.

  Diana didn’t like that part either, but not doing it wasn’t an option. “I’ll be careful, but I have to check for myself. I’m sorry.” She smiled encouragingly, and Ms. Miller lowered her hands back to her sides. The only thing Diana could do to make it more bearable was to finish it as fast as possible.

  First, she checked with her stethoscope for bowel movement and then carefully palpated the patient’s abdomen, avoiding the lower right quadrant until last. When she put her hand on the soft skin, the young woman moaned. Diana ignored it and pressed with all fingers as deep into the abdomen as the involuntary guarding would allow. Keeping eye contact with Ms. Miller, Diana ran through the other tests as fast as possible, mindful of Dr. Barnes’s presence.

  She leaned against the counter on the far wall, arms crossed over her chest. Whenever Diana glanced in her direction, her gaze bored into her.

  Diana pulled down the patient’s gown without touching her abdomen again. “Is the pain manageable while lying like this, or do you need something?”