Page 16 of Crossing the Line (Phoenix Ridge Medical #6)

CARMEN

C armen's afternoon schedule lay spread across her desk: teaching rounds at two, cardiac consultation at three-fifteen, and administrative meetings that would consume what remained of her day.

She'd arranged her week with astute precision, building structure around the chaos Harper Langston had introduced to her carefully ordered world.

Three days. That's how long she'd been maintaining professional distance while watching Harper navigate the cardiac wing with a maturity that surprised her.

Gone was the defensive energy Carmen had expected after their disastrous first encounter.

Instead, Harper approached every interaction with careful respect and genuine focus that made Carmen's protective walls feel unnecessarily rigid.

Carmen checked her watch. Two o'clock. Time for rounds with the surgical interns assigned to her supervision. She gathered her files and moved toward the conference room, where three first-year residents waited with the particular alertness of people determined to prove themselves.

Harper sat with perfect posture, notepad ready, her attention focused entirely on the medical charts spread across the table.

Beside her, Brooke Donovan reviewed surgical approaches with the methodical thoroughness Carmen appreciated in interns.

Willow Franklin had arranged her materials with obsessive precision, color-coded tabs marking different sections of her notes.

"Good afternoon," Carmen said, settling into her chair with practiced authority. "We'll be reviewing post-operative protocols for cardiac patients, specifically monitoring for complications during the first forty-eight hours."

Three hands moved across their notepads in synchronized efficiency. Carmen began her explanation of arterial pressure monitoring, but found her attention drifting to Harper's careful questions that were intelligent, relevant, and demonstrating preparation that went beyond basic requirements.

"Dr. Langston," Carmen said, testing Harper's knowledge. "What's the primary concern with patients showing irregular heart rhythms twelve hours post-surgery?"

Harper's response was immediate and comprehensive.

"Potential for arrhythmia indicating incomplete repair, medication interactions affecting cardiac rhythm, or early signs of infection.

We'd want to review surgical site integrity, check medication levels, and consider doing an echo evaluation to assess mechanical function. "

Perfect. Carmen felt something twist in her chest, professional pride mixing with personal complication in ways that made concentration difficult.

"Correct," Carmen said, moving to the next topic before her expression could betray anything beyond professional assessment.

The hour progressed with increasing technical complexity.

Harper's responses remained thoughtful and accurate, but more importantly, she seemed genuinely engaged with cardiac surgery rather than performing for evaluation.

Carmen found herself explaining advanced techniques with more detail than usual, drawn by Harper's obvious passion for the specialty.

"The key to successful cardiac repair," Carmen was saying, "lies in understanding that every intervention affects multiple systems. You can't approach the heart as an isolated organ."

"Like the intersection between cardiac function and neurological response during surgery?" Harper asked. "I've read about surgeons monitoring cognitive indicators during complex procedures."

Carmen paused, genuinely impressed. That level of thinking went far beyond intern-level knowledge. "Exactly. The brain-heart connection during surgery is crucial for optimal outcomes."

Their eyes met across the conference table, and for a moment, Carmen forgot about professional boundaries. Harper's intelligence wasn't an act designed to impress supervisors. It was genuine curiosity that reminded Carmen why she'd fallen in love with cardiac medicine.

The moment shattered as the hospital's emergency system crackled to life.

"Code Red, all available surgical staff to trauma bay one. Multiple casualties, residential fire, ETA five minutes. Code Red, trauma bay one."

Carmen was moving before the announcement finished, her teaching materials forgotten. Behind her, the three interns scrambled to follow, but her attention focused on the controlled urgency in Harper's movements. No panic, no hesitation—just immediate transition to emergency protocols.

"What are we looking at?" Brooke asked as they hurried through hospital corridors.

"Residential fire means potential smoke inhalation, burn trauma, and possible cardiac complications from oxygen deprivation," Carmen explained, her mind already cataloging treatment approaches. "Willow, you'll assist with airway management. Brooke, trauma assessment and stabilization."

She turned to Harper, professional necessity overriding everything else. "Harper, you're with me on cardiac monitoring. Fire victims often present with irregular heart rhythms from smoke exposure."

Harper nodded, falling into step beside Carmen with natural ease. "Should we expect firefighter casualties as well?"

"It’s possible. Phoenix Ridge Fire Department responds to everything, and residential fires can be unpredictable."

They reached the trauma bay as the first ambulance arrived, its red lights painting the windows in urgency. Carmen could see EMT teams preparing stretchers, the controlled chaos of emergency response unfolding with practiced efficiency.

"Remember," Carmen told her team, "we work together, we trust each other's assessments, and we save lives. Everything else is secondary."

Harper's steady presence beside her felt both comforting and dangerous. Professional necessity demanded they work as a team. Personal history demanded she maintain distance.

Carmen chose necessity. Lives depended on it.

The ambulance doors opened, and emergency medicine took over.

Carmen assessed the situation with clinical detachment: three firefighters with varying degrees of smoke inhalation, two civilians with severe burns, and a construction worker who'd been trapped during the building collapse that followed the fire.

"Trauma bay two for the construction worker," Dr. Hassan called out, coordinating triage with practiced efficiency. "Dr. Méndez, we need you on the firefighter with chest trauma."

Carmen moved toward the stretcher where EMTs were transferring a woman in her thirties, her Phoenix Ridge Fire Department uniform charred and torn. The patient's breathing was labored and her skin pale despite the soot covering her face.

"What do we have?" Carmen asked the lead paramedic.

"Captain Jennifer Walsh, thirty-two, trapped under debris for approximately fifteen minutes. Chest impact, possible rib fractures, erratic cardiac rhythm noted during transport."

Carmen's hands moved to the patient's chest, feeling for breath sounds while her eyes tracked the cardiac monitor.

The rhythm was irregular, concerning but not immediately life-threatening.

Beside her, Harper appeared with cardiac monitoring equipment, anticipating Carmen's needs without being asked.

"Heart rate fluctuating between ninety and one-twenty," Harper reported, deftly adjusting the monitor leads. "Oxygen saturation is improving with supplemental oxygen, but we're seeing frequent PVCs."

Carmen nodded, impressed despite herself. Harper was reading the cardiac patterns with accuracy under extreme pressure that went beyond basic training. "Probable cardiac contusion from the chest impact. We need an echo to assess wall motion."

"Already ordered," Harper said, her voice steady despite the controlled chaos around them. "ETA three minutes."

They worked in seamless coordination, Carmen handling the primary assessment while Harper managed cardiac monitoring and anticipated equipment needs. When the echocardiogram machine arrived, Harper had the transducer ready and the patient positioned optimally for imaging.

"There," Carmen said, pointing to the screen as she moved the probe across the patient's chest. "See the decreased wall motion in the anterior segment? Classic contusion pattern."

Harper leaned closer, studying the images with genuine fascination. "The irregular rhythm is secondary to the cardiac bruising. Should we consider anti-arrhythmic medication?"

"My thoughts exactly. What would you recommend?"

"Low-dose amiodarone to stabilize the rhythm without compromising cardiac output," Harper replied without hesitation. "Then we monitor closely for improvement over the next six hours."

Carmen found herself nodding in approval. Harper's assessment was not only correct but demonstrated understanding of the delicate balance required in cardiac trauma cases. "Agreed. Draw up twenty milligrams amiodarone, slow IV push."

As Harper prepared the medication, Carmen continued her examination.

The firefighter's breathing had stabilized, and the cardiac rhythm was already showing signs of improvement.

Around them, the trauma bay hummed with efficient activity—other medical teams handling the remaining casualties, nurses managing IV lines and medications, the controlled urgency of emergency medicine at its finest.

"Dr. Méndez," Dr. Hassan called from across the bay. "How's Captain Walsh?"

"Stable. Cardiac contusion is responding well to treatment. We'll need overnight monitoring, but the prognosis is good."

"Excellent. Can you assist with the civilian burn patient? There’s possible airway compromise."

Carmen glanced at Harper, who was meticulously documenting the firefighter's vital signs and medication response. "Can you handle Captain Walsh's continued monitoring?"

"Absolutely," Harper said, her confidence genuine rather than boastful. "I'll track cardiac rhythm and watch for any changes in her respiratory status."