Chapter One Disaster Status
Fire captain Scott McKenna bolted through the doors of Pacific Mercy ER, his boots thudding and heart pounding as the unconscious child began to stiffen and jerk in his arms. He cradled her close as her small spine arched and her head thumped over and over against his chest. “Need help here. Seizure!”
“This way.” A staff person beckoned. “The code room. Someone page respiratory therapy stat!”
Scott jogged behind a trio of staff in green scrubs to a glassed-in room, laid the child on a gurney, and stepped back, his breath escaping in a rush of relief. He swiped a trickle of sweat from his forehead and tried to catch a glimpse of the girl’s face. He’d swept her up too fast to get a good look at her. Now, with merciful distance, Scott’s heart tugged. Six or seven years old with long black braids, frilly clusters of hair ribbons, little hoop earrings, she looked disturbingly pale despite her olive skin. Her dark eyes rolled upward, unfocused, as the ER team closed in to suction her airway, start oxygen, and cut away her flowered top and pants.
The alarms of the cardiac monitor beeped as a technician attached gelled electrodes to her tiny chest. Thankfully, the seizure ended, although saliva—foamy as a salted garden snail—still bubbled from her parted lips.
Scott inhaled slowly, the air a sour mix of illness, germicidal soap, and anxious perspiration. He thought of his nephew, Cody, lying in a pediatrics bed two floors above.
The ER physician, a vaguely familiar woman, gestured to a nurse. “Get an IV and pull me some labs. I’ll need a quick glucose check and a rectal temp. Let’s keep lorazepam handy in case she starts up again. What’s her O2 saturation?”
“It’s 98 percent on the non-rebreather mask, Dr. Stathos.”
Leigh Stathos. Golden Gate Mercy Hospital. Scott nodded, recognizing her—and the irony. She left San Francisco. I’ve applied for a job there . . . and everywhere else.
“Good. Now let’s see if I can get a medic report.” Dr. Stathos whirled to face Scott, her expression indicating she was trying to place him as well. Her gaze flickered to his badge. “Oh yes. McKenna. Didn’t recognize you for a second there. So what’s the history? And where’s the rest of your crew? Are they sending you guys out solo now?”
“No. But no crew. And no report. I was here as a visitor, until some guy waved me down in the parking lot. I took one look at this girl and decided to scoop and run.” Scott nodded toward a woman crying near the doorway. “That could be family. They were in the truck with her.”
“Don’t know. My Spanish isn’t the best. I think they said ‘sick’ and ‘vomiting,’ but—”
One of the nurses called out for the doctor. “She’s starting to twitch again. IV’s in, and the blood glucose is good at 84. No fever. How much lorazepam are you going to want? She weighs about 20 kilos.”
Dr. Stathos moved back to the gurney. “We’ll start with one milligram slowly. But let me get a look at her first, listen to her lungs, and check her eyes.” She looked up as a blonde nurse appeared in the doorway. “Yes, Sandy?”
“Sorry, Doctor. I couldn’t get much, but her name’s Ana Galvez. Six years old. No meds, no allergies, and no prior seizure history. I think. There’s a language barrier, and I don’t have an official interpreter yet. But thought you should know I’ve got a dozen more people signing in for triage, all with gastric complaints and headaches. The parking lot’s full of farm trucks, and—” She stopped as the child began a second full-blown seizure.
Two respiratory therapists rushed through the doorway.
Scott tensed. A dozen more patients? Then his Spanish was good enough to have understood one last thing the terrified family had said before he took off running with their child: “Hay muchos más enfermos”—There are many more sick people.
He glanced back at the child convulsing on the gurney. What was going on?
Muscle it. Punch through it. Control it. Be bigger than the bag.
Erin Quinn’s fist connected in one last spectacular, round-winning right hook, slamming the vinyl speed bag against the adjacent wall. And causing a tsunami in her grandmother’s goldfish tank. Water sluiced over the side.
“Whoa! Hang on, buddy. I’ve got you.” She dropped to her knees, steadying the tank with her red leather gloves. Everything she’d done in the last six months was focused on keeping Iris Quinn safe, secure, and happy, and now she’d nearly KO’d the woman’s only pet.
Erin watched the bug-eyed goldfish’s attempts to ride out the wave action. She knew exactly how he felt. Her own situation was equally unsettling: thirty-one and living with her grandmother and a geriatric goldfish named Elmer Fudd in a five-hundred-square-foot beach house. With two mortgages and a stubborn case of shower mold. She caught a whiff of her latest futile bout with bleach and grimaced.
But moving back to Pacific Point was the best option for her widowed grandmother, emotionally as well as financially. Erin was convinced of that, even if her grandmother was still skeptical . . . and the rest of the family dead set against it. Regardless, Erin was determined to put the feisty spark back in Nana’s eyes, and she had found the change surprisingly good for herself as well. After last year’s frustrating heartaches, being back in a house filled with warm memories felt a lot like coming home. She needed that more than she’d known.
Erin tugged at a long strand of her coppery hair and smiled. The fact that her grandmother was down at the chamber of commerce to inquire about volunteer work was proof they were finally on the right track. Meanwhile, she had the entire day off from the hospital. March sunshine; capris instead of nursing scrubs; time to catch up with her online course work, jog on the beach, and dawdle at the fish market with her grandmother.
She turned at the sound of her cell phone’s Rocky theme ring tone, then struggled, teeth against laces, to remove a glove in time to answer.
She grabbed the phone and immediately wished she hadn’t. The caller display read Pacific Mercy ER. “Yes?”
“Ah, great. We caught you.”
“Not really,” Erin said, recognizing the relief charge nurse’s voice and glancing hopefully toward the door. “In fact, I was just heading out.”
“Dr. Stathos said she’s sorry, but she needs you here. Stat. We’ve got kind of a mess.”
Mess? Erin’s breath escaped like a punctured balloon. In the ER, a mess could mean anything. All of it bad. She’d heard the TV news reports of a single-engine plane crash early this morning, but the pilot had been pronounced dead on the scene, and there were no other victims. The hospital shouldn’t be affected. Then . . . “What’s going on?”
“Eighteen sick farm workers,” the nurse explained, raising her voice over a cacophony of background noise. “Maybe a few more now; they keep coming in. We’re running out of gurneys, even in the hallway.”
“Sick with what?” Erin asked. The sheer number of patients qualified as a multicasualty disaster, but only if it were a motor vehicle accident, an explosion, or a similar tragedy.
“Dr. Stathos isn’t sure. But she’s thinking maybe food poisoning. They’re all from the same ranch. Everyone’s vomiting, and—”
It’s a real mess,” Erin finished, sighing. “I got that part. But how come the ambulances are bringing them all to us? Dispatch should be sending some to Monterey.”
“They’re not in ambulances. They’re arriving in work vehicles. A couple of guys were even sprawled out on a flatbed truck. They’re lucky no one rolled onto the highway. The police are at the ranch investigating, but meanwhile we’re overwhelmed. And of course the media got wind of it, so now we have reporters showing up. You know how aggressive they get. I’m sorry, but I feel like I’m in over my head with this whole thing.”
The nurse was new at taking charge, and Erin remembered how scary that felt when things went south in the ER. Monday shifts were usually fairly tame, but this sounded like . . . “Tell the nursing supervisor I’m on my way in and that we’ll probably need to go on disaster status and . . . Hold on a second, would you?” She yanked off her other glove and strode, phone to her ear, toward the miniscule closet she shared with her grandmother. “Close the clinic and use that for overflow. Get security down there to help control things, the chaplain too. And see if the fire department can spare us some manpower.”
Erin pulled a set of camouflage-print scrubs from a hanger, then began peeling off her bike shorts with one hand. “I’ll get there as soon as I can. Just need to take a quick shower and leave my grandmother a note.” And kiss my free day good-bye?
No, she wasn’t going to think that way. As a full-time charge nurse, the welfare of the ER staff was a huge priority. Besides, Leigh Stathos wouldn’t haul her in on her day off if it weren’t important. Erin had dealt with far worse things. Like that explosion at the day care center near Sierra Mercy Hospital last year. In comparison, food poisoning wasn’t such a big deal, even two dozen cases. Messy, yes. Life-altering, no. Central service would find more basins, she’d help start a few IVs, they’d give nausea meds and plenty of TLC, and they’d get it all under control.
“No problemo,” she murmured as she hung up, then realized the inarticulate phrase was pretty much the extent of her Spanish. She made a mental note to be sure they had enough interpreters. Interpreters, basins, more manpower, and a full measure of TLC to patients—and her staff. That should do it.
Ten minutes later she snagged an apple for the road, wrote Nana a note, and stowed her boxing gloves on the rack beneath the TV. She wouldn’t need battle gear for this extra stint in the ER. And then she’d be back home. In a couple of hours, tops.
When Erin turned in to the hospital parking lot, she realized she’d forgotten her name badge. Good thing security knew her. Her eyes widened as she approached the ambulance entrance. She braked to a stop, her mouth dropping open as she surveyed the scene at the emergency department’s back doors: four dusty and battered trucks—one indeed a flatbed—at least three news vans, a fire truck, an ambulance, and several police cars. She quickly put the Subaru in park, then opened her door and squinted up at the sky. Oh, c’mon, was that a helicopter? A plane crash wasn’t big enough news today?
Several nurses stood outside the doors holding clipboards and dispensing yellow plastic emesis basins to a restless line of a least a dozen patients in long sleeves, heavy trousers, and work boots. Including one elderly man who seemed unsteady on his feet as he mopped his forehead with a faded bandanna. A young uniformed firefighter paramedic, the husband of their ER triage nurse, was also helping out. Good, Erin’s request for extra manpower had been accepted.
Reporters in crisp khakis and well-cut jackets leaned across what appeared to be a hastily erected rope-and-sawhorse barricade. It was manned by a firefighter in a smoke-stained turnout jacket with the broadest shoulders she’d ever seen. And an expression as stony as Rushmore.
Erin locked the car, grabbed her tote bag, and jogged into the wind toward the barricade, trying to place the daunting firefighter. Tall, with close-cropped blond hair, a sturdy jaw, and a rugged profile. He turned, arms crossed, to talk with someone across the barricade, so she couldn’t see all of his face. But he wasn’t a full-time medic; she knew them all. An engine company volunteer? Maybe, but she hadn’t met him. She was sure of that. Because, even from what little she’d seen, this man would have been memorable. Her face warmed ridiculously as she slowed to a walk.
But her growing curiosity about his identity was a moot point. There wasn’t time for that now. She needed to slip between those sawhorses, hustle into the ER, touch base with the relief charge nurse, brainstorm with Leigh Stathos, and see what she could do to help straighten out this mess.
Erin stopped short as the big firefighter turned abruptly, blocking her way.
“Excuse me,” she said, sweeping wind-tossed hair from her face as she peered up at him. Gray. His eyes were granite gray. “I need to get past you. Thanks. Appreciate it.” She attempted to squeeze by him, catching a faint whiff of citrusy cologne . . . mixed with smoke.
“Don’t thank me. And stop right where you are.” He stepped in front of her, halting her in her tracks. There was the slightest twitch at the corner of his mouth. Not a smile. He crossed his arms again. “No one can come through here. Those are the rules. And I go by the book. Sorry.”
By the book? As if she didn’t have policies to follow? Erin forced herself to take a deep breath. Lord, show me the humor in this. Called to work on her day off and then denied access. It was funny if you thought about it. She tried to smile and managed a pinched grimace. This was about as funny as the mold in her shower. She met his gaze, noticing that he had a small scar just below his lower lip. Probably from somebody’s fist.
“I work here, Captain . . . McKenna,” Erin explained, reading the name stenciled on his jacket. “In fact—” she patted the left breast pocket of her scrubs, then remembered her missing name badge—“I’m the day shift charge nurse. But I forgot my badge.”
“I see,” he said, uncrossing his arms. He pointed toward the trio of reporters leaning over the barricade. “See that reporter over there—the tall woman with the microphone and bag of Doritos? Ten minutes ago she pulled a white coat out of one of those news vans and tried to tell me she was a doctor on her way to an emergency delivery. Premature twins.”
“But that’s unbelievable. That’s—”
“Exactly why I’m standing here,” the captain interrupted. “So without hospital ID or someone to corroborate, I can’t let you in.”
Her jaw tightened, and she glanced toward the ER doors. “One of your paramedics is back there somewhere; Chuck knows me. He’s married to my triage nurse. Find him and ask him.”
McKenna shook his head. “Can’t leave this spot.”
“Then call.” Erin pointed to the cell phone on his belt. “Better yet, ask for Dr. Leigh Stathos. Tell her I’m here. She’ll verify my identity. The number is—”
“I’ve got it,” he said, lifting his phone and watching her intently as he made an inquiry. He gave a short laugh. “Yes. A redhead in what looks like Army fatigues . . . Ah, let’s see . . . green eyes. And about—” his gaze moved discreetly over her—“maybe five foot nine?”
Erin narrowed her eyes. What was this, a lineup?
The captain lowered the phone. “Your name?”
“Erin Quinn,” she said, feeling like she should extend her hand or something. She resisted the impulse.
“Hmm. Yes,” he said into the phone. “I see. Okay, then.” He cleared his throat and disconnected the call.
She looked at him. “Did you get what you needed?”
“Well,” he said, reaching down to detach the rope from a sawhorse, “it seems you’re who you say you are. And that I shouldn’t expect a commendation for detaining you. Apparently it’s because of your request that I’m here. Not that I wanted to be. I still have men out on the plane crash, but . . .” He hesitated and then flashed the barest of smiles. Though fleeting, it transformed his face from Rushmore cold to almost human. “Go on inside, Erin Quinn. You’re late.” His expression returned to chiseled stone. “And for what it’s worth, I’m sorry. But that’s the way this has to work.”
“No problemo.” Erin hitched her tote bag over her shoulder and stepped through the barricade. Then she turned back. “What’s your first name, McKenna?”
She extended her hand and was surprised by the warmth of his. “Well, then. Good job, Scott. But going by the book isn’t always the bottom line. Try to develop a little trust, will you? We’re all on the same team.”
Twenty minutes later, Erin finished checking on her staff and rejoined Leigh Stathos in the code room. They both looked up as the housekeeping tech arrived at the doorway.
“You wanted these?” Sarge asked.
“Yes. Great. Thank you.” Erin nodded at the tall, fortysomething man wearing tan scrubs, his brown hair pulled back into a short ponytail and arms full of plastic emesis basins. “Put those in the utility room, would you? And I think we could use some extra sheets and gowns too. If you don’t mind.”
His intense eyes met hers for an instant before glancing down. “Yes, ma’am, double time.”
Erin smiled at Sarge’s familiar and somber half salute, then watched him march away, his powerful frame moving in an awkward hitch to accommodate his artificial leg. She returned her attention to Leigh and the dark-eyed child on the gurney beside them. The ventilator, overriding her natural breathing, whooshed at regular intervals, filling the girl’s lungs. “She had two seizures but none before today?”
“Looks that way.” The ER physician, her long mahogany hair swept back loosely into a clip, reached down and lifted the sheet covering the child. “But see how her muscles are still twitchy? And her pupils are constricted. I’ll be honest: I don’t like this. The only thing I know for sure is that the X-ray shows an aspiration pneumonia. Probably choked while vomiting on the truck ride in. I’ve started antibiotics. Art’s coming in,” she added, referring to the on-call pediatrician. “And I paged the public health officer.”
“Good.” Erin’s brows scrunched. It was puzzling; an hour after arrival, Ana Galvez remained unresponsive, her skin glistening with perspiration. Though Leigh had inserted an endotracheal tube and the child was suctioned frequently, she was still producing large amounts of saliva. Her heart rate, barely 70, was surprisingly slow for her age. She’d had several episodes of diarrhea. Poor kid. What happened to you?
Erin glanced toward the main room of the ER, grateful things appeared to be settling down out there. “I still don’t get this, though. Ana came from home? Not the ranch where everybody got sick?”
“Yes, but—” Leigh fiddled with the stethoscope draped across the shoulders of her steel gray scrub top—“she’d been there earlier. Felt sick after lunch and her father took her home.”
“So that goes right back to the food. But salmonella takes time. Still, the symptoms fit. Triage says most of the patients are complaining of headache, nausea, cramps, and diarrhea.” Erin checked the monitor: heart rate 58. Why so slow? “What did they eat?”
Leigh sighed. “Sack lunches. Every one different. That doesn’t fit at all. I wanted it to be huge tubs of chicken stew that everyone shared. That would make sense. But Sandy’s seen twenty-six patients in triage now, and the story from everybody sounds the same: picking strawberries since 6 a.m., lunch together around eleven, and—”
“I’m sorry to interrupt, but something’s . . . wrong.” Erin and Leigh turned at the sound of the triage nurse’s voice at the doorway.
Erin’s eyes widened. The triage nurse looked awful—pale, sweaty, teary-eyed. Sandy was holding her hand to her head, trembling. What happened?
Before she could ask, Sandy’s eyelids fluttered and her knees gave way.