Chapter One

Sara Patterson snaked her way through the cafeteria tables to the one in the alcove reserved for hospital employees. It had been a long, stressful morning. The outlets on the microscope bench weren’t working, the printer was in one of its contrary funks and she had just reported test results showing a young mother with acute lymphocytic leukemia.

Sara had only been working in the hospital laboratory for a few weeks, but wasn’t sure she’d ever get used to heartbreaking results. Her previous job as an assistant in a research lab

  meant her day was spent pipetting serum samples and recording test results. Not interacting with actual patients.

She needed this lunch break and looked forward to it if only for a chance to sit down and relax. With luck she’d have thirty minutes of friendly conversation with co-workers to recharge her batteries. And with a little more luck the woman from Physical Therapy wouldn’t keep hitting on her. A nice enough person probably, but Sara didn’t have time for that. She had one last class to finish her master’s degree in medical laboratory science and a student loan from hell to pay. At thirty-four years old, she had the job she had always dreamed of and was in the prime of her life. But since her last relationship hadn’t worked out, dating wasn’t very high on her priority list. She wasn’t ready to plunge back into that dating pool. Not yet. Sure, she had those little urges from time to time. Who didn’t? That’s why God invented batteries. Right now she wanted to enjoy her egg salad sandwich and a cup of fresh, non-reheated coffee.

“Hello,” she said, setting her lunch sack at an available space. “What’s the cafeteria special today?” She studied the trays, wondering if she’d rather forego her sandwich for something cooked with melted cheese on it.

“Cardboard tartare,” offered a gray-haired woman in Hello Kitty scrubs, her sneer speaking volumes. “It must be a new recipe.”

“Oh, ew.” Sara pulled a ceramic coffee cup from her sack and went to fill it, a perk offered to hospital employees who supplied their own cup. By the time she returned, three others had joined the table.

“Hey, Sara. Did you sign up for the cruise?” a stocky woman with bushy eyebrows asked with an expectant smile. “The deadline is Friday. We need five more to get the free shuttle and happy hour discount.”

“I can’t, but thanks for asking. I don’t have any vacation time yet.”

“That is so stupid. They should give you two weeks when you start. Not after six months.”

Sara unwrapped her sandwich and took a bite. She was tired of egg salad. And she was tired of being asked every day if she was going on the cruise. Even if she had vacation time she wasn’t sure she’d spend it on a cruise. She was probably the only person at the table who hadn’t been on a cruise somewhere. Ilwaco, Washington, sat at the mouth of the Columbia River on the northern shore across from Astoria, Oregon. As part of Washington’s Long Beach Peninsula, home to nearly five thousand residents and a popular tourist destination, Ilwaco was one of several towns along the shore. Cruising was a way of life, or at least it seemed to be. West to the Hawaiian Islands, north to Alaska and the Inside Passage or just up the Columbia River for a lazy weekend. As a voracious reader, Sara would rather spend her spare time curled up with a good book or walking the shores of Long Beach. Quiet, peaceful, stress-free in unobtrusive solitude.

“Did you ever consider she didn’t sign up because she doesn’t like cruises?” A thin woman slid her tray in next to Sara. “Hi. I don’t think we’ve met,” she said, smiling down at Sara. She wore a light gray pantsuit and navy blouse over small breasts. “I’m Margie Snow. Patient Accounts. Welcome to the tribe.”

“Hello. I’m Sara…” she said behind her hand as she hurriedly chewed.

“Patterson. Yes, I passed you in the hall outside the lab Monday afternoon. I was going to introduce myself then, but you looked like you were in a hurry. You were carrying one of those trays of tubes.”

“Phlebotomy tray. Yes, I was on my way to ER.” Sara offered a handshake. “Nice to meet you, Margie. And you’re right. Cruises aren’t my favorite thing.”

“It’s okay. When the spirit moves you you’ll sign up for one. I finally did and loved every minute of it. At least I did until we left the dock. Do yourself a favor. Buy a fifty-gallon drum of Dramamine before you go.”

“Thank you. I’ll remember that.”

“You’re going to scare her off, Margie,” Hello Kitty scrubs whined. “We’re trying to break her out of her shell. Not send her running for the hills.”

“Is that true? Are you lacking a daring spirit, Sara?” Margie stirred her fork through her salad, picking out bites of tomato.

“She’s cautious.”

“I’m practical,” Sara replied.

“Don’t look now, Ms. Practical, but here comes your boss.”

Everyone at the table looked at the white-haired man entering the cafeteria. Dr. Irving Lesterbrook had been laboratory director for more years than most employees had worked at Ocean Side Hospital. He wore dark trousers, and a white dress shirt and tie. That was his attire, every day, year round, rain or shine, regardless of the season, and topped with his ubiquitous plain white lab coat. Somewhere in his late sixties, it was assumed he was approaching retirement although he never discussed it. As far as anyone knew, his life revolved around his job at the hospital. He was a no-nonsense boss with an almost military demand for efficiency. He was also an expert on microbiology. Sara admired that in spite of his authoritative attitude.

“I have a feeling my lunch break is about to end,” Sara muttered as Dr. Lesterbrook crossed the room with purposeful strides.

“Sara, we’re jammed up. Edie is covering ER and Trevor is in the ward. I need you to come take care of a couple walk-ins. It shouldn’t take long. Sorry to interrupt your lunch.” He didn’t sound sorry. He sounded impatient.

“Sure. I’ll be right there.”

Sara took a quick bite then dropped the sandwich in the sack and headed for the lab. Seniority-wise, she was low person on the totem pole. This wasn’t the first lunch or coffee break she had been asked to give up. Working at a small regional hospital with staffing and budget constraints, she knew it wouldn’t be the last either. She considered it a rite of passage. Demonstrate she was worthy of his trust. Demonstrate she was a team player. Demonstrate she could grin and bear it.

Sara stopped at the laboratory receptionist to collect the orders. Dr. Lesterbrook was right. The waiting room for walk-in patients needing laboratory tests was indeed jammed up. A gentleman with a two-day-old beard occupied the first chair just inside the door, his eyes staring off into space as if lost in thought. A thirty-something woman with a sleeping toddler on her lap sat across from him. Another child a year or two older stood on the chair next to her, playing with the woman’s jacket zipper. Another woman Sara guessed to be in her mid-twenties sat in the corner chair. She wore faded jeans, a green army jacket and had her legs crossed. Not the typical crossed at the ankle or at the knees but a full-fledged, foot-perched-on-the-opposite-knee leg cross. In spite of her rough-edged attire and brazen posture, she had an anxious look about her.

“Hello. My name is Sara and I’ll be taking care of you today. I’m not sure who was first.”

“Take them,” the woman in the army jacket said, pointing to the mother and the two small children.

The man by the door nodded in agreement in spite of his vacant stare.

“Marietta Lattimore?” Sara read from the computer printout. “That must be this little gal.” She stroked her hand over the toddler’s curly hair. “Mrs. Lattimore, would you like to come with me?”

The woman turned to the child standing in the chair and scowled.

“Loretta, you sit down and don’t touch anything. Do you hear me?”

The child slid down onto her bottom and began swinging her legs. Sara had no children of her own but recognized a mischievous just-wait-until-you’re-gone look.

“Ma’am, why don’t you bring them both? We’ve got plenty of room for her.”

There wasn’t. The drawing station was a cubicle large enough to accommodate a phlebotomy chair, a small cabinet and room for the technician to draw blood. But Sara thought leaving an energetic child unsupervised in a waiting room with strangers seemed overly presumptuous.

The woman followed Sara to the drawing station, one child sleeping against her shoulder, the other scanning the room as if searching for something to grab as she was pulled along by the hand.

“Mrs. Lattimore, you can have a seat here and Loretta, is it?” Sara smiled down at the child, diverting her hand as she was about to grab the tray of test tubes. “I have something for you.” She opened the cupboard and took out a plastic box of small toys and miscellaneous gadgets left by sales reps. “Would you like to play with these? I think there’s an Etch A Sketch in there somewhere. And a few Legos.” The child immediately sat down on the floor and began digging through the goodies.

Sara quickly collected what she needed for the tests, including a swaddling blanket with Velcro straps. As gentle and kind as she would try to be, there was no way to draw blood from children without them screaming and fighting the procedure.

“The doctor has ordered a throat culture and a CBC on Marietta. Why don’t we do the throat swab first?” She unwrapped a sterile swab while the mother situated the groggy child on her lap. “Marietta, can you open your mouth for me and say ahhhh, sweetheart?” she asked, cupping her free hand under the little girl’s chin. “It won’t hurt, sweetie. I just want to touch the back of your tongue.”

The child wiggled and tried to pull away, barking a raspy cough.

“Hold still, Marietta,” the mother coaxed. “The lady said it won’t hurt. Open your mouth.” She kissed her cheek then helped hold her head. Finally she opened her mouth wide enough for Sara to quickly swab the back of her throat.

“That was great. You are so brave. Thank you, Marietta.” Sara placed the swab in a tube, labeled it and set it aside. That was the easy part. “Marietta, can I see your arm, sweetie?”

Sara was willing to try to do the stick without wrapping the child in a protective restraint, but she wasn’t expecting that a two-year-old would cooperate enough for that. She was right. The minute Sara tried to straighten her arm she began to squirm and whine.

“Shh.” The mother tried to soothe the unhappy child. “Hold still.”

“Mrs. Lattimore, why don’t you bring her up here? Let’s wrap her in this blanket.” Sara cleared the counter and spread the blanket. “I know it seems harsh but this way she won’t thrash around and hurt herself.”

“No wonder the doctor’s office didn’t want to do it.”

“It’ll just take a minute. I know it isn’t what she wants but it’ll be over before she knows it.” Sara handed the toddler a ping-pong ball with a smiley face on it as they went about wrapping her in the blanket, leaving one arm free. “How you doing down there, Loretta?” she asked, checking to make sure she hadn’t wandered off into the lab. She was busy with the contents of the box. “Mom, I need you to hold Marietta’s head against your body, just like this. Put your other hand on her shoulder.”

Sara quickly secured a rubber tourniquet around the child’s arm and traced her fingertip downward, searching for a vein. When she found what she was looking for she cleaned the area with an alcohol wipe, affixed a small-gauge needle to a syringe and pulled the child’s arm down straight.

“You’re doing so well, Marietta.” Sara held tight to her arm as she slipped the needle in the vein and released the tourniquet. Just as she expected, the girl let out a blood-curdling scream and tried to pull away. “One more second, sweetie. Almost done.” She quickly drew the three cc’s she’d need. She covered the puncture site with a gauze square as she removed the needle. “There. All done.” She applied a Band-Aid to the gauze then helped unwrap the child, hoping it would soothe her screaming. It didn’t. Sara could hear it all the way down the hall and until they were out the door into the parking lot. Poor thing, she thought. Children, especially sick ones, shouldn’t have to endure things like that.

Sara transferred the blood in the syringe into a labeled tube. Normally she would place the tube in the rotator and she would culture the swab onto an agar plate. But she had additional patients waiting. She set the samples in the refrigerator to be processed later and went back to the waiting room for the next patient.

“He’s next,” the woman in the corner said as Sara came through the door.

“Okay. Mr. Yates would you like to come with me and we’ll get your pro time drawn? I’m sorry you had to wait.”

“I didn’t mind. Got to take a little nap.” He smiled and looked her up and down. “You’re new, aren’t you?”

“Yes sir.”

She followed him to the drawing station. According to the lab orders, Mr. Yates was a regular. He was taking a blood thinner and stopped in once a month to have his clotting checked. He was an old hand at having his blood drawn. He sat down, rolled up his sleeve and extended his arm. Sara collected his sample and labeled the tube.

“See you next month, Mr. Yates,” she said, escorting him to the door, inserting the tube into the centrifuge as she passed the table.

“You’re a good poker,” he announced with a kind nod. “Didn’t feel a thing.”

“I’m glad. You take care.”

One patient left. The woman in the army jacket in for routine blood counts, a pregnancy test and a BRCA test to detect the gene mutations responsible for many breast and ovarian cancers. Sara couldn’t help but wonder whether someone in the woman’s family had succumbed to breast cancer, raising her doctor’s concern that she too might be at risk, or already have breast cancer herself.

“Jessica Singer?” Sara read from the printout.

“Jessie Singer,” the woman replied, still sitting cross-legged, her arm draped over the back of a chair. “It’s not Jessica. Just Jessie.” She rolled her eyes up to Sara.

“Oh, I’m sorry. Jessie Singer.” She smiled, lingering a moment in the woman’s big brown eyes full of apprehension. “Are you ready?”

“Sure. I guess so.” She took a deep breath then stood. The color in her cheeks faded slightly.

“How are you today, Ms. Singer?” Sara used small talk to allay the woman’s fear, as she tried to do with all the patients she had to stick.

“I’m fine. Is this going to take a lot of blood?”

“No, just two tubes.” She stopped at the laboratory restroom and handed Jessie a specimen cup. “Could you also provide a urine sample for me?”

“Why do I need that?” She looked down at the cup but didn’t take it. “I thought this was a blood test.”

“The BRCA and CBC are blood tests. This is for the HCG test.”

“Which is?”

“The pregnancy test.”

“I’m not taking that.” Jessie chuckled sarcastically.

“Your doctor ordered it. It’s just routine.”

“I’m not taking a pregnancy test. I’m not pregnant.”

“The test measures the HCG hormone in your body and can tell if you are pregnant even before you miss your first period.”

“Look, Miss Patterson,” she said, staring at Sara’s name badge. “I’m not taking a freaking pregnancy test. I’m not pregnant. There is absolutely no way I’m pregnant. I don’t sleep with men and I don’t believe in immaculate conception. I’m gay.” She took the cup from Sara’s hand and placed it back on the shelf. “Any questions?”

“Nope. Not a one.” Sara led the way into the drawing station trying to hide a smile. She wasn’t all that surprised Ms. Singer was gay, but she was surprised at her blatant admission to it. In spite of the orders, Sara had to agree with her. If Sara’s doctor ordered a pregnancy test she would decline as well and for the same reason.