8. Shep

EIGHT

Shep

Tuesday, July 9

6:49 am

The operating room hums with tension as I stand poised over the patient, a thirty-two-year-old female. She's my age, and I have her life in my hands. Her brain is exposed as I work to save her life.

A complex arteriovenous malformation snakes through the delicate tissue, a ticking time bomb of tangled blood vessels. One wrong move could trigger catastrophic bleeding.

"Suction," I command, my voice steady despite the stakes. The assisting nurse responds instantly, clearing my field of view.

I precisely manipulate the microsurgical instruments, carefully separating the malformed vessels from healthy brain matter.

"BP's dropping," the anesthesiologist warns.

"I see it," I bark, not taking my eyes off the microscope view. "Almost there."

Sweat beads on my forehead as I meticulously clip and cauterize feeder arteries. The malformation gradually shrinks, and its blood supply is cut off. But the real test is yet to come.

"Preparing for final resection," I announce. The OR collectively holds its breath.

With painstaking care, I excise the tangled mass of vessels. Long, tense minutes pass as I work to remove every last trace without damaging surrounding tissue.

Finally, I straighten up. "It's out. Let's close her up."

A collective sigh of relief ripples through the team. As we begin closing, I allow myself a small smile behind my mask. Another life case completed successfully, another seemingly impossible challenge overcome.

9:58 am

I pace the hospital corridor, phone pressed to my ear, frustration mounting with each unanswered call. Where the hell is Ari? It's not like her to ghost on Opie.

I decide to contact our mutual friends who still stay in close contact with Ari. I've left her three messages and texted her. She obviously will not call me back. Hopefully, they have heard from her.

"Hey, Matt. It's Shep. Have you heard from Ari? She was supposed to pick up Opie yesterday but didn't show and isn't taking my calls."

Matt's voice crackles through the line. "Oh yeah, she flew to Houston for the holiday weekend. I think her flight back was Monday afternoon. I'll call Leddie to see if she's heard from her."

My jaw clenches. "Houston? Yeah, man, if you don't mind asking her. Thanks."

I never thought Ari would do something like this. She has been seeing a pilot who is based out of Houston. She must have gone there to spend the Fourth with him. I don't care what she does with her personal life, but I do fucking care when it involves her neglecting our son.

"Sure, I'll drop you a line once I talk to Leddie."

I hang up, my blood pressure rising. Carly approaches, clipboard in hand.

"Everything okay, Dr. Duncan? You look ready to punch a wall."

I run a hand through my hair. "I am. Ari's MIA. Apparently, she took an impromptu trip to Houston with her boy toy and decided to go dark. I wouldn't care, except she left Opie hanging yesterday. I'm just irritated, that's all."

Carly's eyes widen. "Houston? Didn't you hear about Hurricane Beryl? It slammed the coast pretty hard yesterday. I hope she is okay."

My anger deflates, replaced by a knot of worry. "Wait, What? No, I haven't looked at the television or news in days. I didn't even think it was hurricane season yet."

"First one of the season. It's been all over the news for a good week. It slammed some islands first, and then I believe it hit Texas yesterday sometime. Flooding, power outages. I wouldn't be surprised if the airport shut down."

I lean against the wall, mind racing. "Shit. But why didn't she call? I hope she's okay."

Carly pats my arm. "I'm sure she is. They're probably just dealing with the aftermath. Do you want me to help you with Opie or anything? My shift ends today at two. I'm happy to hang out with him if you need me to."

Grateful, I nod. "I appreciate it. He is with his nanny right now, but I know she can't do it for unlimited time, so I may take you up on it."

She clears her throat. "While I've got you, there's something else. Elizabeth Herring, the girl with the fence picket injury from this weekend? She's having some complications. Mind taking a look at her chart?"

"Of course," I say, reaching for the tablet she hands me. I scroll through Elizabeth's latest vitals and notes, my brow furrowing. "Hmm. Her temperature spiked to 101.3, and her white blood cell count is elevated. Could be the start of an infection."

I continue reading, concern growing. "And it looks like she's experiencing some numbness in her left foot. That could indicate nerve compression or inflammation near the surgical site."

Carly nods. "That's what I was worried about. She's over in rehab next door. Think you should take a look?"

"Definitely," I agree, already heading for the door. "I want to examine her myself and maybe order some additional bloodwork and imaging. We need to catch any complications early with an injury like this."

I typically don't make calls to rehab. Normally, I would have the nurses put her on my schedule and bring her to me over here. But I can't pass up the opportunity to drop in to say hi to Elle. This way, it doesn't seem desperate if I'm already over there.

11:01 am

I finish examining Elizabeth, relieved to find that her numbness seems to be resolving and her fever is responding to the antibiotics we started. As I step out into the hallway, I realize I'm just a few doors down from Elle's room.

Almost without conscious thought, my feet carry me in her direction. But when I arrive, her room is empty.

"Excuse me," I say, flagging down a passing nurse. "I'm looking for Elle Klass. Is she around?"

The nurse consults her chart. "She's in a therapy session right now. Down the hall and to the left."

I nod my thanks and head that way, my pulse quickening with each step. When I reach the therapy room, I watch through the large plate glass window.

Elle is seated at a table across from her therapist, her injured hand resting on a molded putty surface. The therapist guides her through a series of exercises, having her press her fingers into the putty to strengthen her grip and dexterity.

I watch, transfixed, as Elle concentrates on the movements. Her brow furrows with determination, her lips pressed together. Even from here, I can see the sheen of sweat on her forehead from the effort.

God, she is beautiful. Her long brown hair is twisted up into a messy bun on top of her head. Loose hair falls, framing her face.

Something twists inside my chest at the sight of her like this. She's vulnerable yet resilient, wounded but refusing to be broken. It stirs up a surge of protectiveness and tenderness that catches me off guard.

Elle glances up and meets my gaze through the window as if sensing my presence. Surprise spreads across her face, followed by a tentative smile.

I take that as my cue to enter. "Hey there," I say softly, not wanting to disrupt the session. I was just down the hall checking on another patient and saw you two hard at work. I was just admiring your tenacity. I didn't mean to interrupt."

The therapist waves off my apology. "No worries; we were just finishing up." She helps Elle clean the putty off her hand, carefully wraps her hand and arm on a backing board, and then places them in a sling.

"In that case, would you mind if I walked you back to your room?" I offer, hoping I don't sound too eager. I've got a few minutes before my next surgery."

"I'd like that. Thanks, Shep."

My heart stumbles at the sound of my name on her lips, so familiar yet new all at once.

"Don't forget to work on those few exercises we practiced," the therapist says as she puts her canvas bag on her shoulder and heads toward the door. "I'll be by your room in a few hours for round two."

"I'm on it," Elle says back.

I help her up from the chair, acutely aware of her nearness as we exit the therapy room side by side.

As we walk back to Elle's room, I can't help but marvel at how natural it feels to walk with her like this again, even after all these years. Our banter flows effortlessly, the playful quips and teasing reminders of the easy rapport we once shared.

"You know, I was planning to bring you something better than hospital food for dinner tonight," I mention casually, glancing over at her. "But I need to get back home to Opie."

My mind flashes to Ari's situation, the unanswered questions, and the rising concern. But I push those thoughts aside, for now, not wanting to burden Elle with my personal drama.

"How about a rain check?" I suggest, instead, an idea forming. "I could bring something from my favorite restaurant in Birmingham tomorrow if you're up for it. We could have dinner together, give you a break from the oh-so-gourmet hospital cuisine."

Elle laughs, the sound warming me from the inside out. "I'd love that, Shep. Although I must admit, I've had worse than the food here."

"Well, prepare to have your mind blown," I tease, grinning. "I'll let you know tomorrow if I can make it happen."

We reach her room far too quickly for my liking. Reluctant to leave her company, I linger in the doorway.

Regrettably, I say, "I hate to run, but duty calls. I might have to come back by after surgery to check on my patient down the hall, though." The small fib rolls off my tongue before I can stop it. "If I do, I'll poke my head in to say bye."

Elle smiles softly, a knowing glint in her eye that makes me wonder if she sees right through my flimsy excuse. "I'll be here. Don't work too hard, Dr. Duncan."

"No promises," I reply with a cheesy wink, backing out of her room. Oh my God. Why did I wink?

As I walk away, I'm already counting down the hours until I can see her again, my mind buzzing with the idea of bringing her dinner tomorrow. I'm toeing a dangerous line, letting myself get drawn back into her orbit. But right now, basking in the afterglow of her smile, I can't bring myself to care.

2:22 pm

I walk out of the scrub room after my last surgery of the day and head to the surgical waiting room to update family members that we are done with surgery. Pulling down my facemask, I'm grateful for the unobstructed fresh air that fills me.

The hospital corridors are filled with heightened activity, replacing the usual craziness. Nurses and doctors rush by, their faces etched with concern and urgency. Maintenance crew members are in every direction. Something big is going down.

I grab the arm of a passing nurse. "What's happening?"

"Pipe burst on the west end," she explains hurriedly. "It's causing major flooding in that wing. They're trying to contain it now, but we are trying to secure empty beds on this side to move patients."

After speaking with Mr. Anderson's wife, I come back to the computer to chart a few things from his surgery while they are fresh in my mind. The surrounding commotion is almost dizzying. Staff rush past, their voices blending into a constant hum.

I catch snippets of conversations about the water main line bursting and the fallout from the patients all the way down to supply closets. It's a mess, but thankfully, the OR is on the opposite side of the hospital, so it isn't my immediate problem.

As I finish my notes, I hear Marijka on the phone. She's the "mama bear" of our unit, always looking out for everyone. Her accented voice carries over the chaos, firm and steady, as she asks about open beds for rehab patients.

A cold realization hits me. The rehab center is connected on the west side. My stomach drops, a heavy weight settling in. Elle. Is she caught up in this mess? Suddenly, this feels like it is my immediate problem.

I lean over to the nurse beside me. "Do you know if the rehab is affected?" I ask, a knot forming in my stomach. I am already certain of the answer based on the phone call I just overheard.

She nods grimly. "They're hit the worst from what I hear."

I take off toward Marijka's post. She is barking orders into a phone, her face pinched with stress.

"Marijka!" I call out, jogging over to her. "What's the plan for the rehab patients?"

She hangs up the phone with a heavy sigh. "It's a mess, Dr. D. We've got to transfer all of them to different facilities in the tri-county area, maybe even further if we can't find enough beds nearby."

I run my hand over my face, my stubble rough on the palm of my hand. I try to process the magnitude of the situation. "How many patients are we talking about?"

"Over seventy," Marijka replies, her accent thicker than usual in her agitation. "On a normal day, finding one open bed is a feat. Now we've got to relocate an entire ward."

The gravity of the situation hits me like a ton of bricks. I realize some patients, Elle included, could end up God knows where. On top of that, there's the logistical nightmare of the paperwork and transport involved... Most of them will likely be held in the limbo of hell, trying to get wherever they are going.

"I want to assist," I say, already considering which of my hospital contacts to reach out to. "What can I do?"

Marijka responds with an appreciative gesture. "Thanks, Doc. I don't think you can do much unless you have some beds to offer. This is an exercise in moving coconuts, a hope, and a prayer that we can find a place for these patients."

I do have two extra beds, as it turns out. I obviously won't offer them to strangers, but I could put Elle up until they secure a place for her. Maybe a night or two, and they will have the issue fixed, and she can come back here. As opposed to being shipped off somewhere else, God only knows where. If they do that, the likelihood of her transferring back is next to zero.

I pick up my phone and call Charlie Hampton's number, my heart racing with expectancy. He answers on the third ring.

"Charlie, it's Shep. You heard about the flooding?"

"Yeah, I just got the news. It's a mess. I've got patients in that rehab."

I take a deep breath. "Remember I mentioned that Elle that I go way back? She's a good friend of mine from college," I say, stretching the truth of how we are connected.

"I've been thinking about how I can help. If you're not ready to release her, I can offer her a room at my place for a night or two until this gets sorted out. She could continue her therapy with our hospital therapists."

Charlie's voice comes through, tinged with relief. "That's an excellent idea, Shep. I was considering transferring her to Florida, but, to be honest, I'd prefer to keep her close for at least a few more days. Her charts show she's doing well, but this first week or two after surgery is a crucial time. Not to mention, she has a follow-up appointment in my clinic at the end of the week. If I could keep her in Birmingham until then, that would be ideal."

"Great," I say, trying to keep the excitement out of my voice. "If it works for Elle, of course."

"Of course," Charlie agrees. "Run it by her and keep me posted."

We hang up, and I lean back in my chair, running a hand through my hair. Now comes the tricky part—figuring out how to invite Elle to stay at my house without making it seem like I'm asking her to come shack up with me. I've got to approach this carefully and make it clear it's a medical decision, not a personal one.

Yeah, right.