Chapter 4 - THE BOY SHE COULDN’T LOSESarah reached Eli’s bedside before anyone could stop her.
“Eli!”
A nurse caught her arm.
“Dr. Carter—”
“That’s my brother.”
Ryan’s professional instincts took over.
“Sarah, step back.”
She looked at him as if he had struck her.
“I can help.”
“You’re his sister.”
“I’m a doctor.”
“Right now you’re his sister.”
The distinction devastated her.
Ryan turned to the code team.
“What happened?”
“Sudden ventricular tachycardia. Collapsed during a school field trip.”
Ryan looked at the monitor.
Eli was fourteen.
Thin.
Pale.
Too young to be lying beneath fluorescent lights while adults fought to convince his heart to keep beating.
“Shock.”
The defibrillator fired.
Eli’s body jerked.
Sarah flinched.
Nothing.
“Again.”
Another shock.
The rhythm changed.
A pulse returned.
Sarah covered her mouth.
Ryan didn’t relax.
“Echo. Labs. Genetic panel. Get cardiology down here.”
Then he looked at Sarah.
“When did he start having symptoms?”
Her silence worried him.
“Sarah.”
“Three months ago.”
“What symptoms?”
“Dizziness. Shortness of breath.”
“And?”
“Two episodes of fainting.”
Ryan stared at her.
“You knew?”
“I took him to a clinic.”
“What did they say?”
“Dehydration. Anxiety.”
“You’re a physician.”
“I was a medical student when it started.”
“You knew enough to question that.”
Her face tightened.
“You think I don’t know that?”
Ryan immediately regretted the tone.
Sarah looked through the glass at her unconscious brother.
“I was studying for boards. Mom was working nights. Eli kept saying he was fine.”
Her voice broke.
“I believed him because I needed him to be fine.”
Ryan softened.
“We’re going to figure this out.”
“You can’t promise that.”
“No.”
He remembered his orientation speech.
Never lie to a patient.
Never hide uncertainty.
So he corrected himself.
“I promise we’ll do everything possible.”
Sarah nodded.
Hours later, the scans revealed the problem.
Hypertrophic cardiomyopathy.
Severe.
Likely genetic.
Eli’s heart muscle had thickened dangerously, creating an electrical instability capable of causing sudden death.
Ryan explained the findings to Sarah and Margaret Carter in a private consultation room.
Margaret looked twenty years older than Ryan remembered.
When she recognized him, something like fear passed through her face.
“Ryan Dalton.”
“Mrs. Carter.”
“You stay away from my daughter.”
Sarah turned.
“Mom.”
Margaret stood.
“No.”
“Mom, he’s Eli’s surgeon.”
“He’s a Dalton.”
Ryan absorbed the words.
Sarah said, “He didn’t know what his father did.”
Margaret laughed bitterly.
“They always know enough.”
Ryan could have defended himself.
He didn’t.
“Mrs. Carter, you have every reason not to trust my family. But right now Eli needs an implantable defibrillator, and depending on additional testing, he may need surgery.”
Margaret stared at him.
“Will he live?”
Ryan answered carefully.
“I believe we can give him a very good chance.”
Margaret’s eyes filled.
“That’s not what I asked.”
“No.”
Ryan paused.
“I can’t promise you he’ll live. No honest doctor can. But if he were my brother, I would recommend exactly what I’m recommending to you.”
Margaret slowly sat down.
Sarah watched him.
Something changed between them.
Not forgiveness.
Not yet.
But trust had taken its first breath.
Eli woke that evening.
His first words were, “Did I die?”
Sarah laughed and cried simultaneously.
“Almost.”
“That seems dramatic.”
“You’re impossible.”
Eli noticed Ryan.
“Who’s the suit?”
Ryan looked down at himself.
He had changed after surgery.
“Dr. Ryan Dalton.”
Eli blinked.
Then looked at Sarah.
“Oh.”
Sarah stiffened.
Ryan noticed.
“What does ‘oh’ mean?”
Eli smiled weakly.
“You’re that Ryan.”
Sarah nearly dropped the cup in her hand.
“Eli.”
“What?”
Ryan looked at Sarah.
“That Ryan?”
“My brother is medicated.”
“I’m extremely medicated,” Eli agreed.
Ryan almost laughed.
Sarah pushed the call button.
“I’m asking them to increase it.”
For the first time since she arrived at Franklin, Ryan saw her smile.
It disappeared quickly.
But he had seen it.
The next morning, another problem arrived.
Franklin’s hospital board chairman, Theodore Wexler, requested Ryan in the executive conference room.
Marcus Hale was waiting.
So was legal counsel.
Wexler slid a document across the table.
“Dr. Carter’s relationship with you creates a conflict.”
Ryan’s expression remained flat.
“What relationship?”
Wexler looked uncomfortable.
“Prior personal history.”
“We knew each other twelve years ago.”
“And now her brother is your patient.”
“I’m aware.”
Hale leaned back.
“You’ve publicly contradicted an attending on her behalf.”
“I contradicted him because he was wrong.”
Hale’s face hardened.
Wexler continued.
“There’s another issue.”
He placed Sarah’s application file on the table.
“She received the Dalton Foundation Fellowship.”
Ryan frowned.
“I didn’t know.”
“The committee did.”
“And?”
“And there will be questions about whether Dr. Carter earned her position.”
Ryan stood.
“She graduated near the top of her class.”
“That isn’t the point.”
“It is exactly the point.”
Wexler lowered his voice.
“Ryan, you are not simply an employee here. Your family foundation is Franklin’s largest private donor.”
There it was.
Money.
Again.
Reaching into Sarah’s life.
Ryan looked around the table.
“What are you suggesting?”
“That Dr. Carter transfer to another residency program.”
“No.”
“Ryan.”
“No.”
Hale smiled slightly.
“Then perhaps you should recuse yourself as department chief.”
Ryan turned toward him.
“If those are the choices, I’ll recuse myself from evaluating Dr. Carter.”
Wexler shook his head.
“That may not be enough.”
Ryan leaned forward.
“Then find enough.”
He walked out.
Sarah was waiting in the hallway.
She had heard enough.
“You shouldn’t do that.”
“Do what?”
“Risk your position.”
“My position isn’t at risk.”
“Don’t lie to me.”
Ryan stopped.
Sarah’s eyes were angry.
“I don’t need you rescuing me.”
“I know.”
“Then stop.”
“I’m not rescuing you.”
“What would you call it?”
Ryan stepped closer.
“Correcting something my family should never have been allowed to break.”
Sarah’s expression softened despite herself.
Before she could answer, Allison hurried toward them.
“Ryan.”
Something in her voice changed everything.
“What?”
“It’s Eli.”
Sarah went white.
“He’s conscious.”
“Then what?”
Allison handed Ryan a scan.
“We found something else.”
Ryan studied it.
His stomach dropped.
Eli’s cardiomyopathy was not the only problem.
There was a mass pressing against the left atrium.
And judging by its position, removing it might require a surgery only a handful of surgeons in the country would attempt.
Sarah looked at Ryan.
“What is it?”
May you like
Ryan raised his eyes.
For the first time since she had known him, Sarah saw fear on his face.
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