Heart Like Mine Read online

  “You want to really know what it’s like to work a patient floor, right?”

  She sat back. “Um, no. You want me to know what it’s like to work a patient floor. Apparently. When did we change the part about me just hanging out in the background?”

  “Millie—she’s the head nurse you met—and I talked earlier this morning. We both think that if you are really invested in making the best decisions for this floor, then you need to muck right in.”

  “Muck right in? What does that mean, exactly?” Delaney looked at her watch. It was only seven o’clock, and he’d already had a meeting with the head nurse? “What kind of hours do you work, anyway?”

  “We work a lot of hours, Delaney. I think this is one of the things you’re only going to see if you’re down there. I’ve got salaried nurses doing fifty to sixty hours a week right now.”

  “How is that possible? Isn’t the union going nuts?”

  “We’re paying hellish overtime, that’s how. Because—as you kindly pointed out—our staffing ratios are high enough that I haven’t been able to make a case for more nurses.”

  She sighed quietly. “I’m sorry I said that.”

  She was. The more research she’d done this weekend, the more convinced she’d become that they didn’t, in fact, have enough nurses on the floor. The first item on her original proposal had been to reduce staffing, but it was already clear how shortsighted that had been, and she hadn’t even started her official observations yet.

  He looked at her intently, and she tried not to squirm under his gaze. “I appreciate you saying so.”

  She put up her hands. “Dr. Mackenzie, I will be the first to admit when I’m wrong, okay?”

  “But let me guess. It doesn’t happen often?”

  “No, it doesn’t.” She pointed to the box she’d dropped. “That box is full of research I did over the weekend, and it’s clear to me that the list I showed you last week was perhaps a bit premature, though it was the best I could come up with on short notice, with limited time to do proper analysis.”

  He pointed his chin at the box. “And now you think you’ve done that analysis?”

  “I’ve done a lot of it, yes.”

  “So do you have a new list?”

  “Only in my head.”

  And on my laptop. And on three printed pages in this folder under my hands.

  “And are you going to show it to me?”

  She took a breath, wondering if it was awful that she was enjoying his momentary discomfort as he wondered just what she’d put on the list this time. “I’d like to do some observing first, to see if my ideas hold water. Then we can talk.”

  He nodded slowly, sipping his coffee. “I guess that’s the best I can ask, given the situation.”

  “Agreed. And in the future, I’d really like to be involved in any conversation about what I will or won’t be doing on your floor. I’m not sure me mucking in is an approach that will help us meet our goals here.”

  She hid her hands under the desk as she realized they’d started shaking. What did mucking in mean, exactly? She was completely unqualified to do anything medical—they knew that, right? She was okay with interacting with patients—in a quiet, nonmedical, just-observational way—but that was it.

  Her goal for the week was to study their staffing models up close, examine their training programs, and conduct as many interviews as possible so she could make her recommendations with as clear a conscience as possible.

  She didn’t do anything halfway, and she hoped Dr. Mackenzie realized that.

  “Trust me. It’s the only way you’re going to really understand.” He sipped the coffee in his hand. “And no offense, but having my staff see somebody care enough to spend a week on the floor will be a refreshing change for them. I’m sure you realize there’s a certain level of distrust between patient floors and the executive suite here.”

  She tried not to bristle at his words. Distrust? Really? Did anyone on pediatrics have any idea how much money she’d helped bring to that floor over the past five years? Any idea how many grants she’d researched, proposed, and spent countless hours attaining? Any idea how many hours she’d sat in this office-with-a-view trying to figure out how to keep a pediatric department that ran on a razor’s-edge budget from going under?

  She didn’t think so. Even Dr. Mackenzie seemed unaware of just how hard she’d been working behind the scenes. To him, she was a signature on paperwork, and looking at his desk last week, it was pretty clear the man never had a chance to read said paperwork.

  Delaney took a steadying breath. “Dr. Mackenzie, no offense right back at you, but I think you—and your staff—need to be careful of your assumptions. There are a lot of people in this hospital who care about pediatrics. I can assure you you’re not the only one trying to make things work here.”

  “I know.” He put up a defensive hand. “I do.”

  She raised her eyebrows. “I can’t say I’ve ever agreed to move into anyone else’s closet, after all.”

  “Office.”

  She tipped her chin down and raised her eyebrows. “That is a closet.”

  “Fine. It’s a closet. In my defense, though, it is the only empty four-by-four space on the entire floor. And in my further defense, if you’re going to be down there anyway, we don’t want you hiding in an office.”

  Delaney sat back in her chair. “What is it, exactly, that you think I should do?”

  “Glad you asked.” He smiled, and her bristly feeling faded quickly. “We discussed a number of possibilities. I think today we’ll let you just observe at will. Tomorrow I’ll probably assign you to a staff member to shadow.”

  “You’ll assign me? Really?”

  “Does that bother you?” He raised his eyebrows. “Not used to being directed, Delaney?”

  She felt her eyes narrow. “How about we keep firmly in mind that I agreed to spend a week down there of my own volition?”

  He sighed, putting his head back. “Listen, let’s just see if we can make this work, okay? It’s way too early in the morning to do the verbal-sparring thing.”

  She felt a smile poking at the corners of her lips. “Haven’t had enough coffee deliveries to think straight yet?”

  He popped his head back to its normal position. “How do you know—”

  Delaney pointed to her file box. “Research, doctor. I do very thorough research.”

  Chapter 7

  Research, his ass. Josh rolled his eyes as he strode past the nurses’ station and into his office. Of course, there was a steaming cup of coffee on the desk, dammit.

  He pictured Delaney’s cute little smirk as she’d pointed to the box on the floor of her office, and he shook his head. She obviously had him pegged as some lothario doctor who loved having his staff swoon at his feet.

  It wasn’t his fault they did nice things for him. He’d never asked anyone to get him a coffee—not once in two years. They just—did it, which even after all this time, still stymied him. He looked in the mirror exactly once a day—typically to make sure he’d remembered to shave, but he just looked like … Josh. Not Dr. Dreamy, or whatever he’d caught Therese whispering one day.

  Seriously. If Therese had known him in seventh grade, with his dorky cowlick and braces and the God-awful pants that his legs always outgrew before his parents could afford to buy new ones, he was pretty sure she wouldn’t be trying so hard to be the one who got coffee to him first in the morning.

  “Morning, doc.” Millie poked her head into his office, pointing at the cup. “I see you’re already supplied this morning?”

  He sighed. “Looks like.”

  “Tough life, honey.” She smiled. “Are we expecting Miss Fancy Pants this morning? Or has she changed her mind?”

  “She’s coming, as far as I know. Said she had to do some paperwork before she came down.”

  “You want me to do the orienting? Or do you want the honors?”

  He pictured Delaney pointing at her door with her e
yebrows raised after he’d offered to escort her to pediatrics.

  I can find my way, thank you, she’d said, her voice frosty.

  He sighed. “Let’s just let her decide what she wants to do today.”

  “Thought you wanted me to make her an observation schedule?”

  “Pretty sure Delaney Blair is used to making her own schedule, Millie. We’ll give her free rein today—just make sure everybody’s on their best behavior, okay?”

  Millie shook her head. “Great. Now I’ve got a full floor of patients, I’m one nurse short, and I’ve got to tiptoe around a finance office visitor.”

  “Sorry.”

  She sighed as she turned to go. “What’s our plan here, Joshua? She serious about the budget cuts?”

  “Afraid so.” He looked at the mounds of paperwork on his desk. Somewhere under there was a folder of grant paperwork he hadn’t yet gotten to. Could he find some grant money to plug the holes she was about to dig?

  “Can I give you a little advice, then?”

  “Depends on what kind of advice it is.”

  “Kill her with kindness, honey. Use those looks your mama gave you, and wear her down.”

  “Not funny, Millie.”

  She sighed. “We’re bare bones, Joshua. We cut any more dollars, we’re talking patient safety.”

  * * *

  “Miss Blair. Come on in.” At nine o’clock sharp, Millie motioned for Delaney to come into the break room, where Therese had just delivered her.

  Delaney stepped inside, but it was standing-room only, so she stayed by the door. All eyes were on her, and she tried to keep her chin up and a smile pasted on her face. She’d dressed down a little bit today, anxious not to appear like an officious health inspector—or finance analyst—on a mission. Megan had taken one look at her neat little short-sleeved sweater, skirt, and boots, and had shaken her head. Then she’d reached for Delaney’s top button.

  “So, everyone, this is Delaney Blair from the finance office. As you know, Dr. Mackenzie has invited her to observe on the floor this week, and she has agreed.”

  Delaney smiled, trying to give off the impression that yes, she was just here on a friendly observation mission. As she scanned the faces all the way around the room, though, she knew her efforts were in vain. That sort of cover story wouldn’t fool anyone.

  “Today she’ll just be doing a little walking around, and probably asking a lot of questions. Please do your best to answer them, and if you can’t, you can direct her to me. Starting tomorrow, we’ll be having her shadow some of you for a few hours at a time.”

  Nobody groaned out loud, but Delaney could swear she heard every one of them do it internally.

  Millie turned to Delaney with what looked like a manufactured smile, opening the door to usher her out. “Thank you. I just have a few more things to run through here, but we don’t need to take up your time. Just wanted to introduce you so everyone here could put a face to the name.”

  Delaney took a deep breath and walked down the hallway, heading for her closet. She hadn’t even bothered to cart her laptop down with her. No way would she get anything useful done, not with the noise and chaos of this floor. And certainly not if she was—mucking in. She’d just have to plan on a lot of late nights upstairs.

  As she went by Dr. Mackenzie’s office, she stutter-stepped when she saw him at his desk. A pang of sympathy hit her hard when he rubbed his forehead, swearing silently at a piece of paper on his desk. She wondered how many hours he worked in any given week.

  Did the man sleep?

  She knocked softly on his door, not wanting to startle him. As he looked up, she could actually see him trying to wipe the irritation off his face.

  “You made it.” He smiled, but it was distracted.

  “I did. Millie just told the nursing staff that I’d be lurking around interrogating them all day, but to please pretend I’m their best friend so I don’t recommend they be laid off.”

  He sent his eyebrows upward. “She did not say that.”

  “No.” Delaney shook her head, rolling her eyes. “But they all knew what she meant.”

  “Now, now.”

  Delaney stepped into the office, pointing to his guest chair. “Okay if I sit for just a second?”

  “Sure.” He pushed his chair back, those crazy-gorgeous eyes settling on her.

  She closed the door behind her, sitting down carefully in the chair. She glanced at the piles of paper on his desk. “Isn’t the hospital fully electronic? Why in the world do you have so much—paper—in here?”

  “Yes, we’re supposedly electronic, but—executives—made the auspicious decision to buy our systems from different vendors, and those systems still won’t talk to each other except on Tuesdays with full moons. So … I print.”

  Delaney felt her eyebrows crowd together. “Our systems aren’t fully integrated?”

  “No.” He tipped his head. “This really is news to you?”

  “Ye-es. This is definitely news. We just had a presentation from the EMR folks the other day, and they assured us the transition is ninety-five percent complete.”

  “Were there any medical staff members in the presentation?”

  Delaney thought back, realizing too late that no, there had only been executives in the meeting. And those executives all worked on the sixth floor, never touching the electronic medical records of patients—and therefore having no idea the system apparently wasn’t working as promised.

  “It was just an executive overview. Their sales guys came in to update us. But they did a full demo. It looked … great.”

  Her voice trailed off as she realized how ridiculous she sounded. Of course the sales teams wouldn’t want to let on that things weren’t going perfectly. And of course their demo would carefully skate around the areas they knew were problematic.

  Dr. Mackenzie’s eyebrows went upward again. This was getting to be a habit. “And you didn’t hear that there were any glitches? Shocker.”

  Delaney looked at him for a long moment, but his eyebrows stayed locked halfway up his forehead. Fine. She pulled out a notepad and pen. No time like the present to start recording observations, she figured. And a problematic, underutilized EMR system that had cost millions could go right to the top of today’s list.

  She scribbled a note, then pointed to his laptop. “Do you think the vendors are fully aware that things aren’t working correctly?”

  “Yes, they’re aware. And all three of them have their installation consultants on-site, probably costing us dollars we don’t have, trying to make three systems that were never intended to work together—work together.”

  She paused, hearing the tightly controlled frustration in his voice. Another decision handed down by a disconnected executive team, it said.

  “There were physicians on the vendor selection committees, you know.” She hated the defensive tone in her voice, but really? Was he accusing her office of saddling doctors with an unusable system? They weren’t the only ones who’d been involved in the purchase decisions.

  “I know. I was on one of them. But I bet if you went back through meeting minutes, you’d be hard-pressed to find one physician who voted to go with three separate vendors. We’ve been down that road before, and this is what always happens. That’s all I’m saying. In the end, this came down to a finance office decision.”

  “Only because we were assured that the systems could work together seamlessly.”

  “By the salespeople, right?”

  Delaney sighed. “Yes.”

  “Well”—he pointed to the piles on his desk—“in the meantime, until they figure it all out, I print.”

  “Okay.” She nodded, then shook her head. Time to steer the conversation back to her original goal in coming into his office in the first place.

  She took a deep breath, crossing her legs. His eyes followed her movements closely, landing squarely on her shoes. Seemed like Dr. Mackenzie had a thing for black heels. Megan would encourage Delaney
to use that knowledge … as she pointed once again to Delaney’s buttons.

  She poised her pen, ready to take more notes. “So what can you tell me about Millie?”

  His eyes skated back up her body, but she couldn’t tell whether he’d even noticed they’d gone wandering. She felt suddenly warmer in the tiny office.

  “What do you mean?”

  “I just mean—I’d like to know more about her. She’s obviously a staff leader down here, and if I’m going to be here for a week, I’d love some insight into what makes her tick.”

  “And how not to tick her off?”

  Delaney laughed, and she saw his eyes go to her lips. “That, too.”

  “Um.” He seemed discombobulated, and she got a funny little fluttery feeling in her stomach, kind of enjoying it. “There’s only one way to get on Millie’s good side.”

  “And that is?”

  He shook his head. “You have to earn your way there. I could vouch for you from here to kingdom come, but it won’t hold water until she decides for herself what she thinks of you.”

  Delaney pictured Millie’s tight smile and stiff posture. “I think I already have a pretty good feel for what she thinks of me.”

  “She doesn’t know you yet.”

  “Do I have a chance of convincing her I might actually be human, even though I work on the sixth floor?”

  He smiled. “Slight one. Can’t speak for the rest of the nurses, but if you treat Millie with the respect she’s earned, you’ll get the same back from her.”

  Delaney nodded. That was a relief. “How long has she worked here?”

  “Thirty-five years.”

  Holy cow. Delaney mentally calculated the salary-plus-benefits equation on that. Over the weekend, she’d come up with a tick list of things she wanted to dig into while she was down here, and one of those items involved the fact that over a third of Joshua’s nurses were at or above the standard retirement age. Her new draft proposal contained a line item for early retirement packages, and Millie looked like a perfect candidate.

  “Is she thinking about retiring?”

  “No.” Dr. Mackenzie shook his head. “And if you mention the R word to her, I can’t do anything to save you. Millie will probably die on this floor, and I suspect that won’t be for another forty years or so.”