Читать книгу The Surgeon's Engagement Wish - Алисон Робертс - Страница 8

GOOD grief!

Luke was still shaking his head in disbelief as he scrubbed up for Jackal’s emergency laparotomy ten minutes later.

Seeing Beth again after all these years was unbelievable enough. Seeing her doing that warrior princess act with the gang members had been…

The sexiest damn thing Luke had ever seen in his life.

He scrubbed beneath his nails hard enough to cause real pain.

Beth was the only woman who had ever made him seriously consider marriage.

And she was the only woman who had ever dumped him.

The hurt and the ensuing anger that had caused should have been rendered inconsequential by the blows life had meted out since then, so it was incredibly disturbing to find how easily the years could be peeled back.

One good look into those bright blue eyes and there he was again. Not measuring up. Just not being good enough, no matter how much love he had to offer.

What the hell was Beth doing in Hereford of all places?

Luke took his foot off the water control and reached for a sterile towel. She’d probably come here to give her kids a nice, healthy rural upbringing or something. Snapping on gloves, Luke turned abruptly to let the scrub nurse tie up his gown. That flash of something astonishingly like jealousy at the thought of the father of those children was ridiculous.

So she was still an attractive woman. So what?

So she had grown up a bit and become brave about confronting things she didn’t like. Again, so what?

Luke had more than enough to deal with in his life right now, without complicating things by renewing any kind of relationship with Beth. The last thing he needed was to try poking an old scarred area when the potential to find a tender spot was so clearly possible.

A deep breath was called for here. And rational thinking. This disturbance was probably just part of the surprise factor of seeing Beth again. All he needed to do was ride it through and there would be no shortage of distractions if that proved in any way difficult. It was a relief to use the one immediately available.

‘Let’s get this show on the road, shall we?’

With his hands held carefully crossed in front of his chest, Luke used his shoulder to push open the swing doors into Theatre.

At just after 3 a.m. on a Tuesday morning, Ocean View’s emergency department was stretched to slightly over its full capacity.

One of the high-tech resuscitation areas was still occupied by a seriously injured patient, the other one having just been vacated by the hit-and-run victim, who had gone up to Theatre 2 for the attention of an orthopaedic surgeon. All the beds in the cubicled area were also full and half of those patients were still waiting to have bones X-rayed or lacerations sutured. The treatment rooms were full and there were no spare seats in the waiting area either.

A few people with minor injuries were in Reception but most of them were simply there to offer solidarity to their mates, and they included some of the loudest and most unpleasant women Beth had ever encountered.

They were all unkempt, tattooed, pierced in multiple places and inebriated, and only too happy to demonstrate their contempt of any authority figures or lack of appreciation for any medical assistance. But the police presence was strong enough to ensure the safety of staff and the background noise of obscene language and shouting was so constant Beth could tune it out now.

It had already become automatic to seek the company of a police officer before approaching or treating a patient, and all the nurses remembered to wait until a member of one gang had left the X-ray department before escorting a member from the rival gang down the corridor.

Hopefully, the stab victim who was currently in Resus 1 would also be sent up to Theatre soon. When the doctors could be freed from attending the critically injured patients they should be able to deal with the minor injuries rapidly. They would be able to clear the department and then they could all have a well-deserved break.

Oddly enough, the chaos and unpleasantness of her current environment had been quite enjoyable over the last hour or so. Not the patients, of course, but their uniform lack of co-operation or appreciation had provided a bond of camaraderie amongst the staff members that had only increased under pressure.

And Beth was very firmly one of them. Thanks to that inadvertent episode of venting her tension, having stepped into the path of the converging gang members, Beth had not only been welcomed into the ranks of Ocean View’s emergency department staff, she was currently being used as a lynchpin.

Even though it had only taken a few seconds and could quite easily have been a huge mistake, the fact that Beth had taken control had become a kind of emotional bank in which snippets of humour or stamina were being deposited and could be withdrawn whenever someone needed the lift of a shared smile or a pat on the back.

‘I’m just so not in the mood for this’ had become the catch-phrase of the night and never failed to produce a smile.

Dennis, the local cop, had claimed Beth as one of their own with a hint of pride.

‘Keep your eyes open,’ he had told one of the Nelson police officers about to accompany Beth when she needed an escort to Radiology. ‘You might learn something from our Beth they never thought to teach you at police college.’

How ironic that Beth could feel so at home in a new place so quickly when she was still having serious doubts about the wisdom of having come here at all. She even knew her way around the storeroom now, having gone in there so often to fetch new supplies, and she was there again now, checking the fridge, as requested, to see how much O-negative blood they had on hand. Then she moved towards the shelves supporting boxes of dressings.

A number of extra-large gauze pads had been needed to staunch the arterial flow from the blood vessel severed by a knife wound in the car-park skirmish. And a fresh intubation pack was needed to restock Resus 2. Searching for the location of cuffed endotracheal tubes, Beth’s eye was caught by the sterilised, draped rolls of surgical gear.

The obstetric pack was probably useful, but how often would they have the need for a thoracotomy kit here? Beth had only ever seen someone’s chest opened in an emergency department once, and that had only been done because it had been in a big hospital and they’d had a cardiothoracic surgeon available for back-up.

Luke had had ambitions in cardiothoracic surgery so why on earth was he working here? And how could Beth hope to start a new life when there would be such constant reminders of the past?

If she didn’t stay at Ocean View, though, would she end up being back in some emergency department large enough for the triage staff to wear headsets and microphones? Beth’s sigh was heartfelt. She had really been looking forward to the change of working in a much smaller and potentially friendlier environment. And what on earth was she going to say to the nurse manager?

Sorry. This is a great place to work but I can’t possibly stay because the man I was passionately in love with years ago happens to be working here as well, and I’m not sure if I could handle seeing him every day.

How pathetic was that?

Especially when it had been her that had broken up the relationship.

Beth added some other sizes of gauze dressings to the load she was carrying and wondered how the supplies of lignocaine were holding up. A lot of local anaesthetic was being used in the repair of lacerations. The thought was only fleeting, however, and Beth did not reach for any ampoules. She was too busy thinking about something else.

It hadn’t been her that had broken things up, though, had it? Not really. Ending it had been the last thing Beth had wanted. And having her nose rubbed in the puddle of her lost dreams by living in the same small town as Luke Savage was just unthinkable.

And finding him beside the bed of the stabbing victim in Resus 1 was unexpected enough to add considerably to those doubts about her new job. She had thought Luke would be tied up in Theatre for the rest of the night and that maybe encounters with the surgeon would be the exception rather than the rule. Beth averted her gaze hurriedly to avoid renewed eye contact but the surgeon was listening too intently to Mike to notice the arrival of a nurse carrying supplies.

‘…femoral artery,’ Mike was saying. ‘Class III haemorrhage. Estimated blood loss of around two litres, but we’ve finally got it under control with the pressure bandage.’

‘Blood pressure?’

‘Coming up finally. Ninety-five on fifty now. We’ve run in two litres of saline and I’m just waiting for blood results.’

Beth was behind Luke now. It was quite safe to risk a glance. Not that she needed to confirm the impressions gained earlier, but it was tempting to add to them.

The shaggy black hair was a little longer than it used to be and there was just a hint of silver at his temples. Thirty-six seemed a bit young to be going grey, but Beth had found the odd white hair amongst her own recently and she was two years younger than Luke.

His face was browner and leaner, which made him look more serious somehow. Judging by the arms and the smooth V of chest visible around the baggy scrub suit, the rest of Luke’s body was browner and leaner than it used to be as well.

Beth had to take a rather deep breath all of a sudden. No. Luke Savage had not lost his looks in the last ten years. Quite the reverse, really…damn it!

‘Beth?’

‘Sorry, were you talking to me?’

‘I just wondered how the supplies of O-neg were looking.’

‘There’s two units. Plus some packed cells.’ Beth continued putting the dressings into the drawer of the trolley but it would have been rude not to look up again. Mike was nodding. Luke was looking at the patient.

‘How are you feeling?’ he queried.

The gang member gave a noncommittal grunt.

‘We’re going to have to take you up to Theatre and repair that gash in your leg,’ Luke explained. ‘Have you had anything to eat or drink in the last four hours?’

‘Yeah. I had a feed.’

‘How long ago was that?’

‘Dunno.’

‘And you’ve been drinking?’ The question was superfluous, given the smell of alcohol that hung over most of their patients that night, but Luke managed to sound nonjudgmental.

‘Yeah. Had a few beers, man.’

The gang member actually smiled at Luke. ‘You going to fix up my leg, then?’

Beth was slipping out of the cubicle as Luke turned towards Mike. ‘Looks stable enough to go upstairs. We should be ready in twenty minutes or so, I guess. What about…?’

Beth was now far enough away for Luke’s voice to be covered by the general noise in the department. Or maybe it was because the noise level had suddenly increased out here. A wave of weariness hit as Beth wondered if she needed to call for more police assistance.

But it was a police officer who was doing the calling.

‘Help! We need some help here.’

Beth moved fast towards the reception area. She could see a woman lying on the floor near the seats in the waiting room. Another woman was struggling to get away from the grip the police officer had on her arm.

‘I told you Stella was sick,’ the woman shouted. ‘And you wouldn’t listen, you bastard!’ She kicked at the officer, who winced but held on.

Beth dropped to a crouch, reaching to shake the apparently unconscious woman’s shoulder.

‘Stella? Can you hear me?’ With no response to the shaking, Beth pinched the woman’s ear lobe. ‘Open your eyes.’

The woman groaned and rolled her head from side to side. Beth could see her chest rising and the groans were loud enough to suggest that her airway was clear. She was feeling for a pulse on the woman’s wrist as she heard a deep voice behind her.

‘What’s happened?’

‘She fainted or something,’ the police officer said. ‘One minute she was sitting on that chair and the next she was on the floor.’

‘She’s been bloody hurt, that’s why!’ The second woman was clearly furious. ‘She’s been feeling like crap but nobody would listen!’ With the stream of obscenities that followed this statement, it didn’t surprise Beth that nobody had wanted to listen. Still, there was no excuse for missing a potentially serious injury.

Luke was frowning as though he’d had the same thought. He crouched down close to Beth and put his fingers on the woman’s neck, feeling for a carotid pulse.

‘There’s no radial pulse,’ Beth told him quietly.

Luke nodded, acknowledging the information that the woman’s blood pressure had to be very low. He glanced up at the people standing nearby. ‘Can somebody tell us what happened to her?’

‘She got hit in the chest,’ the second woman spat. ‘With a bloody softball bat, that’s what happened.’

‘How long ago?’

But Luke’s query was ignored.

‘And it was that bitch over there that did it. And I’m going to do something about it.’

Fortunately, two more police officers arrived to deal with the woman who was making a new and more frenzied attempt to get free.

‘It must have happened in the car park,’ the first officer told Luke. ‘Probably well over an hour ago.’

‘Thanks.’ Luke slid an arm beneath the woman’s back, the other under her legs, standing up with apparent ease despite the weight of his burden. ‘Let’s go,’ he said to Beth. ‘What’s free?’

‘Resus 2.’ Beth led the way, relieved to move away from the tension in the waiting area, which was now escalating thanks to the screams of their new patient’s friend.

‘Let me go! Where are you taking her? She’s bloody dead, isn’t she?’

Stella wasn’t dead but she wasn’t looking at all well. Mike came into Resus 2 as Luke gently deposited the woman on the bed.

‘What’s happened?’

‘Collapse,’ Luke told him succinctly. ‘Possible blunt chest trauma from a softball bat more than an hour ago.’

Beth slipped an oxygen mask over the woman’s face and turned the flow up to 10 litres a minute, before swiftly turning her attention to pulling open Stella’s shirt. Then she grabbed a pair of shears to cut through the singlet top beneath the shirt.

‘She’s tachycardic,’ Luke told his colleague. ‘And she’s got JVD.’

Beth hadn’t noticed the distension of the jugular veins on the woman’s neck but she recognised the significance of the sign, reaching for the ECG leads as she dropped the shears.

‘Chest-wall contusion,’ she reported.

Stella groaned loudly, swore incoherently and tried to move as Mike put his hands on the obviously bruised area on the left side of her chest.

‘It’s all right,’ he reassured their patient. ‘We’re just checking you out.’ He looked up. ‘Do we know her name?’

‘Stella,’ Beth supplied.

‘I know it hurts, Stella. Hang in there.’ He looked up again. ‘Fractured ribs,’ he said. ‘But she seems to be moving air all right.’

Luke had wrapped a BP cuff just below the tattoo encircling Stella’s upper arm. ‘Hypotensive,’ he noted. ‘Systolic’s barely 80. Let’s get an IV started.’

‘Make it two,’ Mike said. ‘Beth, can you get a line in on your side, please?’

‘Sure.’ Beth stuck the last ECG electrode in place and turned to grab a tourniquet. Mike was watching the screen of the cardiac monitor.

‘Sinus tachycardia,’ he said. ‘And…yes, we’ve got electrical alternans.’

Luke’s grunt sounded almost satisfied as he pulled the cap off a cannula. ‘Thought so. Pericardial tamponade.’

Beth glanced up at the screen, noting the way the spikes of the QRS changed direction every few beats, indicating a change in the cardiac axis. She knew the first line of treatment for an acute pericardial tamponade was a rapid infusion of saline. Bleeding around the heart, trapped by the membrane encasing the organ, was interfering with its ability to pump blood. By increasing the fluid volume of the patient, the output of the heart could be improved.

Pleased to have known to choose a wide-bore cannula without being told, Beth had also gone for easy venous access inside the left elbow. The cannula slid into place and she occluded the vein at the end of the tubing as she withdrew the needle and reached for a luer plug.

Luke was reaching for a luer plug as well. For a split second they caught each other’s gaze and there was a hint of a smile lurking on the surgeon’s face.

‘Snap,’ he murmured. ‘Guess we’ll have to call that one a draw.’

Mike watched them both as they finished attaching giving sets and started the fluids running. ‘Definitely a draw.’ He smiled. ‘Nice work.’ Then his face settled into a frown of concentration as he placed his stethoscope on Stella’s chest.

‘Heart sounds are pretty muffled.’

‘Jugular veins are more distended now.’

‘Stella!’ Mike raised his voice. ‘Open your eyes for me.’

There was no response. Mike pinched her ear lobe but her level of consciousness had dropped enough for the pain to be ignored. ‘GCS is dropping,’ he warned.

‘Beck’s triad.’

Beth wasn’t aware she spoken aloud until she caught Mike’s glance. ‘You know your stuff, don’t you?’ The older consultant sounded impressed. ‘What do we do next, then?’

‘Pericardiocentesis?’ Beth was aware that Luke was watching her. She’d been little more than a student nurse when they had worked together all those years ago. Would he also be impressed at the level of knowledge and the skills she had acquired since then? ‘Removal of as little as 20 mils of blood can improve cardiac output and patient condition considerably, can’t it?’

‘Spot on.’ Mike nodded. ‘You’ll find the kit on the shelf above the IV cannulas.’

Luke drew up the local anaesthetic while Beth swabbed the skin on Stella’s chest. Mike inserted the six-inch, plastic-sheathed needle, aiming towards the base of the heart, and they all watched the monitor screen carefully for ECG changes.

‘QRS complex is widening,’ Luke warned at one point. ‘Draw back a little, Mike.’

Beth held her breath. If it wasn’t blood around Stella’s heart that was causing the problem then their patient was in serious trouble. She relaxed slightly as she saw the needle fill with blood.

‘Here we go.’ Mike drew back on the syringe. ‘Five mils,’ he noted. ‘Ten…fifteen…’

Then the flow stopped. It seemed that enough blood should have been removed to help, but there was no improvement in Stella’s condition. In fact, it got worse. The ECG began to change, with the heart speeding up and missing beats. Stella wasn’t moving or even groaning any longer.

And then Chelsea called out from the adjoining resuscitation area.

‘Mike? He’s bleeding again. I can’t seem to find the right spot to apply manual pressure. Shall I take the bandage off?’

‘Coming.’ Mike glanced up at Luke. ‘Can you manage?’

Luke glanced at Beth. ‘Sure.’

The management of the femoral artery bleed next door was obviously difficult and the rest of the department was still humming. Nobody could be spared to assist in Resus 2 even when Stella’s heart gave up the struggle of trying to pump against constriction.

The electrical stimulus was still there but their patient was pulseless and Luke’s attempt to draw more blood from the pericardium with the needle proved fruitless.

‘Start CPR,’ he instructed Beth.

She worked hard to make her chest compressions as effective as possible, but Luke shook his head as he felt for a carotid pulse moments later.

‘We’re still not getting a pulse.’ He raised his voice. ‘Mike? I’m going to have to go for a thoracotomy here.’

Beth’s jaw dropped but Mike sounded perfectly calm. ‘That’s fine,’ he called back. ‘I’ll come and intubate for you in a second.’

Luke had caught Beth’s astonished expression and his tone suggested he had taken her reaction as a personal criticism. ‘You’ll find a thoracotomy kit in the storeroom, Beth.’

She was pleased to be able to turn away. ‘I know where it is.’

He was a surgeon after all, and maybe Luke had had experience with opening people’s chests. He certainly seemed confident enough, and it was probably the only procedure that was going to save a life here, but it was still horrific to watch him divide Stella’s sternum with a saw in what seemed like only a few minutes later.

It was just as well she’d had theatre experience in the past, Beth decided, handing instruments and wound towels to Luke. It was how they’d met in the first place. Luke had been a surgical registrar and Beth had just been starting work as a theatre nurse. She’d transferred, of course, when their relationship had hit the rocks and the fascination and pressure of working in the emergency department had gone from being a welcome distraction to a real passion.

And here they were again. The bizarre impression of being in a time warp was heightened after Luke took a scalpel and carefully incised the membrane of the pericardium. The rush of blood wasn’t enough to suggest a fatal cardiac injury and there was a collective sigh of relief as the vigorous pumping of Stella’s heart could be actually seen.

Mike had his fingers on the side of Stella’s neck. ‘Great output,’ he said delightedly. ‘Fantastic!’

His voice startled Beth. The feeling that she and Luke had been a single—and isolated—unit had been so strong she had actually forgotten Mike was there in the last few minutes. She had been standing so close to Luke. Their hands had touched more than once when she had handed him instruments, and that closeness—that touch—had wrapped them into a space that had been theirs alone. Luke merely nodded in response to Mike’s delight. ‘We’re not out of the woods quite yet,’ he warned. ‘Let’s cover everything with dressings and sterile drapes and get her up to Theatre to finish.’

But he paused fractionally when he caught Beth’s gaze and for the third time that night she was trapped by the expression in those dark grey eyes.

There was no hint of displeasure in them this time. Or the suggestion that she had changed beyond recognition. And, very oddly, the flicker of warmth that she saw was far more of a shock than Luke’s earlier reactions to seeing her had been.

His voice touched exactly the same tender place as that fleeting glance had.

‘Thanks, Beth,’ Luke said softly. ‘You were brilliant.’