Читать книгу Undressed by the Rebel - Алисон Робертс - Страница 9

THE wail of the ambulance siren still echoed in his head as Max followed the stretcher carrying Ellie into the emergency department of Dunedin’s Queen Mary hospital.

The sound had been the consistent background to a blur of activity that he had orchestrated from the moment Ellie had collapsed on his floor. He had been the one to place the large-bore IV cannula to allow vital fluids to be administered to counteract the blood loss. He had inserted a second line when it had become apparent that her blood pressure was already alarmingly low and her level of consciousness was rapidly dropping. It was Max who kept an eye on the ECG monitor to see what effect the blood loss might have on her heart rhythm and increased the level of oxygen being given as the reading of circulating levels slowly deteriorated.

This was far worse than any complication he might have imagined her encountering on an international flight. She would have been in trouble if this had happened only hours ago on a short domestic hop. Or out on the street before she had knocked so unexpectedly on his door.

She was in trouble anyway.

So was the baby.

Not that he could afford to worry about the infant just yet. He knew that the mother’s condition was the priority. He had dealt with such cases in his department more than once. Ruptured ectopic pregnancies. Uterine ruptures. Trauma. But this wasn’t some unknown woman who’d been rushed into his department by an ambulance with its siren wailing urgently.

This was Ellie and he’d promised her she was safe now.

‘Antepartum haemorrhage,’ he told the startled-looking triage nurse as the stretcher burst through the electronic doors into a brightly lit department.

‘Max! What on earth are you doing here?’

He ignored more than one head turning in his direction. Maybe this wasn’t the way he usually arrived at work and he rarely turned up wearing his bike-riding leathers but it was no excuse for unprofessional behaviour from his colleagues.

‘Is Trauma One free?’

‘Yes. We got the radio message. Someone from O and G is on the way down.’ The nurse followed the rapidly moving stretcher. So did the receptionist, who was clutching a clipboard.

‘We haven’t got a name,’ the clerk said anxiously.

‘Ellie,’ Max snapped. They were through another set of double doors now, in the best-equipped area in the department to deal with a critical case. The paramedics stopped the stretcher right beside the bed with its clean, white sheet. Staff were waiting, having been primed to expect them, and they were wearing their aprons and gloves, ready to begin a resuscitation protocol. They all knew their first tasks. The portable monitoring equipment from the ambulance would have to be switched over to the built-in equivalents. A junior nurse held a pair of shears, ready to cut away Ellie’s clothing. A trolley was positioned near the head of the bed, an airway roll already opened in case intubation was necessary.

It was no surprise to see who was ready to control both the airway of this patient and the running of this emergency scenario. Jet was wearing theatre scrubs now and had a stethoscope slung around his neck. There was nothing unprofessional about his immediate reaction to seeing who had come in with this patient. He didn’t even blink.

‘On my count,’ he said smoothly. ‘One, two…three.’

There was a pool of blood on the stretcher as they lifted Ellie across to the bed. She groaned and her eyes flickered open.

‘It’s OK,’ Max said, leaning closer. ‘We’re in the hospital now, Ellie. Jet’s here and he’s going to look after you. We’re all going to look after you.’

Her eyes drifted shut again.

‘GCS is dropping.’ Max tried to sound clinical. Detached. It didn’t work.

Jet was holding Ellie’s head, making sure her airway was open. He was watching the rapid rise and fall of her chest and his gaze went to the monitor as the oxygen saturation probe on her finger began relaying the information he wanted.

He frowned and flicked the briefest glance at Max. ‘What the hell happened?’ he murmured.

‘Massive haemorrhage. Seemed to come from nowhere as soon as she stood up. Severe abdominal pain as well.’

The clerk was still in the room, hovering behind the nursing staff who were changing ECG leads, hanging the bags of fluid and getting a blood-pressure cuff secured.

‘What’s Ellie’s last name?’ she asked. ‘How old is she?’

A registrar had his hands on her swollen abdomen. ‘It’s rigid,’ he announced. ‘Is she in labour? What’s the gestation?’

‘Thirty-six weeks and two days,’ Max said.

Ellie was almost naked now. Totally vulnerable. Exposed to an expanding team of medical personnel. Someone from the obstetric department had arrived, closely followed by a technician pushing a portable ultrasound machine. Jet was holding a mask over Ellie’s face and frowning as he watched the numbers changing on the overhead monitor.

‘Ellie…’ He had his mouth right beside his ear and was speaking loudly. ‘Can you hear me? Open your eyes.’

She wouldn’t want to, Max thought. This would have to be absolutely terrifying.

‘Are there any relatives who could give me her details?’ the clerk persisted. ‘Did her husband come in with her? Or…her partner?’ The woman knew she was failing in her task but she made yet another effort. ‘The father of the baby?’

That flicked a switch in Max’s head and its effect was magnified by how vulnerable Ellie was. How much trouble she was in right now. He had tried to protect her and somehow he had stepped into a new nightmare and was still by her side. Was she aware of what was happening? Still terrified? Did she know he was here?

She had been so determined to stay away from hospitals to protect her child. Maybe the best thing he could do for her at this moment was to respect that determination and carry on with what had already worked once.

‘Yes,’ he said clearly. ‘I’m the father.’

Somebody dropped something metallic on the far side of the room and the sound rang out in the suddenly still moment following his statement. Jet uttered a low profanity but his gaze was still fixed on the monitor and the sound could well have been taken to be concern at a new development in Ellie’s condition. Max was close enough to speak to his friend without being overheard by anyone else.

‘I’ll explain later,’ he murmured. ‘Just back me up.’

The clerk was happy, scribbling on the sheet of paper attached to the clipboard. ‘Surname?’ she chirped briskly.

Oh, Lord. If she got registered under her real name, they have to deal with Marcus Jones turning up and he’d have plenty of time to get here. Even if things went better than any of them could expect in this room, there was no way Ellie would be getting discharged in a hurry.

There was no time to think. In for a penny, in for a pound.

‘McAdam,’ he said wearily. ‘We’re married.’

The nurse, who was sticking on the leads required for a twelve-lead ECG, looked up, open-mouthed, and others exchanged astonished glances but the clerk knew she was on a roll.

‘How old is your wife?’

‘Twenty-eight.’

‘Date of birth?’

As if he’d know. This had gone far enough. Far too far, judging by the look Jet slanted his way.

‘Leave it,’ Max growled. ‘We can sort the paperwork later.’

‘But we need—’

‘Get out,’ Jet snapped. ‘We’re busy.’ He looked up, avoiding Max but catching most others in the room as he issued his orders.

‘I’m going to intubate,’ he warned. ‘Oxygen saturation levels have fallen far enough. We need a central venous line in. And an arterial line.’

‘I’ll do that,’ Max offered.

Jet gave his head a negative jerk. ‘On your wife? I don’t think so.’ He nodded at his registrars, giving them the signal to get started. ‘Get some bloods off as well. We need to know her blood group. Stat.’

‘I’d like a rhesus factor and antibodies, too.’ The obstetric consultant was watching the technician begin the ultrasound examination. ‘Looks like we’ve got a central placenta praevia here and she’s in labour. Fully dilated.’

Less than an hour later, in the middle of the life-and-death battle to save Ellie Peters, she gave birth to a tiny baby girl.

There was a paediatric team amongst the crowd in Trauma One now. And a consultant from the intensive care unit, who was a specialist in dealing with haemorrhagic shock resulting from such massive blood loss. Ellie was being cared for. The baby was being carefully assessed.

Having been forced onto the sidelines due to his own admission of involvement, there seemed to be nothing for Max to do other than watch. He was torn between watching the monitors to evaluate the success of the treatment Ellie was receiving and staring at the scrap of humanity the paediatric consultant was bent over.

‘She’s small but doing OK,’ she pronounced eventually. ‘I’m happy with her breathing but the heart rate’s a bit on the slow side. Did I hear someone say the father is here?’

Ellie was deeply unconscious. The obstetrician was happy that the bleeding had ceased now that delivery was complete but the control of the blood loss might have come too late. The mother of this tiny baby was now on a ventilator to manage what looked like adult respiratory distress from fluid loss. Jet and the ICU consultant were worried about her kidneys. Her production of urine had virtually ceased and her most recent blood test showed deterioration in renal function.

Max had done what he’d thought was the right thing in continuing the pretence that he was the baby’s father and he couldn’t back out now. Jet wouldn’t say anything because he’d asked him to back him up and the brotherhood that they made up, along with Rick, was glued together with a loyalty that would never be broken. There were plenty of other people ready to say something, however. To point him out and draw him into the case that this department would be talking about for a very long time.

‘You’re the father?’ The paediatrician didn’t know him so there was no undertone of astonishment. ‘Good. Come with us. We’re going to take your daughter upstairs and she’ll need you.’

Max took a step towards the group looking after the baby. And then another. And then he stopped.

‘I can’t…’ He looked over his shoulder at Ellie. And then back to the baby, now dried and wrapped in soft, warm towels. What the hell had he got himself into here?

Jet’s voice was calm. ‘Nothing you can do for Ellie at the moment, mate,’ he said. ‘We’re going to transfer her up to ICU very soon. Best you go with the baby. I’ll come and update you as soon as I can.’

And wherever the baby was being taken, whether it was a maternity ward or the paediatric ICU, it would be a more private place, Jet’s tone suggested. They would be able to talk about this. Hopefully, they might even be able to sort out the mess Max had created.

It seemed a reasonable plan. Max wasn’t due on duty here in the emergency department until first thing tomorrow morning. They had a whole night to sort things out. Stepping back from taking any responsibility for Ellie might be a good first step. He took another step towards the baby and nodded.

‘Let’s go,’ he agreed.

‘How would you feel about holding her?’

‘Ah…I’m not sure that’s a great idea right now, is it?’

The paediatrician also took another glance at the monitor where the newborn baby’s heart rate was slowing down yet again.

‘It could help. Have you heard of kangaroo care?’

‘No.’ Max was staring at the baby in the plastic crib. It was lying on its side, a soft white hat covering the dark whorls of hair on its head. One arm was bent, a tiny starfish hand resting on its cheek.

Max hadn’t spent this long in the company of a baby this small…ever. He’d participated in a fair few deliveries, of course, throughout his training and then in a short run on O and G but it was a rare occurrence in Emergency and the babies were always whisked off to places like this paediatric intensive care unit. He’d never had a reason to stay involved. He didn’t now, except as a fraud.

He shouldn’t really be here at all.

‘It’s been around since the late seventies,’ the paediatric consultant broke into his guilt. ‘But it’s gaining quite a following. It’s basically skin-to-skin contact with a parent. As long as the infant is medically stable, there’s no reason not to use it and it’s been shown to improve oxygenation and respiratory rates. It can actually make a significant difference to something like bradycardia.’

‘Skin-to-skin?’ Max couldn’t keep the dismay out of his voice. ‘Are you kidding me?’

‘You don’t sit around naked.’ The doctor smiled. ‘In fact, the baby needs to be under your own clothing to help maintain body temperature stability.’ Her smile became reassuring rather than amused. ‘I know she looks tiny and fragile and that her arrival was a bit unexpected…’

‘You have no idea,’ Max murmured.

‘And I know you’re worried about Ellie,’ she continued, ‘but this is a way to help everybody, including—maybe especially—yourself.’

‘Oh?’ Max was listening now. He needed to help himself. Fast. ‘How, exactly?’

‘You’ll be doing what Ellie can’t do at the moment, which is caring for her baby. You could well make a big difference medically for this little one.’ She was watching him and a tiny frown line appeared. ‘If you’re really not comfortable, then I can get one of the nursing staff to do it, but it’s far better if it’s a parent. It can be a way of bonding that could make all the difference to the stress of the next few days.’

Max had the sensation of being trapped in a kind of glass box. He was being watched. By the paediatrician and her registrar. By the nurse who was hovering near the crib. Even by other nurses in this unit as they went about their own tasks. They all seemed to have paused right now to hold their breath and see what he was going to do.

They all believed that he was this baby’s father and what kind of a father wouldn’t want to do something that might help his kid? If it became obvious that he had no need—or, let’s face it, desire—to bond with this infant, people might start asking questions. Gossiping at the very least, and the less any of this was talked about the better. For Ellie’s sake.

Which was how all this had started, wasn’t it?

He really would have to be more careful next time, he decided with a wry inward smile as he found himself nodding and then being guided to the comfortable armchair rolled into this corner of the PICU.

A nurse took the layers away from the baby. They left her with a nappy and her hat on, an oxygen saturation monitor clipped to a minuscule toe and some unobtrusive sticky dots and soft wires that connected her to a cardiac monitor. She was mostly naked, Max noted with some alarm. Small and pink and awkward-looking, with stick-like arms and legs.

‘Keep her prone and upright,’ the paediatrician advised. ‘The nurses will keep an eye on you both and levels are set for an alarm to go off if the oxygen levels or cardiac rhythm need interventions.’

Max had sacrificed the neck of his T-shirt so that he didn’t need to discard any of his own clothing. The vertical cut allowed him to fold the neckline down so that the baby’s face would be uncovered. He heard the whimper of the baby as she was picked up.

Good grief…he really didn’t want to do this. Was it too late to back out?

An alarm began to sound. A slow bell that pinged ominously. Maybe the baby didn’t like the idea, either. Her heart rhythm was jumping erratically.

‘Does she need to go back in the crib?’ Max tried not to sound too hopeful.

‘Let’s see how we go for a minute or two.’

With an inward sigh, Max held up the bottom of his old, soft T-shirt while a nurse positioned the baby and then covered her. A layer of the leather jacket came next and then she helped him put his arm in the right place for support. He felt awkward. Uncomfortable.

He could feel the baby wriggle against his chest, moving tiny limbs as if in protest. He could feel the miniature chest heaving as she attempted to breathe and cry at the same time but the effort seemed exhausting and the movements diminished.

Max took a cautious glance downwards and found the baby’s eyes were open. So dark they looked black and they were fixed on him. He took a deep, careful breath and let it out very slowly.

‘Look at that.’ The paediatrician sounded delighted. ‘Heart rate’s coming up and it’s steady.’

They waited another minute as Max sat as still as humanly possible.

‘Looking good,’ came the expert verdict. ‘We’ll leave you to it, Max.’

‘Ah…’ He watched as staff began to disperse. To stop watching, even, from all over the unit. Any second now and he would be virtually on his own. ‘How long should I stay here?’

‘The longer the better,’ a nurse said cheerfully. ‘As long as you can, anyway.’

Max tipped his head back and closed his eyes. He breathed. In and out. He could feel the baby breathing. In that first long, quiet minute of being left to himself he could even feel the baby’s heart beating. A soft, rapid ticking against his chest. Almost on top of his own heart.

Weird.

He opened his eyes and tilted his chin so he could look down again.

The baby was still awake. Still watching him with a curiously intent gaze that managed to look utterly bewildered at the same time.

‘Mmm,’ Max murmured sympathetically. ‘I know just how you feel. But don’t worry. We’ll get it all sorted out in no time.’

‘Whoa! What are you doing?’

‘Oh, man…’

Rick, closely followed by Jet, had come into a now dimly lit PICU to find Max still in the armchair, with a tiny baby nestled on his chest beneath his leather jacket.

‘Shh…don’t wake her up.’

Rick’s eyebrows were sky high. ‘I bumped into Jet as he was coming out of the big people ICU,’ he said in a stage whisper. ‘Thought I’d come and say hi and…’ His grin widened. ‘I’m sure glad I did. Wouldn’t have missed this for quids. What are you doing?’

‘Being a kangaroo,’ Max muttered. ‘Go away.’

Jet was looking at the monitors. ‘Kid looks stable enough,’ he said. ‘Why don’t you put it back to bed and we’ll go get a coffee or something.’

Max sighed. ‘Because every time I try and put her down she goes into a bradycardia and the oxygen levels drop.’

The nursing staff hadn’t missed the arrival of Max’s friends. More than one of them was finding a task that necessitated getting a lot closer to this extraordinary scene. Three large men and one very small baby.

‘She loves her daddy,’ the closest one said with a smile directed at Rick.

He smiled back. ‘And who wouldn’t?’

The nurse giggled. Max could swear she even batted her eyelashes at Rick. He sighed again.

‘What’s the story, Jet? How’s Ellie doing?’

‘On dialysis,’ Jet said grimly. ‘Renal function hasn’t picked up yet and there’s still some concern about her lungs. They’re going to keep her sedated and on the ventilator, at least overnight.’

‘Prognosis?’

Jet shrugged. ‘She’s hanging in there. Could go either way.’

Max swallowed. What was going to happen to this baby if Ellie didn’t make it? He should be worried that he’d put his hand up as her only available relative but, instead, he found himself more worried about what life might have in store for this tiny girl.

Rick was leaning closer. ‘Kinda cute, isn’t it?’ He was grinning again. ‘You know, I think I can see the family likeness.’

Jet snorted. He took a glance over his shoulder as if his scowl might be enough to ensure that the staff minded their own business for a while.

‘How long are you going to keep this up, Max?’

Max said nothing. He was quite used to the feel of the baby against him now. In fact, at some point during the last couple of hours he’d experienced an odd sense of relief when the contact was re-established and things had settled down again. He wasn’t going to make another attempt to put the baby back in her plastic crib any time soon. Maybe it wouldn’t feel right until he knew whether or not her mother was going to survive.

Rick’s smile had finally faded. ‘Jet told me what happened in ED.’ His mouth quirked again briefly. ‘And if he hadn’t told me, I would have found out pretty damn quick. The whole hospital is buzzing with the news of your sudden fatherhood, mate.’

‘I’ll bet.’

‘I mean, it was one thing to tell the weasel you were the father so that he’d go away but…’ Rick sucked in a long breath, an eloquent sound that encompassed the depth of the trouble Max had got himself into here.

‘The guy raped her,’ Max said quietly.

There was a moment’s silence. Max could feel an echo of his own reaction to that information. The way it changed things. The anger on Ellie’s behalf. On behalf of all women, really. They all liked women. A lot. He could sense the way his friends stilled. He saw Jet’s hands curl into fists.

‘And then he got her fired,’ he added. ‘When she tried to get away from him. He’s been stalking her ever since.’ He cleared his throat. ‘And I told her she was safe.’

Another moment of silence as Rick and Jet absorbed and then accepted the implications.

‘She won’t be safe until she’s well enough to look after this baby and get away.’

‘She’ll never be safe.’ Rick’s eyes were narrowed. ‘The bastard.’

‘Anyway…’ Max didn’t want to consider the future right now. The present was more than enough to deal with. Especially given that the baby was stirring. Woken by the intense conversation around it, perhaps. Or maybe it could sense the tension in the body it rested against.

The whimper became a warbling cry that made both Rick and Jet shift their feet uncomfortably. It also brought a nurse, who was carrying a bottle.

‘Looks like it’s dinnertime,’ she said. ‘Here you go, Daddy.’ She handed Max the bottle.

‘Maybe you better do this,’ he muttered.

The baby’s cry strengthened. Jet’s pager sounded and he reached for it to read the message with obvious relief as Max fumbled with the bottle, trying to fit the teat into the tiny mouth.

‘Gotta go,’ Jet said. ‘Sorry, mate. I’ll get back later.’

‘I’ll come with you,’ Rick said. Clearly this experience was rapidly losing its entertainment value.

Jet slanted a backward glance at Max. ‘You want me to arrange cover for your ED shift tomorrow?’

The baby’s mouth had finally closed over the teat and she was trying to suck. Max tilted the bottle to help. The baby sucked harder, her dark gaze fixed on the man who didn’t seem to know what he was doing. But then she tasted the milk and the sucking settled into a rhythm.

‘Max?’ Jet prompted.

‘Yeah…cover would be good.’ Max couldn’t break the eye contact with the infant so he didn’t even try and look up. ‘I’m not going anywhere for a while.’