Читать книгу The Surgeon's Special Delivery - Fiona Lowe, Fiona Lowe - Страница 11

CHAPTER THREE

‘I KNOW you wanted to get in fast so I’ve sedated him with midazolam and propofol and he’s all set to go.’ Tess’s worried eyes looked at Callum over her theatre mask. ‘He’s lucky you’re here.’

A niggle of concern pulled at Cal but the beeping of the monitor registering Vince’s low blood pressure intervened. ‘Let’s start.’ He put his gloved hand out for the gastroscope.

Ken Liu, the theatre nurse, handed him the long, black, flexible tube, whose plain colour belied its ability to light and electronically magnify the gut.

Cal had to give the staff credit—they’d mobilised quickly and there’d been no messing around. He glanced up at the screen as he passed the tube down the oesophagus. ‘No sign of varices, always good.’

‘Excellent news.’ Tess’s hidden smile played through her voice. ‘Often patients aren’t one hundred per cent honest about their history if alcohol is involved.’ The ECG monitor beeped rhythmically and reassuringly next to her. ‘Esther, is the blood here?’

‘It’s on its way but we’ve got plasma expander. Do you want that put up?’ Esther’s questioning brows rose over her green surgical mask.

Tess checked Vince’s BP. ‘Right now his pressure’s holding so I think we can wait for the blood.’

Cal grunted in frustration. ‘His stomach’s full of blood. Sucker, quickly.’ He needed to clear the area and find the source of the bleeding.

Ken handed him the instrument and the sound of suction filled the tense air of Theatre. Just as suddenly it stopped. ‘Damn it, the sucker’s blocked by clots. Saline. I need saline to clear it.’

‘Pressure’s falling,’ Tess stated in words what the incessant beeping told them.

He swore softly under his breath. ‘I’m scubadiving here and I can’t see anything except blood.’ He readjusted the sucker, his hand gripping tightly, and pressed his eye hard against the viewfinder of the ’scope. Don’t bleed out on me before I find the cause.

‘The blood’s arrived.’ Esther called out in relief as she accepted the welcome units from the blood-bank technician.

Tess moved fast. ‘Esther! Start squeezing one unit of blood into the left IV, now.’ She quickly snatched the second unit out of the nurse’s hands and attached it to the other large-bore IV she’d inserted.

Four hands worked furiously, pushing life saving blood into their patient, giving his heart the much-needed volume to pump around. A frown line appeared on the bridge of Tess’s nose. ‘Callum, how much of this is going straight into his gut?’

‘More than we want.’ His terse voice carried his apprehension.

‘I should have tubed him.’ Tess’s usually calm voice sounded ragged at the edges.

He couldn’t look up but he wanted to reassure her. ‘You made the right choice at the time. You’re not an anaesthetist and light sedation is usually better.’ Tension strained every muscle as Callum moved the ’scope to find the bleeder. ‘He’s hosing blood, damn it, but from where?’

The sedated Vince suddenly shuddered and blood and clots projected from his mouth, all over the floor and onto Callum’s shoes. He moved his feet. ‘At least now I can see a bit better. No sign of a peptic ulcer.’

‘I should tube him—he could aspirate.’ Tess ran a fine nasal suction tube down into Vince’s trachea.

Vince’s half-empty stomach immediately filled with blood as Callum probed into the duodenum, the sucker working overtime. Suddenly he caught sight of inflammation, the ugly ragged edges of an ulcer with an enormous clot in the centre. Thank you. ‘Found it. It’s an enormous duodenal ulcer. No wonder he’s been bleeding like a stuck pig.’

He injected the saline down the three-millimetre channel in the ’scope and sent up a prayer that it wouldn’t make things worse.

Ken’s eyes were glued to the screen, his voice disbelieving. ‘Is that a spurting artery at the base of the ulcer?’

It had made things worse. ‘Hell, yes.’ The clot had been trying to seal the bleeding. He sent down more saline to clear the area of blood so he could see what needed haemotosis.

Ken immediately passed him adrenaline. ‘Or will you use diathermy?’

‘Adrenaline first.’ His concentration brought conversation down to the bare minimum. He injected the adrenaline, wishing it speed in constricting the blood vessels and bringing the bleeding under control.

Bringing the whole situation under control. He relaxed slightly. ‘Right, I’ll just put the—’

The monitor screamed and Tess picked up her laryngoscope. ‘His O2 sats are dropping, and he’s got a lung full of blood. Callum, you need to pull out now so I can tube him.’

Sweat pooled on his forehead. He was so close. ‘Give me a minute to put on the haemoclip. I’m almost done.’

‘We don’t have a minute.’ Her eyes flashed with fear and steely determination.

‘Yes, we do. I’ve done this before.’ Callum put out his hand. ‘Kenny, the clip.’

The nurse hesitated, glancing between them.

‘Now,’ Cal barked, and the clip hit his hand.

Tess increased the nasal oxygen, her voice stern with dread. ‘We’re risking him arresting.’

‘Trust me, I’m on it.’ Callum blocked out the panic in Tess’s eyes, blocked out the screaming monitors, the stunned gazes of the nursing staff and did what he did best. With the finesse of the finest craftsman he sealed the bleeding ulcer with the clip.

Exhilaration thundered through him at the save, the buzz making him feel alive in a way no other event or situation ever could. ‘I’m done. The bleeder is plugged and he’s all yours.’ He removed the ’scope from Vince’s gut.

‘Thank you.’ Tess smiled at him with open admiration tinged with school marm disapproval. She immediately busied herself, aspirating the blood Vince had inhaled into his lungs. ‘You’ve done a fabulous job despite giving us all heart failure there for a minute.’ Her eyes held slight censure. ‘Just one more thing. You need to explain it all to Vince’s sister.’

His gut dropped. James had been the ‘touchy-feely’ Halroyd, the people person. Cal didn’t want to have to deal with hysterical relatives, especially when he knew Tess would do it so much better. ‘I can wait for you and we can do it together.’

She shook her head. ‘I’m going to be tied up here for a bit longer getting him stable. The family will be stressing and you need to put them out of their misery.’ Her face was hidden behind her mask but her eyes said it all. ‘I’ll be there as soon as I can.’ She turned back to Esther and issued instructions about commencing antibiotics.

Stunned, he stared at the back of her head. It wasn’t supposed to work like this. He did the life-on-the-edge stuff, not the routine hack work. But Callum Halroyd, the feted Frontline surgeon, had clearly just been organised and dismissed by a country GP.

He didn’t like it at all.

* * *

Callum ran his hand through his hair. Clipping the ulcer had been a walk in the park compared with the conversation he’d just endured with Vince’s sister. Tess had eventually rescued him from the emotional woman and ushered him into the tiny lounge off Theatre.

Glancing over the top of his cup of steaming coffee, he noticed black smudges under Tess’s eyes, marring her clear skin. She pressed one hand to the small of her back while she sipped her tea. She really should be tucked up in bed.

An image of her face relaxed in sleep and her lush body sprawled across a bed thudded through him. Despite fatigue, despite his grief, his groin tightened. Hell. He downed his coffee, almost welcoming the quick scald against his mouth and throat.

‘Sorry about your shoes.’ Tess’s apologetic gaze dropped to his bare feet. ‘I’ve never seen anyone bleed like that before, not even during my residency in Sydney.’

He gave a wry grin. ‘Oh, they can bleed all right. So now you know that you always tube anyone with a belly full of blood and save the surgeon’s shoes.’

‘Not to mention the patient’s life.’ Chuckling softly, she lifted her legs up onto a chair and rotated her ankles. ‘You did brilliantly tonight, action man. Thank you very much. We’d have been in strife without you, and on the plus side you got a bit of excitement tonight after all, so it was a win-win situation all round.’ She smiled smugly.

He knew he’d pushed her out of her comfort zone back in Theatre. ‘Sorry it got a bit hairy in there and that I overrode you, but I knew I could get the clip on.’

She shot him a knowing look. ‘See, general practice isn’t as mind-numbing as you seem to think.’

He snorted, unable to help himself. ‘And the last time you had to open Theatre for an emergency was?’

She had the grace to look like a kid caught with her hand in the lolly jar. ‘We do small procedures here and elective surgery cases go to Mildura or Wagga.’

He nodded, happy in the knowledge that he had Narranbool pegged. ‘And really serious cases would go to Melbourne to state-of-the-art equipment and experienced staff. It’s how the system works.’ He stood up, rinsed his cup and placed it on the drainer. ‘It’s midnight. I’ll take you home.’

Her brows pulled together as she swung her feet down onto the floor. ‘I should stay a bit longer.’

‘Vince is stable and in good hands with Esther and Ken. They’ve got my mobile number and if his condition deteriorates they’ll ring. I’ll visit him in the morning before the service, and check the results for Helicobacter pylori. I imagine that’s the culprit causing the ulcer, and if so I’ll start him on combined antibiotics.’

He gently took her empty cup from her hands. ‘So now all you have to do is go home and crash.’

Luminous eyes stared up at him, clear and penetrating. He expected her to object, and decided to pre-empt her and not wait for the words of refusal to pour from her amazing mouth. A mouth that could go from a pout to a wide smile in a heartbeat. ‘Tomorrow is going to be a long day and—’

‘That sounds like a good idea.’

Amazement rocked him. ‘Pardon?’

She smiled against a closed mouth, her lips compressing and her chest rocking as she stifled laughter. ‘You’re right. I’m exhausted and tomorrow will be huge.’

Relief trickled through him. Earlier this evening when they’d discussed going to Melbourne, he’d decided that Tess had a stubborn streak that ran long and deep. He hadn’t expected her to readily agree with him about taking over Vince’s care. She’d obviously come around on all fronts.

‘So we’re in agreement—excellent.’ He quickly calculated their estimated time of departure. ‘I’ll pick you up at ten-thirty in the morning. I think it’s best to wait until after the funeral to tell my parents—they sure don’t need that sort of distraction before the service.’ He shoved his hands deep in his pockets. ‘There’ll be hours in the car on the way to Melbourne to discuss everything and sort out the details.’

Her jaw tilted slightly and her shoulders straightened. ‘I’ll go to Melbourne on one condition.’

His hand automatically rubbed his forehead as he rested his bottom on the table and looked down at her. ‘And what would that be?’ The words rolled out on a sigh.

‘That you stay here and work in Narranbool.’

He heard the words but his brain refused to believe them. ‘That’s a ridiculous request. Narranbool doesn’t need me as part of its medical personnel.’

‘Yes, it does.’ Her sombre tone hung between them.

The serious light in her eyes, along with the tension clinging to her face, sent unease swirling through him. Slowly, through the fog that was his mind, realization dawned.

He absently rubbed the palm of his left hand with his right thumb. Tess was thirty-seven weeks pregnant and on call. There had been no reference by any of the staff of a registrar. Narranbool is very fortunate to have you on board now James has gone. He closed his eyes against the truth that bore down on him, hard and unyielding, like an avalanche. Forcing his eyes open, he met her gaze. Not even bothering to ask it as a question, he spoke slowly. ‘You’re the only doctor in town now.’

She nodded. ‘That’s right.’

The idea of working in a small town almost choked him. He’d go stark raving mad being a GP, listening to a catalogue of rambling woes and ailments, but no town deserved to lose all its medical personnel in the one week. Still, he needed Tess safe in Melbourne, needed to keep the baby safe.

He dragged in a resigned breath. ‘So you’ll go to Melbourne if I stay here? That’s blackmail.’

‘No, it’s not—it’s a choice.’ She folded her arms and even though she was sitting and he was standing, no way was she a powerless participant. ‘I refuse to leave my community without medical care. If you want Oscar born in Melbourne then this is the best solution.’

Every cell in his body railed at the idea. ‘What about me being in Melbourne for the birth of my nephew?’

‘I have three weeks to go until my due date and we’ll have organised another doctor by then.’ A slow smile washed over her face as her eyes glowed with keen intelligence. ‘Of course, if you can’t hack the slow pace of an outback general practice, I can stay in town and keep working.’

His gut rolled as personal need clashed violently with professional ethics. He didn’t want to stay in Narranbool, damn it, but he couldn’t leave the town without a doctor. He rubbed the back of his neck, his fingers hardly making a dent in the tight muscles. She had him well and truly over an ethical barrel.