Читать книгу The Surgeon's New-Year Wedding Wish - Laura Iding - Страница 7

“WHAT do you have for me?” Leila Ross asked, entering the emergency department of Cedar Bluff’s hospital. As the trauma surgeon on call, she’d been summoned from her home late on Saturday night, Christmas Day night, in fact—not that she’d made any special plans, aside from a date with her bed, and the sound of her pager had jerked her from a restful sleep.

When she saw the tall, dark-haired ED attending physician standing in the center of the arena, her smile faded and her muscles knotted with tension, starting in her shoulders and moving all the way up her neck.

“Twenty-year-old male with acute abdominal pain in his right lower quadrant,” Dr. Quinn Torres said in his lyrical, East Coast voice. If he were any other man, his deep tone and sensual accent might have been attractive. “Elevated white count and acute nausea indicates appendicitis. He’s in room eleven.”

Despite his Boston accent, Quinn Torres looked Italian with his black hair and olive-toned skin, but his dark eyes made her think maybe his genes had come from Spain or Portugal. Her interest in his heritage was nothing more than pure curiosity, since his face was creased in its usual deep, perpetual scowl.

“Okay, I’ll take a look.” Leila swept her long straight hair back into a rubber band and quickly washed her hands before approaching the patient. She glanced at his chart. “Jimmy? My name is Dr. Leila Ross and I’m here to evaluate you for possible surgery.”

Jimmy Lawton glanced up at her, his green eyes full of pain and an unmistakable hint of fear. “Doc, you have to help me. My stomach hurts so bad I can hardly stand it.”

“I will,” she promised gently, placing a reassuring hand on his arm and scanning his vital signs before sending Quinn Torres a sharp glance. “Has he been given anything for pain recently?”

“Of course.” His haughty voice grated on her nerves. Torres was the newest ED physician on staff, having recently replaced Edward Cagney, who’d retired a few months ago. “He was given 8 milligrams of morphine forty minutes ago.”

“I think we’d better give him another dose,” she said, tempering her response with an effort. She didn’t like Quinn Torres. He was rude, arrogant, aloof and couldn’t have been more of an opposite from the rest of the staff at Cedar Bluff, who all radiated warmth and friendliness. He clearly didn’t belong here. Even now, the way he stood in the middle of the trauma room, like a king holding court over his subjects, made her want to poke his inflated arrogance with the tip of her scalpel. Why on earth was he here in Cedar Bluff, when a more prestigious hospital was obviously more his style?

She didn’t know and didn’t really care enough to ask. Liking or disliking Dr. Torres didn’t matter, as she was required to work with him regardless. So far, she couldn’t fault the quality of his medical care, even if he did have the personality of a toad. He was meticulous about everything he did, a trait she reluctantly admired since she was very much the same way.

Quinn gave the nurse a nod and she proceeded to give Jimmy another dose of pain medication. Leila tried to ignore Quinn’s dark, intense gaze as she continued to examine her patient.

“Have you performed any scans?” she asked, when she finished her physical exam.

“No, I thought I’d wait to see what you required.”

Giving an absent nod, she realized she could go either way. A CT scan would be nice, but given Jimmy’s young age and the elevated white count she was fairly certain Quinn’s diagnosis was correct. The CT scan could be a waste of time and she didn’t want a delay to cause his inflamed appendix to burst.

“I’ll take him to the OR to explore his abdomen,” she decided. “I’ll call the supervisor to get the OR crew in.”

“I’ve already ordered the OR crew to come in,” Quinn informed her. “They should be here soon, if they haven’t arrived already.”

His foresight shouldn’t have annoyed her, but it did. She told herself to get over it because, really, she was grateful. This way she could take Jimmy into surgery right away. “Thanks,” she said, trying to smile. “I appreciate it.”

Torres didn’t respond and his lack of congeniality only added to her ire. Would it hurt him to be cordial? She spent a few minutes explaining the procedure to Jimmy, ordered a dose of antibiotics and then asked Susan, the nurse, to get her patient prepped to go upstairs. She turned and reached for the chart at the same time Quinn did and as their fingers tangled, a jolt of heat sizzled all the way down her spine.

“Excuse me,” he said stiffly, turning away at the same moment she’d snatched her hand back. Struggling to calm her racing heart, she stared at his retreating back, stunned by her unexpected, and unwanted, visceral reaction to the man she intensely disliked.

“Do you need anything else, Dr. Ross?” Susan asked, handing over the antibiotic she’d requested.

Leila successfully pulled her attention firmly back to the patient. “No, thanks, Susan. Let’s go.” Leila placed the chart on the bed and helped push Jimmy’s gurney upstairs, still slightly shaken by that brief, electrifying touch. No doubt she’d totally imagined it. She’d been physically and emotionally exhausted this past week, the anniversary of her husband’s death hitting her harder than she’d expected. Even though George had died two years ago, she still missed him.

She’d loved her husband, even if their marriage had been too brief. George Ross had been a wonderful, kind and gentle man. There was no way she was even remotely attracted to a guy like Torres. Absolutely not.

As they reached the OR, she left Jimmy in very capable hands while she took time to scrub, resolutely pushing those irksome thoughts away and focusing every iota of her attention on the patient who needed her care.

Refusing to waste another second thinking about Quinn Torres.

Leila finished operating on Jimmy Lawton, thankfully catching his engorged appendix before it ruptured, only to receive another trauma call. Wryly preparing herself for a long night, minus any sleep, she hustled back down to the ED.

She was surprised to see Quinn was still there. Hadn’t his shift ended at eleven? Apparently not, since he was currently giving orders in a harsh tone that reminded her of a marine drill sergeant.

“What’s going on?” she asked, stepping into the trauma bay. There was a lot of blood surrounding the male patient lying on the gurney, and she could tell he was bleeding from his head, nose and mouth, not to mention the places she couldn’t see, like internally. Two nurses pumped blood and fluid on a level-one rapid infuser while another one scurried to get blood for additional lab work.

“He took a swan dive off the roof of his parents’ two-story house, leaving behind a suicide note. He hit the concrete driveway from an estimated distance of twenty feet.” The pertinent details didn’t come from Quinn, but from the charge nurse. “Took the brunt of the force on his legs, which might be the only reason he’s still alive.”

Oh, boy, she hated jumpers. They were the worst because the trauma was often so severe there wasn’t much chance of survival. Why couldn’t he have hit the snow-covered ground instead? At least then he’d have a better chance.

What a horrible Christmas memory for his parents.

“Leila, he needs to get to the OR, stat,” Quinn said when he saw her. The grimly fierce expression on his face surprised her, no sign of his cool arrogance now. “He’s losing blood faster than we can pump it in and I’m certain he’s bleeding internally.”

She was certain of that, too, but this patient’s status as a viable candidate for the OR wasn’t quite as clear. “What’s the extent of his head injury?” she asked.

“Pupils fixed and dilated. He wasn’t found right away, not until one of his friends kept trying to get in touch with him and called the parents,” Mary, the charge nurse, told her. “Their bedroom is on the other side of the house and they didn’t hear him hit the ground.”

“Fixed and dilated pupils are a bad sign. He needs a neurosurgical consult,” Leila told Quinn.

“I’ve called them and they’re on their way, but he has skull fractures, so there’s a chance he won’t suffer brain death. He needs to go to the OR immediately.” Quinn’s intense insistence was very unlike him. Where was his cool detachment?

Upon examining the patient closer, she realized his legs appeared firm and unnaturally taut. Compartment syndrome, bleeding into the tissue around the bone, was a serious, life-threatening complication of multiple trauma. “What is his tissue perfusion pressure?” she asked sharply.

Quinn shook his head, indicating he hadn’t checked it.

Leila glanced at the nurse. “Get me the Stryker STIC monitor, we need to know what his tissue perfusion levels are.”

“Draw a myoglobin level and a lactic acid level, too,” Quinn added, quickly realizing the danger.

She set up the monitor and then inserted a needle into the patient’s muscle. Quinn leaned over to see the reading for himself.

“We’re losing his blood pressure,” one of the nurses running the rapid infuser warned. “Do you want more blood or saline?”

“Both,” Leila and Quinn responded at the same time.

“Two more units of blood and one liter of fluid,” Quinn clarified. “Make sure you have his vasopressors turned up as high as possible.”

“Tissue perfusion pressures are elevated at 38 millimeters of mercury,” Leila said, glancing at Quinn. “I’ll take him to the OR for a stat fasciotomy in both legs and I’ll explore his belly, too. But it’s likely that this massive fluid resuscitation isn’t helping his brain injury at all, so you must realize his prognosis is poor.”

“I know.” Quinn’s dark eyes were grim, haunted, as if he was taking this young man’s fate directly to heart. “I’ll talk to his parents. Please do your best.”

“I will.” Leila turned and quickly gave orders for the patient to be moved up to the OR.

Her adrenaline was pumping, heightening her awareness as she prepared for surgery. The young man’s name was Anton Mayer and as she finished her scrub and entered the OR, she noticed his condition wasn’t any better. In fact, if anything, he looked worse.

Feeling slightly sick to her stomach, Leila reached for her scalpel. She was going to keep her promise to Quinn and do everything possible, but she had an awful feeling that Anton was going to die.

Not yet, she reminded herself grimly, doing the fasciotomy to both lower extremities first and then preparing to explore his abdomen. He wasn’t going to die yet.

But after working on his legs, she moved to his abdomen and when she saw he had a severely fractured kidney, she knew things were worse than she’d feared. She took the damaged kidney out but the bleeding was profuse. She could barely see where the source of the bleeding was coming from in the sea of blood.

“We’re losing him,” Dirk Greenfield, the anesthesiologist, warned. “I can’t sustain his blood pressure.”

“Keep trying,” Leila said, praying she could find the source of his bleeder. Although there was likely more than one source. Sweat dampened the back of her scrubs, running down the sides of her face. She tried to tackle one emergency at a time.

“Blood pressure is gone, he’s in PEA.”

PEA was pulseless electrical activity, which basically meant the kid was bleeding to death. Or he’d already herniated his brain from all the fluids they’d given during the trauma resuscitation.

“Bolus him with epi, I found the arterial bleed.” At least she’d found one of them, though she suspected there could be more.

“I already bolused him with epinephrine several times. Now he’s in a wide complex rhythm.”

“No!” Leila didn’t so much as glance at the heart monitor, keeping her gaze focused on what she was doing. One more stitch and she’d have the artery closed off. Then she could take a look at his spleen. Maybe that was the other major source of his bleeding.

Finishing with the artery, she quickly switched the focus of her exploration on the area of his spleen, cutting the splenic artery in an effort to minimize the blood loss. But once the artery was open, she realized the blood wasn’t pulsing at all, but simply oozing at a slow rate.

Horrified, she glanced up at the monitor, realizing it was too late.

“Didn’t you hear me, Leila?” Dirk asked. “I said he’s gone.”

She momentarily squeezed her eyes closed and dropped her chin to her chest. She hadn’t heard, hadn’t wanted to believe what her professional eyes were telling her. After taking a moment to compose herself, she lifted her head and glanced at the clock. “Time of death 1:32 a.m.”

There was nothing more they could have done. She knew it, yet that didn’t make the prospect of telling Anton’s parents that their seventeen-year-old son was dead any easier.

When she returned to the ED, Quinn immediately crossed over, although he stopped abruptly when he saw by her expression that the news wasn’t good.

“I’m sorry,” she said in a weary tone. “I did the bilateral fasciotomies, but he had a severely fractured kidney, a ruptured spleen and so much other internal damage along with his head injury that I just couldn’t save him.”

Quinn stood there for a long moment, his jaw clenched, his gaze dark and resigned as he gave a brief nod. “I’ll talk to his parents.”

She wasn’t sure why, maybe because he seemed to be taking the news so hard, but she reached out to touch him. “I’m the surgeon of record. I should do it.”

As still as a statue, he stared at her hand on his arm as if it was something he’d never seen before and then finally raised tortured eyes to hers. “We’ll both go,” he said in a low, gruff voice.

Surprised by his acquiescence, she simply nodded and walked alongside him to the small private waiting room he’d given to the boy’s parents, not far from the larger public one.

His mother took one look at them and promptly burst into tears.

Quinn opened his mouth, but no sound emerged from his throat. He swallowed hard and sent Leila a silent plea for help.

Leila stepped up. “My name is Dr. Ross. I took Anton for emergency surgery, but he had too many injuries, to his spleen, his kidneys and his brain. I’m so sorry to tell you, he’s gone.”

“No-o-o,” wailed the mother, collapsing onto her husband for support. When Anton’s father broke into harsh sobs, his large shoulders shaking with grief, Leila felt her own eyes well up, too.

This part of her job never got any easier. Never.

“Why did he do this?” Anton’s mother asked. “Why?”

Again she had no answers. She glanced toward Quinn, whose face was drawn so tight he almost looked angry, but the agonized expression in his gaze reinforced his struggle to hide his own grief and helplessness.

“It’s not your fault,” Quinn finally said, taking a step forward to put a reassuring hand on the sobbing woman’s shoulder. “Please know, this isn’t your fault.”

“It has to be our fault!” The woman cried, nearly incoherent in her distress. “How could we not have known he was so unhappy? How could we have missed it?”

“It’s not your fault,” Quinn repeated.

“Teen suicide is very tragic,” Leila said in a soft tone, picking up a pamphlet from the rack of educational brochures on the wall. “It’s normal to feel responsible, but you need to know Dr. Torres is right. This isn’t your fault.” She slid the pamphlet toward Anton’s mother. “There’s a support group here for parents just like you. When things calm down after a few weeks, please consider giving them a call.”

Anton’s mother continued to cry and didn’t take the brochure. Anton’s father pulled himself together, the gut-wrenching sobs eventually quieting, and he reached for the information, folding the pamphlet before sliding it in his pocket. Leila sincerely hoped they’d get the help they needed.

After a few more minutes, she and Quinn left them alone. The ED nurses would keep an eye on the parents and for now their job was over.

“That was a rough one,” Leila murmured to Quinn. “He was so young.”

“Any suicide is rough, regardless of how young the patient is,” Quinn said in a harsh tone. “Suicide is a horrible thing to do to a family.”

Shocked by his outburst, she didn’t know what to say.

Instantly, his face changed, resuming the remote, cold mask he normally wore. “Excuse me, but I need to make rounds on the other patients in the arena.”

He left and Leila stared after him, the brief moment of camaraderie between them having vanished in a heartbeat.

Yet she wasn’t angry or upset. As she watched him move toward the arena and speak to the charge nurse, she found herself wondering about the enigmatic physician.

Because she was fairly certain Quinn Torres wasn’t nearly as arrogant and rude as she’d originally thought.

She was beginning to realize his outward aloofness might be a shield to hide the suffering he was feeling inside.