Buch lesen: «The Surgeon's Engagement Wish»

CHAPTER ONE

THE car should not have been there.

In the small car park adjacent to the emergency department of Ocean View hospital, yes. In the space reserved for the ambulance, even, if the emergency was dire enough.

But three quarters of the way through the wide electronic doors that led into the reception and triage area?

No way!

Nurse Elizabeth Dawson’s astonishment rapidly gave way to alarm. The car would have been suspicious enough tucked neatly into an acceptable car-parking slot. An ancient, rusting hulk of a V8. A status symbol amongst the elements of society who preferred to simply ignore any restrictions the law might impose on their lifestyle.

The man climbing out of the driver’s seat was even more intimidating. Clad in battered leathers with the ‘patch’ of his gang emblazoned on the back of the jacket, the heavily tattooed and menacing figure would have alarmed even the most confident of any emergency department staff.

And Beth Dawson was far from the most confident right now. She had started a new job in a new town only a couple of hours ago, for heaven’s sake, and everything was still completely unfamiliar.

No. Not quite everything. The aggression emanating from the gang member she was watching was all too familiar.

An unexpected flash of anger cut through her fear. This type of scenario was precisely why she’d left her job in a huge south Auckland hospital so recently. She’d had a gutsful of dealing with violent and uncooperative patients who took any pleasure or even satisfaction out of demonstrating the level of skill she had attained in her chosen profession.

The anger couldn’t last long enough to fuel courage, however, given the fact that she was alone in this part of the department. At 1 a.m. in a semi-rural area you wouldn’t expect a full waiting room, and the only patient who had come in since midnight was now having his chest pain investigated in one of the two resuscitation rooms.

Beth’s finger was pressed firmly against the button summoning assistance and any trace of saliva vanished from her mouth as she watched another two figures emerge from the vehicle. The bizarre sight of the car under the bright lights and filthy tyres on the spotless linoleum had already become just a background to an unpleasant drama unfolding. So had the rhythmic and futile attempts the electronic doors were making to close the small gap left around the obstacle. They touched the rear of the car and then bounced open again. And again.

The movement of the doors did not impede two of the men dragging the final occupant from the rear seat of the car. Little care was afforded the potential injuries of an apparently unconscious victim and a large smear of blood appeared on the pale floor as his feet dragged.

Two more nurses rushed into the space behind Beth, closely followed by the only doctor on duty, Mike Harris. Beth could feel all three of them virtually skidding to a halt as they caught sight of the car inside the building, but she didn’t turn her head. Her gaze was fixed on the slumped figure being held up by the armpits. She drew back instinctively as the gang member who had been driving the car started walking towards them.

‘Jackal’s been shot.’

Beth was aware of broken teeth and the smell of alcohol as the man spoke. She was also quite well aware that the incongruously casual tone of voice was no insurance against the level of implied threat in his next succinct words.

‘You’d better do something.’

They would be armed, Beth had no doubts about that. There would be knives tucked inside those commando-style boots. At least one of the men was wearing knuckle-dusters and she was quite certain there would be more than one sawn-off shotgun easily accessible in that vehicle.

Her breath escaped in something like a strangled laugh. She had left a big city hospital that had protocols for dealing with precisely this type of incident. Any number of security personnel would be available within seconds and a well-rehearsed police squad only minutes away. And even that kind of back-up hadn’t been enough to prevent her best friend, Neroli, giving up her nursing career, having been held at knife point in Beth’s old emergency department.

Beth had come to a small-town hospital near the tip of the south island of New Zealand to find a peaceful place to settle and refocus her life. She had barely begun her first night duty in this tiny emergency department and here she was, facing one of her worst nightmares. A recurrent one, thanks to the trauma she had unsuccessfully tried to help Neroli overcome.

Did Ocean View hospital even have security?

How far away were any police? The closest large town was Nelson and that would be at least ninety minutes away by road.

The tension escalated several more notches as the spokesmen for the gang members moved. His shoulders hunched and the fingers of one hand flexed and then clenched. The fist was thrust towards the only male member staff member present.

‘Now!’

Just do what he says, Mike, Beth urged silently. Please! But Dr Harris hadn’t even flinched.

‘Sure.’ Mike’s face was impassive and Beth found herself suddenly feeling slightly more confident. Well into his fifties now, Ocean View hospital’s emergency department consultant probably had more than enough experience to cope with situations such as this. ‘But I’m not going to tolerate my staff—or anyone else—being intimidated.’

There was a tiny silence as each side weighed up the implications of non-cooperation. It was broken by a groan from the injured gang member and the attention of everybody present was instantly diverted.

‘What’s happened exactly?’

‘He’s been shot, man. I told you.’

‘Yes, but where? And how long ago? How much blood has he lost?’ Mike was moving calmly towards the victim. Beth looked at her nursing colleagues. Should they all follow him? Chelsea was looking as nervous as she felt herself, and Maureen looked grim. The older nurse tilted her head.

‘Chelsea, why don’t you and Beth go and get a stretcher? I’ll stay and help Mike.’ She turned as she spoke so that her back was towards the gang members. ‘Call the police,’ she whispered faintly, her lips barely moving. ‘Fast.’

Chelsea’s nervousness seemed to wear off the moment she was assigned a task. She even grinned at Beth as they hurried from the triage area.

‘Here we go,’ she said almost cheerfully. ‘Again!’

Beth’s heart sank to a new low. ‘You mean you get this type of incident on a regular basis?’

‘We do get bit of trouble from gangs now and then.’ Chelsea paused as they entered the main section of the emergency department and she reached for the wall phone. ‘You’d be used to it, though, wouldn’t you? Didn’t you say you’ve been working in south Auckland?’

‘Yes, but I didn’t expect…’ Beth’s words trailed off as Chelsea started speaking to whoever was on the other end of the phone.

‘We seem to have a code yellow in ED,’ she said briskly. She listened for only a few seconds. ‘Cool…thanks.’

Beth grabbed the tail end of the stretcher and she and Chelsea headed back the moment the phone was replaced.

‘What’s a code yellow?’

‘Trouble with gangs.’

Good grief! So it happened often enough to have its own code?

‘What happens on a code yellow?’

‘Sid will get here first. He’s our night orderly cum security guard. Then one of the local cops who lives just down the road will come in.’ Chelsea was looking almost excited now as she glanced back at Beth. ‘If he thinks it’s necessary, he’ll call Nelson and they’ll chopper in the armed offender squad to help out.’

‘But there’s only one patient!’

‘So far.’ Chelsea gave Beth a questioning glance now. ‘This really bothers you, doesn’t it?’

‘I’m OK.’ Beth wasn’t about to demonstrate any inadequacy on her first shift. ‘Like you said, I’m used to it. A bit too used to it, maybe. A friend of mine had a knife held to her throat by a gang member not so long ago.’

Chelsea looked horrified. ‘Was she hurt?’

‘Not physically. She’s given up nursing, though, and gone to work in her sister’s coffee-shop in Melbourne.’

‘Was that why you decided to move as well?’

‘Partly.’ Beth smiled wryly as they turned the corner. ‘I was rather hoping I’d be getting away from this kind of thing by moving down here.’

Chelsea’s quick smile was sympathetic. ‘I hope it wasn’t the main incentive for the shift, then.’

‘It wasn’t.’

Beth’s words were lost as they entered the front of the department to find the stretcher was now superfluous. The injured man’s colleagues had dragged or lifted him as far as the bed in the empty resuscitation area.

‘I said don’t cut his leathers, man!’

‘We’ve got to get his jacket off so I can assess his breathing.’ Mike was still managing to sound calm but Beth could see that his frown lines had deepened perceptibly.

Maureen was plugging the tubing attached to an oxygen mask onto the overhead outlet. ‘I’m just going to put this on your face,’ she warned their patient.

The stream of obscene language made Maureen look even grimmer than she had on first spotting this patient.

‘Airway appears clear,’ she told Mike dryly. Stepping back as two silent gang members unceremoniously stripped the leather jacket off the now groaning man, she noticed the return of the younger nurses.

‘Perhaps you two could clear Resus 2.’ She and Mike seemed practised in trying to keep the atmosphere as casual as possible, but the undercurrent of urgency was easy enough for Beth to detect.

And no wonder. The man in the adjacent resuscitation area was looking alarmed and his wife was terrified. It was just as well that the chest pain he was having investigated had been deemed to be angina rather than a heart attack because otherwise the anxiety caused by the arrival of the new patient might have made his condition a lot worse. He probably didn’t need admission but he certainly needed to be moved.

It took a minute or two to disentangle the patient from the ECG electrodes and other monitoring equipment anchoring him to the area. Beth looked over her shoulder as she pushed the foot end of the bed clear of Resus 2. The injured man in Resus 1 was alone with his medical attendants now. The other gang members had vanished. A second later they all heard the roar of an unmuffled engine as the car blocking the doors was restarted.

‘Our first job is to clear the department of any other patients if it’s possible,’ Chelsea told Beth as they manoeuvred the bed along the corridor separating the emergency department from the rest of the hospital. ‘We close the department to any arrivals that could be seen by a GP as well.’ She shook her head. ‘There was a major riot in the department a few years back apparently, and a bystander in the waiting room got stabbed. That was when code yellow came into force.’

Their patient’s wife was clutching her handbag in both hands as she trotted beside the swiftly moving bed. ‘Did you hear them say they were going to deal with whoever did the shooting? Where’s it going to end?’

‘At least most of them are out of the department for a while,’ Chelsea responded. ‘It’ll give the police time to deal with them before there’s any real trouble here.’

There was a curious calm in the emergency department when Beth and Chelsea returned. Mike was doing an ultrasound on the exposed, tattooed belly of their patient. Maureen was setting up a new bag of IV fluids.

A burly man wearing an orderly’s uniform was standing with his arms folded by the head of the bed, and an equally solid man in police uniform stood in an identical pose at the foot. They both gave Beth a curious stare.

‘Gidday,’ the orderly said. ‘You’re new here, aren’t you?’

‘This is Beth,’ Chelsea told them. ‘It’s her first shift tonight. Beth, this is Sid and that’s Dennis.’

The nods and smiles from the two men were both welcoming and sympathetic. Not a great way to start a new job, they conveyed, but they were pleased to meet her and would make sure she was safe. And Beth smiled back. Suddenly things didn’t seem nearly so disheartening. She would never have been introduced to members of security back-up in her old department and they certainly wouldn’t have made any non-verbal promises about making sure she was looked after. Working in a small community was going to be different.

Better.

‘Who’s on call for surgery tonight?’ Mike’s query broke an almost companionable silence.

‘Luke,’ Maureen told him.

‘Good. He won’t mind being woken up.’

‘Can you call him in, please, Chelsea?’

‘Sure.’

Beth watched as Chelsea headed for the wall phone. She knew there were five surgeons associated with Ocean View hospital. Three general and two orthopaedic. What were the odds that one of them would end up being called Luke?

And how many other reminders would there be for her tonight to let her know that you could never really escape the past and make a brand-new start? Beth shook herself mentally, bending over to pick up packaging from dressings and IV gear that littered the floor.

For heaven’s sake. It had been six years ago. It was pathetic that hearing that particular name could still have any effect on her. And it was weird that it was so much stronger tonight than it had been for a very long time. Maybe that was just because she was displaced. Feeling a little lost in a new environment and seeking links with her past to anchor herself.

‘He’s on his way,’ Chelsea reported. ‘Do you need theatre staff called in?’

Mike angled the ultrasound probe in a new direction, still peering at the screen. Then he nodded. ‘Yes, thanks, Chels. I reckon Jackal here is going to need more of an inside look than I’m getting.’

The gang member’s nickname suddenly seemed quite appropriate. The flash of fear as the comprehension of what was being organised on his behalf filtered through was swiftly followed by an aggressive snarl.

‘No way! You’re not cutting me, man! I’m outta here.’

‘Oi!’ The barked response from both Sid and Dennis was not enough to stop Jackal making an unexpectedly vigorous move to sit up, ripping the IV line from his arm in the process and actually managing to swing both legs over the side of the bed.

Restrained by the larger men, who latched onto both arms, he subsided instantly. In fact, he looked decidedly green within seconds and then, much to Sid’s obvious disgust, he vomited. Sid gamely kept hold of the arm but the restraint was no longer needed. Sitting up had been enough to cut an already diminished blood supply to Jackal’s brain and his level of consciousness was dropping fast.

‘Lay him down.’ Mike sounded almost weary. ‘And watch out for that blood, Sid.’ The orderly was wearing gloves but Jackal’s IV site was bleeding quite heavily. He leaned closer to their patient. ‘Listen, mate. You’re sick. You’ve had a bullet go through your belly. You’re lucky it hasn’t killed you but it’s still done a lot of damage to your spleen. You’re losing blood. Jump up now and you might make things a whole lot worse in a hurry.’

The response was not incoherent enough to disguise the obscenities but Mike simply straightened and reached for a fresh pair of gloves.

‘I’ll get that IV line back in. I don’t think he’s going to put up much of a fight with his blood pressure in his boots.’

Beth looked at the monitor. The pressure reading was 85 over 40. Jackal had to be losing a significant amount of blood. The glance that passed between Sid and Dennis was significant. If this became a homicide, they could all be in for a lot more drama.

Maybe they would be anyway.

Beth handed Mike a new wide-bore cannula and was ready with the luer plug and flush moments later.

‘Any word from Sally?’

‘Sorry.’ Beth shook her head. This was the kind of thing she hated about starting a new job. ‘I don’t know who Sally is.’

‘She’s one of our paramedics,’ Maureen supplied. ‘The ambulance got called not long after Jackal’s mates took off from here.’ Her brief smile was intended to be reassuring for Beth. ‘Police back-up got activated at the same time.’

Beth nodded, pleased to find her hands steady as she completed the fiddly task of screwing the luer plug into place on the cannula hub. She was injecting a bolus of saline to check that the IV line was patent when the radio on the main desk crackled.

‘Ambulance to ED. Do you copy?’

‘Shall I get that?’ Chelsea queried.

‘I’ll do it.’ Mike stripped off his gloves and then glanced at Beth. ‘Can you get some more fluids up?’

‘Sure.’

Beth taped the cannula securely in place, having flushed the line. Then she reached for a giving set and a new bag of saline. The task was automatic enough not to distract her from listening to Mike as he reached for the microphone next to the radio set.

‘Mike here, Sally. Receiving you loud and clear. What have you got?’

‘Status one patient. Car vs pedestrian.’

‘Roger.’ Mike shook his head slowly as he pulled a pen from his shirt pocket. They all knew how unlikely this was to have been any accident. ‘Vital signs?’

‘Heart rate of 130. Respiration rate 36. Oxygen saturation down and blood pressure unrecordable at present. GCS of 8. Head and chest injuries. Multiple fractures.’

Sid and Dennis looked at each other again. They didn’t need medical training to know that this patient was seriously unwell. Neither did they need the ambulance officer’s confirmation that this was another code yellow patient.

The ETA of the ambulance was ten to fifteen minutes and any calm in the small emergency department vanished.

Extra staff began arriving as Beth and Chelsea were assigned the task of setting up Resus 2 in preparation for the new arrival.

‘Have an intubation trolley ready,’ Mike instructed. ‘And a chest decompression kit.’

‘What happens with serious chest injuries here?’ Beth queried, pulling the crumpled sheet from the bed. ‘We don’t have a cardiothoracic surgeon, do we?’

Chelsea shook her head. ‘We stabilise them and then chopper them to Wellington.’ She flapped the clean sheet to spread it over the mattress. ‘Same with head injuries. We don’t run to a neurosurgeon either.’

Chelsea told Beth who the staff members were as the level of activity in the department steadily increased.

‘That’s Kelly—she’s a radiographer. Seth is the house surgeon on call. Looks like Rowena’s coming in to help as well. She’s a midwife.’

The names flowed right over Beth’s head. These people were all still strangers and this was no time to start even trying to remember names.

‘And there’s Luke.’

Beth flicked the laryngoscope she was checking shut to turn off its light. Despite herself, her head turned sharply at that familiar name but any view of the latest newcomer was blocked by the large figure of Dennis, the police officer.

‘The ambulance is here,’ he told them. ‘I’m going to see if they need any help.’

Two other members of the local police force had accompanied the ambulance but the paramedics had been in no danger from the hit-and-run victim they were transporting.

‘Breath sounds absent on the left side now.’ A blonde woman had her stethoscope on the exposed chest, between ECG electrodes. ‘GCS has been dropping steadily. I’ve already done a decompression on the right side.’

‘Bring him straight in here.’ Mike pointed to the available resuscitation area and Beth stepped back as the stretcher moved swiftly towards her. Then she reached to help transfer the patient to the bed.

‘On the count of three,’ Mike directed, holding the patient’s head and neck still by supporting the cervical collar. ‘One…two…three!’

‘We think he was hit at a speed of at least sixty kilometres an hour,’ the paramedic informed Mike. Apparently he was airborne for twenty to thirty metres.’

Maureen handed Beth a pair of shears. ‘See what you can do to get rid of the clothing.’

Beth was aware of more people pressing into the resus area to assist. ‘Tension pneumothorax on the left,’ Mike confirmed tersely. ‘Someone get me a decompression kit, please?’

‘I can do that.’

The calm voice should have eased some of the tension but the shears in Beth’s hands closed with an uncontrolled snap. Her gaze shifted just as emphatically to the speaker and for a split second she actually forgot what she was supposed to be doing.

Luke.

It couldn’t be.

But it was.

Luke Savage.

At Ocean View hospital?

If Beth had tried to think of the last possible place on earth she would expect to see this man again, a smalltown hospital would have been way up on the list. A prison cell might have beaten it to top spot, of course, but not by much.

He hadn’t noticed her. The surgeon was completely focussed on the task of inserting a needle between the victim’s ribs to release air trapped in his chest, which was preventing his lungs from functioning.

‘Pelvis is unstable.’ Mike was doing a survey for other major injuries while Luke was attempting to establish adequate breathing.

The consultant’s statement was enough to start Beth’s hands moving again, her momentary lapse unnoticed. She peeled leather trousers clear of the deformity on the right thigh.

‘Open fracture of the femur,’ she advised.

‘Cover it,’ Mike responded. ‘We can’t deal with that just yet.’

Beth reached for a large gauze dressing and tried to concentrate on squeezing a sachet of saline onto the pad to dampen it, but she simply couldn’t help glancing back towards Luke.

Had Luke recognised her voice as easily as she had recognised his?

Apparently not.

‘Oxygen sats aren’t climbing.’ Luke was staring at the monitor above the bed. ‘We’ll have to intubate.’

‘I’ll get another IV line going,’ Mike said. ‘We need to speed up this fluid resus.’

A new face peered in through the curtain. ‘Luke? They just called to say they’re ready for you in Theatre.’

His glance seemed to bypass Beth effortlessly as she used the damp dressing to cover the gaping wound on their patient’s leg. ‘Thanks. I’ll be up as soon as I can.’

Mike took the cannula Beth was holding out for him. ‘Could you help Sid take Jackal upstairs, please?’

‘Sure.’ The prospect of making an exit was appealing.

Was Luke simply being professional, ignoring her—quite properly—due to the emergency treatment of a patient? It was possible that he had not yet recognised or even noticed her.

It was also quite possible that he just didn’t give a damn.

And why, in God’s name, should that bother her so much anyway?

Beth turned her back on Luke but she wasn’t going to escape quite so easily. The sound of breaking glass made everybody pause.

‘What the hell was that?’

‘We locked the doors when we came in.’ The male ambulance officer had abandoned his paperwork to step closer. ‘Sounds like someone really wants to get in.’

A police officer appeared behind him. ‘ETA for the chopper is only two minutes. We’ve got a bit of a skirmish going on in the car park right now, though.’

The sound of a shotgun being fired was unmistakable.

So was the alarm that sounded on the new patient’s monitor in the tiny silence that followed.

‘He’s in VF,’ Luke warned.

Mike was already reaching for the defibrillator paddles. ‘Everyone stand clear.’

‘I don’t want anyone moving from here until we get some back-up,’ the police officer ordered.

‘Stand clear,’ Mike ordered.

Beth stood clear. In fact, she was quickly penned into the corner of the area, along with the paramedic and Chelsea, and couldn’t escape the awareness of how appalling the situation was.

They watched as Maureen squeezed air into the patient’s lungs and Luke readied himself to do compressions when the initial series of shocks was completed. Mike pressed the paddles into position and pressed the buttons to deliver the second shock and then the third.

Beth closed her eyes for a moment. This was all so bizarre it was almost a joke. Some huge, cosmic joke. And whoever decided which way the winds of fate were going to blow was laughing at her right now.

She had come here to get away from the stress of dealing with violence and was now up to her neck in the most major incident she had ever encountered.

And she had also come to get away from the lingering effect Luke Savage had branded on her life. She had just ended her extremely brief engagement to Brent, for heaven’s sake, because she had recognised that the only qualities he had that were attractive had been the ones that reminded her of Luke.

The prospect of actually crossing paths with Luke Savage had haunted Beth for far longer than the fear of finding herself living Neroli’s nightmare, and coming to a small town like Hereford had seemed like the perfect way to escape that particular ghost.

And here she was, only a few feet away from the man. And it felt like the first time she had seen him all over again. He was just as physically attractive, but it hadn’t been simply his looks that had drawn her so convincingly at that first meeting. It had been his presence. The feeling she’d got that this man would be able to handle any situation he found himself in, no matter what it was. And she could feel that again right now. Luke was just…exactly the same.

It was so bizarre. It went way beyond being a disappointing start to a new beginning. This was gutting. Maybe she should have taken up Neroli’s invitation to go to Australia with her. Melbourne would be a nice place to live and Neroli’s sister was always short of waitresses in that coffee-shop.

The static cleared from the monitor screen after the third shock to show a pattern that settled over several seconds into normal sinus rhythm. The quiet was broken by the steadying beeps of the monitor, loud but muffled shouting from somewhere outside and then the crescendo of an approaching helicopter’s rotors.

Relieved glances were exchanged between staff members and it was only then that Beth’s gaze met that of Luke. The, oh, so familiar dark grey eyes beneath that shaggy mop of black hair widened and Beth realised that he hadn’t been ignoring her.

He couldn’t look this shocked if he had known she was so close.

Her presence was a surprise. And it wasn’t a pleasant one.

It shouldn’t have hurt but it did. Any fantasies she’d ever had of looking into those eyes again and seeing the love that had once been there were crushed in an instant, and Beth could hear echoes of that cosmic laughter.

She wanted nothing more than to get away, and Mike’s repeated instruction to help shift Jackal up to Theatre seemed timely.

It wasn’t until Beth pulled the curtain back and stepped outside the resuscitation area that they realised the move had been premature.

Black-clad, helmeted and armed offender squad members were filing rapidly into the emergency department of Ocean View hospital, but the skirmish that had been taking place outside had also moved in. Somehow one of Jackal’s mates had gained access and was now standing outside Resus 1 with a knife in his hand as a member of an obviously rival gang advanced rapidly towards him.

And Beth had inadvertently stepped right between them.

Was this the punchline of the joke?

There was nobody close enough to help but the fear that should have swamped and immobilised Beth simply wasn’t there.