Her Four-Year Baby Secret

by Alison Roberts

  ‘Green label,’ Fiona directed Shane. ‘Get someone to take him to the tent. He’s got a bit of a wheeze. They’ll need to check if he’s an asthmatic and give him some salbutamol if it gets any worse.’

  The fleeting glance she took around them at the litter of abandoned personal belongings, many of which were spattered with blood or covered with dust, confirmed the futility of anyone taking the time to try and find the missing finger. With lives potentially being lost around them, it had to be rated well down any priority list. Fiona hurried towards the next victim. An update to the control centre would need to be made soon.

  She needed back-up. Preferably highly skilled.

  Nick Stewart heard the call for medical assistance over the PA system but he was already moving back up the track, having heard the crash and then the screams of the injured.

  Why had he decided to go down to the finish flags to watch the last competitor make it home?

  Why had he come here at all when he had known how many ghosts would be in evidence?

  Here he was, a newcomer to a tiny country at the bottom of the world, finally ready to stop running and try to build a life that was grounded and real. And on his first full day he had chosen to resurrect memories that were among the most painful he had.

  Which was why he had come, of course. Nick pushed himself up the steep track at a speed that was making his muscles ache and his lungs burn. If there was a challenge that had to be faced, Nick Stewart faced it. If the obstacle seemed insurmountable, he found a way to break through it. The ghosts had been held at bay until now because there had been no reason to lay them but if he was serious about a new start, he wasn’t going to allow himself to back down from what needed to be dealt with.

  Two ambulances and a Red Cross vehicle had gone well past him now. He should have flagged one down. Told the crews that he was an emergency physician—fresh out of dealing with mass casualty incidents in war zones—and that he had practising privileges in New Zealand because he was the locum for their community hospital for the next month.

  He was too used to relying on his own resources, that was the problem. He’d turned and legged it towards the track he had just come down as soon as he had heard the crash and now he was going to be several minutes behind the play by the time he reached the scene, dammit! His mission of getting uphill was being further hampered by the flow of people being herded away from the scene. Shocked-looking people, who kept slowing and turning to look behind them as though they still couldn’t believe what they’d seen.

  Hopefully, there were some competent paramedics among the crews on those emergency vehicles, but this was rural New Zealand. A disaster like this was probably a once-in-a-lifetime event for these people and, no matter how highly trained they were, nothing really counted like experience.

  The small crowd of people in the largest tent all seemed to have suffered relatively minor injuries. A loud woman was demanding attention, her hands on the shoulders of a young child who had clearly broken both his arms. Some of the group were sporting large green tags on their wrists and Nick recognised the triage labels with an inward nod of approval. Someone here knew what they were doing.

  He approached a man wearing a race official’s vest. ‘I’m a doctor,’ he said crisply. ‘You were calling for assistance. Who’s in charge here?’

  ‘Outside,’ the official directed. ‘Find the medic wearing a vest that says “Scene Commander”.’

  That particular vest was not immediately obvious but there were at least half a dozen people wearing the uniforms of ambulance officers, moving among blanket-wrapped victims lying on the ground. Uninjured people boosted the numbers. Nick passed a man who was holding the head of an unconscious woman as an ambulance officer slipped a stiff neck collar into position. She had a pink label on her wrist.

  ‘I’m a doctor,’ Nick said again. ‘Your patient breathing OK?’

  A second ambulance officer, holding a portable gas cylinder and mask, nodded. ‘We’ll get oxygen on as soon she’s collared.’

  ‘GCS?’

  ‘She’s been moving a bit and wouldn’t tolerate an airway. Maybe 11?’

  Nick nodded. There could well be people that needed his attention more and, besides, he had a responsibility to report to whoever was in charge of this rescue scene. The success of managing a large-scale disaster depended on the chain of command, good communication and the best use of all possible resources. Mavericks who did their own thing were a liability and what good would he be anyway, without anything more than the most basic equipment?

  ‘Where’s your scene commander?’

  ‘Over there.’ The tubing of the mask uncoiled as the ambulance officer pointed.

  Nick passed the wreck of the car wedged against the hot-dog caravan. The group of men—some still holding fire extinguishers, others trying to open the jammed doors—obscured his view of what might be inside. His brisk stride faltered for a second.

  Could he face his worst demon and attend the occupants of this vehicle? Step back in time to when he’d lost not only his childhood hero but the last living member of his family?

  Yes…of course he could.

  He reached the side of the car just as one of the jammed doors was prised open. The words ‘I’m a doctor’ cleared a space for him instantly.

  Two men were inside, both conscious and distressed and talking in what sounded like a European language. They were both breathing without difficulty, had strong pulses and there was no sign of obvious bleeding. One of the men had burns to his face but they weren’t serious and Nick couldn’t see any singed hair or soot inside his nostrils, which might indicate respiratory tract involvement. He knew how to undo the harnesses and could check cervical spines and then chests for any major trauma.

  ‘Nothing life threatening,’ he said to the officials. ‘The front of the car is buckled enough to trap them. Is the fire completely out?’

  ‘Seems to be.’

  ‘You’ll need cutting gear to get them free. They’ll be OK till then. A cold, wet cloth on the driver’s face would be helpful. I need to find the scene commander for the medics.’

  ‘Over there, mate.’

  Yes. Nick could see the vest with the correct designation. On a slight figure who was crouched beside a body. A female, obviously, given the long braid of dark hair hanging between her shoulder blades.

  ‘Pink label,’ he heard her instruct the man beside her. ‘And I’m not happy with his breathing. This one’s top of the list for intubation. How many more for triage can you see, Shane?’

  Her partner was scanning the area. ‘I think this is the last, apart from the guys in the car.’

  ‘Great. We’ll stay here for the moment, then. I’ve just got to update Control.’ She stood up, unclipping a hand-held radio from her belt.

  ‘I’m a doctor,’ Nick said to her back. ‘Emergency physician. Where do you need me first?’

  ‘Right here.’ The woman turned. ‘Status-one patient. Chest injuries…’ Her voice trailed into silence. ‘Oh, my God,’ she breathed a moment later. ‘Nick?’

  He’d know who she was the moment she’d turned. Before that even, from the tone of her voice or that lithe movement when she’d stood up when long limbs had moved with all the grace of a dancer.

  But, then, he’d often seen a similar movement or long, curly dark hair or heard something in a voice or seen it in a smile that had reminded him of Fi, hadn’t he? He’d spent years experiencing the jolt of a missed heartbeat or a catch of his breath only to find it had been just the whisper of a ghost.

  So much time had passed since he’d actually seen Fi and this was unexpected enough to be mind-blowing. He had assumed she was still a nurse in a London hospital somewhere. What the hell was she doing, being a paramedic, let alone being in charge of a disaster scene on a mountain in what was the back of beyond in international terms? Was this why those letters had been returned unopened?

  In its own way, this was as shocking as being plunged into
managing a disaster scene. Fiona’s brain whirled at lightning speed in the second or two she simply stared at Nick.

  Why was it so shocking? If she had ever been going to meet her ex-brother-in-law, the venue of a top-level rally car competition was the obvious setting. Events like this were far more part of Nick’s personal history than her own.

  Given that her adrenaline levels were at an all-time high, coping with the equally unexpected, large-scale disaster, coming face to face with Nick Stewart should barely have registered, let alone be giving her this moment of utter confusion.

  Fiona wanted to throw her arms around this man. To hug him and tell him how wonderful it was to see him again.

  But she also wanted to plant her hands on his chest. To shove him away as hard as she could. To make the accusations that, even as recently as her conversation with Shane just before all this had begun, still echoed in the back of her mind.

  The anger was still there.

  Maybe it was lucky there was no way Fiona could take even another millisecond to choose between the conflicting reactions. With a deliberate mental shake, she banished anything remotely personal. Instead, she allowed herself a wash of relief that somebody more qualified that she was could share the responsibility of caring for all these injured people. Someone that she knew could be trusted to handle anything that could prove too much of a challenge.

  Astonishing how that gave her a new kind of strength. She could cope with this—the biggest incident she had ever faced. She would do her job and do it well.

  ‘My kit’s here,’ she told Nick crisply. ‘It should have everything you need. My partner Shane will help you.’ She turned her back, pushed the button on the radio and began to walk away.

  ‘Three status-one patients,’ she informed Control. ‘Four status two, six status three so far. What’s the ETA for the rescue helicopter?’

  CHAPTER TWO

  ‘IS THERE a stethoscope in that kit?’

  ‘Yep.’ Shane crouched to flip the catches open. He handed the instrument to Nick and then fished in his pocket. ‘You want some gloves?’

  ‘Thanks. Can you expose the chest for me, please?’

  Nick pulled on the latex gloves as Shane used shears to cut the clothing so that they could examine their patient effectively. He took just one more, semi-stunned glance at the retreating figure of Fiona.

  ‘You guys local?’ he asked Shane. With an event this size, extra cover could well have been pulled in from some distance away.

  Shane nodded, cutting through the last section of a woollen jersey and the shirt beneath. Nick unconsciously echoed the nod as he fitted the earpieces of the stethoscope into place, tucking away the satisfying information that he was going to be able to talk to Fi properly when this was over and then transferring his total concentration to watching their patient’s efforts to breathe.

  ‘Asymmetrical chest wall,’ he noted. ‘And paradoxical movement.’ The disc of the stethoscope dangled for a few more seconds as Nick laid his hands on the damaged chest.

  ‘Flail chest?’ Shane queried.

  ‘Yeah. Let’s get some high-flow oxygen going and use a bag mask to provide some positive pressure ventilation.’ Nick listened carefully with the stethoscope to gauge air entry as Shane connected the oxygen and started the flow.

  ‘Absent breath sounds on the left side,’ he said tersely. ‘Do you carry a needle decompression kit?’

  ‘Here.’ Shane handed him the package and then reached for an alcohol wipe to clean the skin.

  ‘Thanks.’ Nick caught the younger man’s gaze for a moment, to communicate the fact that he was impressed. ‘Exactly the right spot. You know what you’re doing, don’t you?’

  Shane’s smile was fleeting. The next few seconds were tense as Nick inserted the needle to allow the air trapped outside the lung in their patient’s chest cavity to escape. The hiss of air was lost in the noise around them but the man’s breathing improved almost instantly.

  Nick took a deeper breath himself. ‘Let’s get some baseline vitals and IV access. Fi’s right—this chap needs intubation.’

  As they worked to try and stabilise the man for the next few minutes, Nick became aware of the change in command taking place around them. The police were now in charge, as they should be, to allow medical personnel like Fiona to do what they did best and care for the injured. He could see her doing just that, only a few metres away from his own position.

  She had a race official holding a bag of IV fluid aloft and she was uncoiling the tubing of a giving set to attach it to the line she must have already secured in her patient’s arm. She was clearly intent on her task but at precisely the moment Nick’s gaze rested on Fiona, she glanced up.

  For just a split second, their gazes caught. A fraction of a moment completely inconsequential in the general level of urgency and stress but it felt curiously longer. And more personal. Almost like a physical touch.

  The connection was still there, wasn’t it? Shockingly so, given the space of time since they’d last seen each other, but, then, this had been so unexpected.

  Disturbing…

  Nick’s gaze shifted virtually instantly. He could see Red Cross personnel setting up a treatment area in the largest tent available as the people with less serious injuries were checked and moved elsewhere. A helicopter was landing, unloading people and equipment, presumably from the local hospital.

  That was where he should be, even though he wasn’t officially due to start work until next week. This was frustrating, not having a handle on what resources were available in the way of staff and theatre facilities or even what the transport times to the nearest base hospitals would be.

  Two first-aid volunteers were pushing a stretcher, with a bright orange backboard on the top, over the rough ground. They came in Nick’s direction.

  ‘Pink label,’ one of them noted. ‘Fi said to go to those first.’

  They veered closer. ‘The tent’s ready,’ the other told Nick. ‘You want to move your patient inside?’

  Nick looked up from where he had unrolled the intubation kit to check its contents. People were carrying equipment like blankets and IV fluids into the tent. He could see bright lights on inside.

  This patient was seriously injured. With a flail chest, there were two or more ribs broken in two or more places, which meant he had sustained a significant blunt chest injury. He was at risk of lung contusion, further deterioration of his breathing due to air or blood in the chest cavity, brain damage from lack of oxygen or going into shock from blood loss. He could well have associated injuries to his thoracic spine, a diaphragmatic tear or even a cardiac injury.

  Until they could get this man to an emergency department, possibly Theatre and then an intensive care unit, all they could do was maintain his level of oxygenation by supporting ventilation. Intubation and manual ventilation would be much easier to manage in the relatively controlled space of the tent.

  ‘We need the backboard,’ Nick told the stretcher crew. ‘And a couple more people to help with a log roll. Shane, can you support his neck and keep the oxygen on?’

  ‘Sure.’

  Another stretcher was being carried into the tent in front of Nick’s patient. Fiona had a bag of IV fluid in her hand as she walked beside it. A second bag was now being held by a police officer.

  ‘Rescue helicopter is due any minute,’ she informed Nick. ‘We’ll evacuate two of the status-one patients as long as they’re stable.’

  ‘This guy won’t be stable until I’ve intubated,’ Nick responded. ‘I’ve done a needle decompression for a pneumothorax but his breathing’s still inadequate.’

  Fiona held his gaze and this time it didn’t create those disturbing ripples. This was a professional discussion and, maybe for the first time, they were on an equal footing. In this situation they had the same skills and the same goals. The only real difference was in the amount of experience clocked up.

  ‘You OK with Shane to assist you?’

  Wha
t would she say if he said he wasn’t? Would Fi offer to assist him herself? That odd feeling in his gut returned. Maybe he wasn’t ready to work quite that closely with this woman. What Nick really needed was just a few minutes to himself to get his head around this and that wasn’t going to be possible in the near future. Besides, Shane had already demonstrated his capabilities as an assistant.

  ‘Sure,’ he told Fiona. ‘More than OK.’

  His confidence was not misplaced. Without being asked, the junior paramedic folded a towel to the thickness needed to provide the ideal ‘sniffing’ position of their patient’s head. He pre-oxygenated while Nick readied the laryngoscope and endotracheal tube and his hand moved to supply cricoid pressure at precisely the moment needed.

  ‘Good job,’ Nick told him. ‘You could be doing this yourself, I think.’

  ‘Nah.’ Shane shook his head as he squeezed the bag mask while Nick listened to the chest to confirm correct placement of the tube. ‘I’m not qualified yet. Fi’s got me into a training programme, though, and she’s the best teacher.’

  ‘Mmm.’ A flash of memory came unbidden to a corner of Nick’s mind as he attended to the automatic task of slipping a bite block between their patient’s teeth and securing the tube protecting his airway.

  He’d been studying for an exam. With so much going on at home it hadn’t been an easy task. The party to celebrate his older brother’s engagement had lasted the whole weekend and it hadn’t helped that Al had, once again, hit the jackpot.

  He’d found the perfect woman.

  Fiona had heard his frustrated sigh as she’d passed the library door. She had given the impression that an excuse to escape the revelry had been more than welcome. She’d been so interested in what he had been studying and had sympathised with the scramble his brain had been in, trying to memorise medical terms that had seemed far too similar.