by Fiona Lowe
He rubbed his chin and hauled his thoughts back to the here and now. ‘You can hand over her care to David Martin.’
A deep V formed at the bridge of her nose. ‘So you’re transferring her to Adelaide?’
What? ‘No, she’s staying here.’ He tilted his head slightly and met her gaze. ‘Abbie.’ He paused for the briefest moment, the beat lending credence to his upcoming words. ‘Thank you for your care. This isn’t personal; it’s just that David’s experience is what Nonna needs.’
For the first time since he’d met her, a smile pulled her generous mouth upwards. It danced along her cheeks and into her eyes, making them sparkle like the rainforest after rain. And then she laughed. A laugh tinged with incredulity and yet grounded with a known truth, as if she’d heard a similar story before. As if she saw straight through him.
A flicker of unease stirred his normally unshakeable confidence.
‘It’s been a while since you last visited Bandarra, hasn’t it?’
And, just like that, he felt the power shift. ‘What makes you say that?’
‘David Martin moved to Adelaide ten months ago and the practice at Naroopna is vacant. As is the one at Budjerree. Right now, Bandarra is the only township within two hundred kilometres with medical staff. Come Wednesday, when Justin leaves, it’s just me and the nursing staff.’
His breakfast turned to stone in his gut. All he’d wanted was the best for Nonna. Instead, he’d let fatigue and fear of the past interfere with his usual clear-thinking and now he’d backed himself into a corner.
The urgent bleep of her pager suddenly blared between them and she checked the liquid display. Without a word, she sprinted past him and out of the room, leaving behind only a lingering and delectable scent of strawberries and liquorice.
He hated that he instinctively took in a deeper breath.
Abbie raced into a chaotic ED, shedding all of her disconcerting and unsuitable thoughts about the infuriating and ridiculously gorgeous Leo Costa. There should be a law against men being that handsome, and a statute that stopped her even noticing. The piercing siren of an ambulance screamed in the distance, instantly focusing her with its howling volume that increased with every moment. An intense sound that never brought good news.
People were everywhere. Two teenagers sat pale and silent holding each other’s hands, an elderly man supported a woman to a chair and a young woman clutching a baby called out, ‘Help me,’ and still people poured through the doors, many bloodied and hurt.
Lisa and Jason were murmuring platitudes mixed in with firm instructions as they tried to examine a hysterical woman with blood streaming down her face. Her shrieks of anguish bounced off the walls, telling a story of terror and pain.
The area looked like a war zone. ‘What’s happened and why haven’t emergency services notified us?’
Justin grimaced. ‘Apparently a bus hit a truck. Those who could, walked here.’
Triage. Years of training swung into action. ‘Lisa, you’re on walking wounded. Get a nurse from the floor to help you stat, and get someone to ring all the nursing staff and tell them to come in. I want a list of all names and all injuries. Prioritise, treat and be aware of anyone who blacked out. Any concerns, consult me or Jason.’
‘Will do.’ The experienced nurse headed to the chairs as Abbie grabbed the emergency radio.
‘Bandarra Base Hospital to Bandarra Police, over.’
Daniel Ruston’s voice crackled down the line. ‘Abbie, a bus and a truck collided. The paramedics are on their way with the first of the seriously injured passengers. It’s not pretty.’
‘How many are there?’
‘Two at least, probably more.’
‘Thanks, over and out.’ She headed straight into the resuss room, which was technically always set up ready for any emergency but she always liked to double-check. She glanced at the brand-new Virtual Trauma and Critical Care Service–a video conferencing screen on wheels. With its camera that used superfast broadband technology to transfer images from the country to the city, GPs in small towns could teleconference with specialists if need be. It was an extra medical lifeline in the tyranny of distance. Everything was ready. She didn’t have to wait long.
The paramedics barrelled through the doors, their stretchers bringing in two patients, both wearing oxygen masks. Paul, the senior paramedic, his face grim, started talking. ‘First patient is Jenny, a thirty-year-old woman, conscious with pneumothorax and suspected abdominal internal injuries. Chest tube and IV inserted in the field but BP continuing to drop. Second patient is Emma, a seventeen-year-old female with suspected spinal injuries, currently on spinal board and immobilised with a collar. Complaining of not feeling legs. IV inserted in the field and observations stable.’
Abbie bit her lip. ‘What else is coming?’
Paul looked sombre. ‘There’s a forty-five-year-old male with a fractured pelvis and multiple lacerations, and a sixty-year-old woman whose leg has gone into the wall of the bus. Jaws of life are on hand.’
Adrenaline poured through her, making her shake. She had at least four seriously ill patients, a minimum of thirty walking wounded and only four staff until the other nurses arrived. The ratio of staff to patients totally sucked.
‘It hurts.’ Jenny’s muffled sob came from behind the oxygen mask.
Abbie put her hand reassuringly on the woman’s shoulder as the trolley was wheeled into the resuss room. ‘I’m Abbie McFarlane and I’ll give you something for pain as soon as I’ve examined you.’
Justin appeared. ‘Lisa’s got it under control out there and I’ve given the hysterical woman a sedative and will stitch her forehead later. If you’re right here, I’ll examine the other stretcher patient.’
‘Great. Thanks.’ Abbie wrapped the automatic blood pressure cuff around Jenny’s arm and attached the electrodes to the ECG dots that the paramedics had applied. The reassuring beat of a regular heart rate traced across the screen.
The blood pressure machine beeped. Eighty on fifty.
Not good. ‘I just have to feel your tummy, Jenny.’
‘Will it hurt?’ Fear lit the woman’s eyes.
‘It might.’ Abbie gently palpated the woman’s abdomen and her fingers met a rigid and guarded upper left quadrant.
Jenny flinched. ‘Do you have to do that?’
‘I’m sorry.’ She’s bleeding somewhere.
‘What do you need? Catheter, plasma expander, abdominal ultrasound?’ Erin walked into the room, lack-of-sleep-induced black smudges under her eyes but as competent as ever.
‘All of the above, Erin.’ And more.
Despite what Leo Costa thought of her, Abbie knew her medicine, knew her strengths and was well aware of her shortcomings. She was a bloody good GP but she wasn’t a surgeon.
A patient with internal bleeding needed a surgeon.
She glanced hopefully at the Virtual Trauma and Critical Care Service but knew in her heart that this time a ‘virtual’ surgeon wasn’t going to meet her needs. She needed a real live hands-on surgeon and she had one down the hall.
One who thought she was incompetent. One she wanted to avoid at all costs, not work with side by side. But her breath shuddered out of her lungs, the sound telling. No matter how much she wanted to avoid the charismatic and opinionated Leo Costa, patients’ needs and lives came first.
The BP machine screamed incessantly, telling its undeniable message in no uncertain terms. Jenny was bleeding into her abdominal cavity. It was just a matter of time before she had more blood there than in her arteries.
She grabbed the plasma expander and plunged the sharp tip of the IV into it, piercing the seal, and then hung the bag onto the hook, opening the flow to full bore. Her choice was no choice at all. Jenny needed surgery and Abbie had to ask for help.
‘Erin, find Leo Costa and get him in here. Now!’
CHAPTER THREE
ABBIE had just finished catheterising Jenny when Leo strode into the room, instantly filling it wit
h vibrating energy and command.
‘You want me?’
His onyx eyes held hers with a hypnotic gaze and a sharp pang akin to hunger shook her so hard her fingers almost dropped the forceps. It had been years since she’d experienced anything like it. She cleared her throat, finding her in-charge voice. ‘Jenny sustained a blunt trauma to the abdomen, is haemodynamically unstable and transfer to Melbourne at this point is risky. She needs a surgeon.’ She pulled the ultrasound machine in close and turned it on, handing the transducer to him as Erin returned with a set of charts.
Leo put his hand gently on the terrified patient’s arm and, using the velvet tone she’d heard him use with everyone except herself, he reassured their patient.
‘Jenny, I’m Leo Costa and I’m a surgeon. Dr McFarlane’s pretty concerned about you so I’m just going to see what’s going on using the ultrasound.’
‘OK.’ Jenny gazed up at Leo as if he’d mesmerised her and all the resistance she’d used with Abbie melted away.
Abbie’s jaw clenched as memories of her father and Greg swamped her but she reminded herself it didn’t matter a jot if Leo Costa charmed every woman he ever met as long as he saved Jenny in a professional manner.
‘It will feel cold.’ He squirted the gel onto her abdomen and gently moved it across her distended belly. Black and white flickered on the screen until the image came into focus. He let out a low grunt. ‘Good catch.’
Abbie followed the trace of his finger against the screen, making out the black mass that was darker than intact liver and splenic tissue. It was everywhere–between the left kidney and the spleen, behind the spleen and ultimately pooling in the pelvis, the blood having travelled via the paracolic gutter. Her diagnosis was correct, not that it made her feel at all happy because Jenny wasn’t out of the woods yet.
Leo wiped the transducer and stowed it in its holder on the machine and returned his undivided attention to the patient. ‘Jenny, I’m fairly certain the impact of the accident has ruptured your spleen and I’m going to have to operate.’
The already pale woman blanched even more, a tremble of fear on her lips. ‘You’re good at this, aren’t you?’
Leo grinned, his smile streaking across his clean-shaven cheeks. ‘Jenny, I’m more than good; I’m one of the best.’ Then, as impossible as it was to imagine, his voice suddenly dropped even deeper, its timbre completely sincere. ‘Most importantly for you, I’ve done this operation many times in Melbourne. Erin’s going to get you ready for Theatre and I’ll see you there very soon.’
Abbie knew at that moment if she’d been the patient she would have followed him to the ends of the earth. Thank goodness she wasn’t. She was a wise and experienced woman and she didn’t follow any man anywhere. Not any more.
Leo tilted his head towards the door, code for, We need to talk, and then strode towards it. Abbie followed him out into the corridor.
Without preliminaries, he cut to the chase. ‘Can you anaesthetise?’
She nodded. ‘I can and Erin can assist but that’s all the staff I can spare because Justin and the nursing staff are needed down here.’
‘Abbie—’ Justin hurried towards them ‘—I’m evacuating the spinal injury to Melbourne by air ambulance.’
‘What about the elderly woman?’
‘She hasn’t arrived yet; they’re still trying to get her out but Paul’s worried about a crush injury and possible risk of amputation.’
Abbie groaned. ‘Man, I wish I could clone us. We’ve still got the fractured pelvis to assess. Get the paramedics to help you when they bring in the next two patients and—’
‘Abbie.’ Her name came out on a low growl as Leo slid his arm under her elbow in an attempt to propel her forward. ‘We need to get to Theatre now.’
His urgency roared through her, along with a tremor of something else she refused to name. ‘Justin if you—’
‘He’ll ring us in Theatre if he needs to consult. Come on.’ Leo marched her back into the resuss room. ‘Erin, cara, let’s move.’ He started to push the trolley through the door.
Then he swung back to Abbie, his well-shaped lips twitching with an unexpected smile tinged with cheeky humour as if he’d just realised something funny. ‘Er… Abbie, exactly where is the operating theatre?’
Her already adrenaline-induced limbs liquefied. She could resist his getting my own way smile, knowing it was manufactured, but this smile was vastly different—it was one hundred per cent genuine and completely devastating. Somehow she forced her boneless legs to start moving. ‘This way; follow me.’
‘It’s a mess in here.’ Dealing with the pulped spleen made Leo frown in concentration as he carefully separated it from its anchoring ligaments. Every part of him operated on high-alert, not just because all emergency surgery meant the unknown but because added into this combination was working with today’s less experienced staff. Still, he couldn’t fault either of them. Abbie McFarlane had run the emergency as well as any of his veteran colleagues in Melbourne and right now she was coping with a tricky anaesthetic and acting as scout.
‘Suction please, Erin.’ The amount of blood in the field had him extremely worried. ‘Abbie, how’s her pressure?’
Remarkably calm green eyes peered from behind a surgical mask. ‘Holding, but only just. I’ll be happier when you’ve zapped the sucker.’
He grimaced behind his mask. ‘You and me both.’ He moved the probe into position and, using his foot, activated the diathermy. The zap sounded loud in the relatively quiet theatre, in stark contrast to Melbourne City where his favourite music was always piped in.
Erin’s hand hovered, holding the suction over the clean site, and he counted slowly. By the time he got to four, blood bubbled up again, filling the space. ‘Damn it.’ He packed in more gauze.
‘Pressure’s still dropping.’ A fray in Abbie’s calm unravelled in her voice. ‘She’s lost three litres of blood and this is our last packed cell until the helicopter arrives.’
‘It will be OK.’ He said it as much for himself as to reassure Abbie and Erin. Closing out the sound of the beeping machines, he carefully examined the entire operation site millimetre by millimetre, looking for the culprit.
‘O2 sats are dropping.’ Stark urgency rang in Abbie’s voice.
The gurgling sound of the suction roared around him as Jenny’s life-force squirted into the large bottle under the operating table almost as fast as Abbie could pump it in. A flash of memory suddenly exploded in his head. Him. Raised voices. Christina’s screams. Dom. Life ebbing away.
His heart raced and he dragged in a steadying breath. He hadn’t known how to save Dom and he’d failed Christina but he was saving this woman.
Look harder. He caught a glimpse of something and immediately fritzed it with the diathermy. Still the blood gurgled back at him. He held out his hand. ‘Four-zero.’
‘She’s about one minute away from arresting.’ Abbie hung up the last unit of blood, her forehead creased in anxiety.
‘I’m on it.’ Sending all his concentration down his fingers, he carefully looped the silk around the bleeding vessel and made a tie. Then he counted.
This time the site stayed miraculously clear. His chest relaxed, releasing the breath he hadn’t been aware he was holding.
‘Pressure’s rising, O2 sats are rising.’ Relief poured through Abbie’s voice as she raised her no-nonsense gaze to his. ‘You had me worried.’
Despite her words, he caught a fleeting glimpse of approbation in the shimmering depths of green. ‘Hey, I’m Italian—we always go for the big dramatic finish.’
Abbie blinked, her long brown lashes touching the top of her mask, and then she laughed. A full-bodied, joyous laugh that rippled through her, lighting up her eyes, dancing across her forehead and jostling the stray curl that had sneaked out from under her unflattering theatre cap.
And you thought she was plain? He frowned at the unwelcome question as he started to close the muscle layers.
A
bbie administered pethidine for pain relief through a pump. ‘Well, we Anglo-Saxons prefer the quiet life.’
‘Speak for yourself. I’m not averse to a bit of drama and flair. It makes life interesting.’ Erin fluttered her pretty lashes at him over her surgical mask, an open sign of if you’re interested, then I’m definitely in.
The day his divorce had been finalised fifteen years ago, he’d committed to dating beautiful women and dating often—a strategy that served him well. He loved women and enjoyed their company—he just didn’t want to commit to one woman. The emotional fallout of his marriage had put paid to that. Now he focused on work, saving lives and enjoying himself. It was a good plan because it left him very little time to think about anything else.
Usually when he was given such an open invitation as the attractive Erin had just bestowed, he smiled, called her cara mia, took her out to dinner and then spent a fun few weeks before the next pretty nurse caught his eye or he caught the glimpse of marriage and babies in her eyes.
But recently that game had got tired.
The theatre phone rang and Abbie took the call. ‘Leo, Justin wants an opinion on the crushed leg so a decision can be made to either evacuate or operate first.’
‘Tell him I’m five minutes away.’
When Abbie finished the call he continued. ‘Whether I should operate or not might be semantics. Evacuation might be the only option due to staffing issues.’
Her shoulders squared, pulling her baggy scrubs across her chest and she rose on her toes. ‘If the patient requires surgery before evacuation then Bandarra Base will make it possible. You worry about the surgery and let me worry about the staffing issue; that’s my job.’
Her professionalism eddied around him—her sound medical judgement, the composed and ordered way she’d run the entire emergency and the undeniable fact she’d stayed calm and focused even when she’d been pushed way out of her comfort zone by the emergency anaesthetic.
