Blythe was checking the patient’s chest sounds with a stethoscope but was aware of the byplay. Also aware from the expression on Sue’s face of something clicking into place.
‘Oh!’ Sue said, as if a light had been switched on. ‘It’s because of—’
Though she had no idea what Sue’s revelation was, Blythe was uncomfortably aware of her friend’s propensity to blurt out the most embarrassing of suppositions. She cut her short with an abrupt, ‘He crashed his plane—that’s how he got me here!’
Sue turned to Cal, who said, ‘Long story, explain later. Now, have we told this young man what we intend to do?’
Blythe nodded.
‘He’s signed a consent form,’ she said, but must have been looking worried about it for Cal touched her lightly on the arm.
‘It’s all you can do,’ he said. ‘Now, let’s get him into Theatre. Who’s going to volunteer to dress me and scrub my one good hand?’
‘I’ll do it,’ Blythe said, cutting in before he received any other offers. ‘I need to talk to you,’ she added more quietly, as Sue and another nurse wheeled the patient away.
‘I know we’re talking exploratory surgery here, and hopefully it will only be a small rupture in a blood vessel causing the problems, but those kinds of things usually seal themselves, and from the distension of his abdomen, there’s a lot of blood in there. What if it’s his liver? His spleen?’
‘We worry about it when you get in there,’ Cal told her, moving with such ease with his stick and bound ankle she tended to forget he was injured.
‘We worry!’ Blythe muttered. ‘I’m the bit of we who’ll be doing it.’
‘But I’ll help—I can talk you through it if necessary. Don’t worry, I’m sure the team of Whitworth and Jones would be capable of anything short of a complete heart-lung transplant. And we could probably do that, too, on one of our better days.’
Blythe was so taken aback by this optimism, she glanced towards him to make sure she was walking with the right man.
‘Well, I’m glad you’re confident,’ she said. ‘At least that makes one of us.’
Cal’s laughter seemed to fill the wide corridor, but then he stopped and his hand on her arm eased her to a standstill beside him. Dark-rimmed grey eyes sought and held hers.
‘You’re a damn good doctor, Blythe Jones, and I happen to remember you telling me one night that you’ve done quite a bit of surgery, so I’m confident you’re an equally good surgeon. But for some reason you’ve had your confidence knocked about. What you need is a T-shirt that says I’M NOT JUST ADEQUATE, I’M GOOD. OK?’
Cal’s eyes compelled her to answer.
‘OK,’ she said softly, and somewhere deep inside, the frozen chunk of misery that housed her doubts and fears began to thaw.
CHAPTER SEVEN
MIRACULOUSLY, once the operation began, once Blythe started the incision, it was as if she’d never stopped operating. With swift, sure movements, she opened up the skin, separating the layers of muscle beneath it, to expose the abdominal organs—or the dam of blood in which they were bathed.
Sue reacted immediately, using large absorbent swabs to clear the blood, standing close so she could continue to reduce it. Blythe continued to search for the problem, lifting the colon out of the way with warm moist gauze, then shifting the stomach with a large clamp, to reveal the broad ligament connecting the stomach to the spleen. Cutting through that would show her the splenic artery, a large, five-branched vessel that came directly off the aorta.
Instinct and the percentage factor in blunt trauma told Blythe the damage would be to the spleen.
‘I’m going to look at the spleen first,’ Blythe explained to her team. ‘The hoof mark is above the lower ribs in the left upper quadrant, right above the spleen, and Byron mentioned pain in his left shoulder earlier, which suggests referred pain from spleen damage.’
She made a small hole in the ligament, gradually enlarging it as she tied off the small blood vessels that ran through it. Eventually, the dense organ was revealed, blood welling from its upper edge.
‘I’m going to tie off the artery,’ Blythe said, glancing up at Cal for confirmation. Above the green mask his eyes met hers and the slight nod he gave was more encouragement than agreement.
Encouragement and something else…
Admiration?
Surely not.
But whatever it was, it boosted Blythe’s confidence as she passed loops of silk around the artery, tying it off. She looked up at Cal, hoping his monitors would show an immediate improvement in the patient’s blood pressure, although she knew instant success wasn’t likely.
Cal was frowning at the monitors but he said nothing, so Blythe continued.
With blood draining out of it, but none coming in, the spleen was shrinking in size. The next stage was to cut a larger hole in the ligament, but even with the artery tied off, blood was still seeping into the abdominal cavity.
‘Blood pressure dropping. There’s still a bleeder in there somewhere, Blythe.’
She turned to the nurse who was acting as runner for the operation, working outside the sterile zone, asking her to set up a second bag of fluid, giving instructions for the rate of flow, but all the time her attention was on her patient as she sought the source of the bleeding.
‘Something small, a capillary, would have closed itself off,’ she muttered into her mask, ‘so it’s big. What’s close? The renal artery. Please, don’t let there be kidney damage as well.’
Anxiety tightened her nerves to the point where her insides quivered, but her hands remained steady as she probed.
‘Finish the spleen and then look,’ Cal suggested, as time ticked by and Blythe’s concern escalated.
She was grateful for the advice. Getting the spleen out of the way made sense, and maybe the blood vessels would seal themselves while she was doing it.
Cutting through the rest of the ligament, Blythe then drew the spleen a little to the right, to tighten then sever the ligament holding the organ to the left kidney.
Once free, she could lift it out, to clamp and tie off the vein, clamp the artery then check it was completely sealed before cutting the ruptured organ from the blood vessels.
‘Neat job,’ Cal said, but Blythe knew from his tone they still had problems. Very carefully, she cleaned the remaining blood from the abdominal cavity, and then watched as more collected.
‘I haven’t got you this far to lose you now,’ she told Byron as she searched for the source of the bleeding. Normally a patient could handle a little blood loss, but someone in Byron’s fragile state would be at risk, and opening him up again later to find a bleeder would probably kill him.
‘Check the splenic artery again,’ Cal suggested, and she lifted the tied-off stump of artery. Satisfied the sutures were holding, she was about to set it back down when she realised it was wet with blood.
‘It’s torn on the other side,’ she whispered. ‘Above the sutures.’
Relief washed through her as she stitched the tear, swabbed it then waited to see that it remained tightly sealed.
‘Got it!’ she said to Cal, smiling with triumph, though it was behind her mask so he wouldn’t see the smile part.
Then, slowly and carefully, she checked for any other injury the thundering hooves might have caused. It was OK to save the young man’s life by removing his spleen, but if she sewed him back up with some other internal injury and lost him through peritonitis, it would all have been in vain.
Once she was satisfied she hadn’t missed anything, and Sue was satisfied they hadn’t left a swab or clamp behind, she closed him up, put a dressing over the wound and, carefully, straightened her back.
‘I’d forgotten that part of surgery,’ she said as her muscles protested.
‘But not much else,’ Cal said, looking at her as if her performance had raised a lot of questions in his mind.
‘I told you I’d done a bit of surgery,’ she reminded him, then changed the subject.
‘How did his lungs handle it?’
‘Without an X-ray, we can only go on the lung sounds and oxygen perfusion in his blood, and from those there’s no reason to panic yet.’
Cal stepped away from the trolley so the patient could be wheeled into the small recovery room, with Sue watching over him until he regained consciousness.
‘Should we X-ray him now we’ve stopped the bleeding and don’t have to keep him flat?’ Blythe asked.
He studied her for a moment before answering. She had pulled off her mask and cap and was throwing them in the bin as if she’d done it a thousand times before.
Remembering the skill she’d shown during the operation, he guessed she might have.
Or hundreds of times, at least…
‘I know he must feel like your patient, but he should still fly out tomorrow or whenever a plane gets here. And with all kinds of investigative radiology available once he gets to a city hospital, I see no point in putting him through an X-ray here.’
She turned towards him and smiled.
‘I agree about the X-ray, but did you think I wanted to keep him? Playing some silly territorial game with that young man’s health? We might have stopped the internal haemorrhage but his lungs are the real problem and keeping someone on a ventilator is specialist stuff. Big hospital stuff, with monitors and round-the-clock respiratory techs. Not for the likes of me.’
Cal found himself smiling back. This woman continued to surprise him.
Continued to do other things to him as well, but he wasn’t going to think about them. Mind you, it was hard not to when she’d come close and was untying the tapes she’d tied earlier, unravelling him from his theatre garb as casually as she might unwrap a parcel.
Though possibly she’d be excited over a parcel…
This gloomy thought failed to stifle a sudden memory of a previous wrapping scenario—and the memory of fixing safety pins into her curtain dress caused further problems.
She was close enough for him to see the moisture sweat had left on her cheeks, yet he could have been as far away as the moon for all the idea he had of what went on in her head.
Since the night by the fire—and possibly because of it, because she felt she’d talked too much—she’d shied away from any personal conversation, switching subjects so quickly at times it was as if she held up a ‘Don’t go there’ sign towards him.
‘I’ll stay over at the hospital,’ he said, determined to get his mind back on track—a medical track. ‘There’s usually a bed to spare, and I’ll be on hand if Byron’s condition deteriorates.’
‘You need rest, not a night bouncing in and out of bed to check on a post-op patient,’ Blythe said to him, turning away to discard his theatre gear.
‘I won’t be bouncing anywhere and he’s my patient now,’ Cal argued. ‘I was the anaesthetist, so I’ll be in charge of his pain relief. But be sure I’ll call you back if there are any problems.’
She turned to look at him, and though he could see tiredness in the bluish shadows under her eyes and the slight slump of her usually straight shoulders, he guessed it was something more than exhaustion worrying her.
‘What is it?’ he asked, reaching out his good arm so he could rest his hand gently on her shoulder.
She smiled, and half shrugged, though not to rid herself of his touch.
‘Let-down, I guess,’ she replied, with the honesty he still found both refreshing and surprising. ‘Big op—well, big for me—and then that’s it.’
Cal felt a surge of empathy so strong he wanted to scoop her into his arms and hold her close. In reality, he’d only have been able to scoop her into one arm, and then he’d probably have fallen over because, though he was managing quite well with his walking stick, that was the hand he used to hold it. And though his ankle was much better, he still needed support.
But the thought was there, so he smiled.
‘That’s not it at all,’ he assured her. ‘I’ve got to check on Byron before I do anything else, but why don’t you go through to the doctor’s office? I’ll send someone in with tea, and whatever leftover goodies Mrs Miller—have you met her? She’s the hospital cook—will have baked for staff afternoon tea. We’ll have a debrief like a real hospital.’
He was rewarded by her smile, which not only stretched the sensual bottom lip to its full glory but also lit up her dark eyes.
‘This place is actually more like a real hospital than some I’ve been in,’ she told him. ‘At least the staff here have the time and facilities to treat patients as people, and spend time doing things that make a difference. Offering reassurance, and support for other family members, taking time to talk, to explain what’s happening.’
The simple praise—for the hospital, not himself, mind you—flustered Cal so much he muttered something about checking Byron’s haematocrit, and hobbled from the room.
* * *
Blythe was waiting in the office when he got back, a tea-tray set with cups and saucers and a plate of scones set on the desk in front of her. She’d broken a scone in half, spread it liberally with jam and cream and had it poised, about fifteen centimetres from her lips, while tears coursed down her cheeks.
‘Hey, what’s up? What’s happened?’
He discarded his stick and propped himself on the desk, touching her shoulder, rubbing at that bit of white skin at the nape of her neck, all the while inwardly cursing his inability to move—to hold her properly.
She responded with a watery grin.
‘I think they’re happy tears. I mean, they must be, mustn’t they? We probably saved that young man’s life, taking out his spleen when we did.’
She didn’t sound too certain, or particularly happy, and Cal slid his hand around to cup her chin and tilt her head towards him.
‘You saved his life. All I did was inject the anaesthetic and watch the monitors. And he’s doing fine, conscious and responding to questions, though he’s still a very sick boy.’
He looked into the soft dark eyes, hoping to emphasise what he was saying. They looked warily back at him—so warily he wondered if he’d done or said something wrong.
Something to upset her…
For some reason, the idea of being the cause of her tears made his gut ache, and he let go of her chin to brush the moisture, very carefully, from her cheeks, then he leant forward and kissed her on that luscious, sexy mouth.
‘You were perfect,’ he said, straightening up before an urge to linger and explore its infinite softness overcame him.
Well, he’d got rid of the wariness from her eyes, but it had been replaced by astonishment.
‘What was that for?’ she demanded, so fiercely he was taken aback.
‘You were crying. It was a ‘‘kiss it better’’ kiss, nothing more.’
‘It had better not have been,’ she declared, the brown eyes no longer soft but narrowed and spitting suspicion. ‘I might have said some stupid things out there in the bush that night, but I also said I’d crossed you out of contention. And that was even before we became professionally involved. Though I didn’t tell you that part of my new approach to men. Definitely no messing about with colleagues. That’s rule number one.’
‘And rule number two?’ Cal queried, teasing her in an effort to cope with his own reaction to the kiss. And his automatic response of disappointment to the ‘colleague’ statement.
Not that he wanted to get involved with her, of course.
He broke a scone in half and spread it with jam while contemplating these things and awaiting her reply.
‘There isn’t a rule number two,’ she admitted, spooning cream onto his scone before helping herself to more. ‘What a stupid conversation, and I’m sorry about the tears. They were for lots of things—but mainly, I suppose, for what might have been. I really wanted to be a surgeon—it’s why I did a second year residency and spent most of it on surgical teams. I think I also did more than my share of weekends—the ghastly job of Duty Surgical Officer on call for emergencies
like appendicectomies and splenectomies.’
She bit into the scone, smearing cream above her shorter, less full lip, the little moustache so delectable Cal had an urge to lick it off. But if she’d fired up about him kissing her tears away, she’d probably rip his head off if he licked her upper lip.
A pink tongue tip appeared and did the job for him, then she smiled cheerfully and added, ‘But I think they were also cleansing tears. Doing that op, for some obscure reason, seems to have wiped away the past once and for all.’
Cal forced his mind away from lovely lips and replayed her explanations in his head. Now he thought about it, her remarks confirmed his suspicion that she’d had the stuffing knocked out of her at some time. Had she failed the first set of exams, which would have put her on track to be a surgeon? But a large percentage of those who sat specialist exams failed the first time, mainly because the pass mark was set so high.
And he knew her well enough to suspect if she’d failed once, she’d have kept trying…
Supposition wasn’t taking him too far.
‘Why didn’t you go on with it? With surgery?’
Blythe set her teacup down and looked up at him, wariness back in the brown eyes. Then she shook her head, making the mass of hair, flattened from the theatre cap, bounce.
‘Long and boring story,’ she said.
‘Not as long and boring as how I came to go into medicine, and you insisted I tell you that. Come on, Blythe Jones, give.’
Blythe studied him for a moment. For a week he’d practised avoidance—oh, he’d been polite enough and had always joined her for meals, but then had scurried away, using work as an excuse. At first she’d been glad as it had given her time to get over the embarrassment of the things she’d said by the campfire, but then his disappearing act had begun to grate on her.
Now, here he was, first firing up her hormones with a kiss that had made her knees vibrate, and now not only spending time with her but prying open bits of her mind she’d clamped shut a long time ago.
‘Well?’
She twitched with uneasiness, scowled at him, then muttered, ‘It wasn’t that important.’
Outback Doctors/Outback Engagement/Outback Marriage/Outback Encounter Page 28
