by Lucy Ryder
The ER shift supervisor grabbed Paige the instant she hurried through the doors. “There’s been an accident up near Angel Lake Ranger station,” he rapped out. “A school bus on the way back from a field trip left the road. Details are sketchy but it sounds like they slid off a sharp incline into a gully. Dispatch said there was a lot of screaming and it was difficult to get information.”
Paige’s heart clenched with dread. She hated it when little kids were hurt in accidents. “Is medevac on their way?”
“Climbing accident up in the mountains,” Chalmers said impatiently. “You’re up. They need someone to help with the kids.”
“I’ve got a young patient who—” she said but he grabbed the report and gave her a nudge towards the ambulance bay doors.
“I’ll take care of it. You. Go. Miss Bryce is waiting.”
Paige took off. The bay doors whooshed open as she approached and she had a split second to register that an ambulance was idling in the bay, passenger door open and Frankie frantically beckoning.
Paige grabbed Frankie’s hand and they took off, the momentum slamming the door closed behind her.
It wasn’t unheard of for an ER doctor to accompany EMTs to the scene of an accident but it wasn’t exactly standard operating procedure either.
Paige prayed they wouldn’t find death today.
CHAPTER FIVE
STATE TROOPERS HAD already blocked off the road and were redirecting the sparse mid-afternoon traffic. They waved the ambulance on, and even before the vehicle screamed to a stop Frankie was leaping out.
Paige scrambled after her and headed for the edge of the road, where troopers were in discussion with forest rangers. Intent on getting to the trapped children, she didn’t see the single figure not in uniform until she was almost upon him. At the sight of familiar wide shoulders, hard chiseled profile and dark wind-tousled hair she’d seen just that morning, her eyes widened and her step faltered.
What the heck was Tyler Reese doing here?
He must have sensed her scrutiny because he turned his head, his laser-bright gaze instantly locking onto her. If he was surprised to see her, it didn’t show. Instead, he broke away from the group and headed towards her.
“You’re here,” he said briskly, taking her arm and pulling her aside.
“What are you doing here?” Paige asked absently, distracted by the skid marks swerving across the road and disappearing into the gap in the foliage. The bus was nowhere to be seen but from below she could hear the frantic cries of children and the soothing tones of male rescuers. Her heart squeezed.
“We came across the accident and stopped to help.”
She made a move forward but Ty tugged her back.
“I need to get to those children, Tyler,” she said, yanking on her arm. “They may be hurt.”
He tightened his grip. “Nate’s down there with a few rangers but we’ve got a bigger problem,” he said in a tone that had Paige’s head jerking up. He looked as grim as he sounded and her belly clenched in dread.
“What?”
“Most of the kids are fine. Some need medical attention but the paramedics can handle them.”
“Then—”
“The teacher is trapped,” he growled. “She was standing when the bus swerved across the road and rolled down into the gully. They managed to get to the children but she’s pinned by crumpled metal.”
“Can’t they get her out?” Paige demanded, looking pointedly at the group milling around instead of acting. “Surely there’s enough muscle here to move the obstacle?”
“They can’t,” he said bluntly, his eyes intent on hers. “Her arm is pinned. The minute they lift it she’s going to bleed out.”
Paige instantly understood Ty’s implications. The metal was providing pressure and was keeping the teacher from bleeding out. The artery would have to be clamped before the weight was removed. There wasn’t time to put pressure on the wound and transport her to a hospital. She would die before they got her up to the road.
“Well,” she said briskly, “it’s a good thing you’re a surgeon, then, right?”
Ty’s mouth twisted as he held up his casted hand. “Not happening, Dr. Carlyle. That’s why I’m glad you’re here. EMTs can’t handle this procedure. It needs someone with surgical experience and knowledge.”
Paige gaped at him then said in a fierce undertone, “Are you insane? I’m a pediatrician, not a surgeon. You, on the other hand, are one.”
He held up his cast. “I can’t use it,” he reminded her tightly.
“Why didn’t dispatch request a trauma surgeon? There’s a very good reason I didn’t choose surgery as my specialty.”
One dark brow rose arrogantly. “You faint at the sight of blood?”
“Don’t be ridiculous,” she growled. “I work in ER.” Ty’s mouth curled very slightly at one corner.
“That’s exactly what she’s counting on. And they didn’t request a trauma surgeon because at the time they didn’t know they’d need one.”
He let that sink in for a couple of beats, then taunted, “You going to let a fifth grade teacher bleed out, Doc? In front of her students?”
“Of course not,” she snapped, furious with him for expecting her to perform something a trauma surgeon should do. Finally her breath escaped in an audible rush. “Fine,” she said tightly. Maybe he couldn’t actually perform the field surgery but he was going to guide her through it. “I’ll do it but I need help.”
Immediately his eyes shuttered and he turned away. “I’ll get an EMT,” he tossed over his shoulder.
But before he could take a couple of steps Paige snapped out, “Hold it right there, buster.”
He froze and after a long moment turned his head, his expression a little stunned.
“Are you talking to me?”
Paige refused to back down. “You’re the surgeon here, Dr. Reese,” she reminded him shortly. “The EMTs are busy, remember. Taking care of the children.”
His whole body recoiled as if she’d struck him. “No,” he said coldly, and turned away.
“Yes,” she insisted fiercely, hurrying after him. “You want me to do this then the least you can do is talk me through it.”
At her words, he stopped abruptly and turned eyes as cold as the North Pacific on her. His entire body vibrated with tension. “I said no.”
Paige caught the hollow misery behind the fury but couldn’t let it deter her. “Dammit, Dr. Reese,” she snapped. “You want a fifth grade teacher to die because you’re mad at the world?”
“I am not mad—”
“You are. You’re hurting and mad at everyone. Are you going to let that stop you from doing what you do best?”
“You don’t know what I do best,” he rasped, fury in the tight lines of his jaw and mouth. “Especially as I can’t do a damned thing.”
Holding his gaze with difficulty, she gave a casual shrug even as her heart pinched. Now wasn’t the time to feel sorry for him. She needed him. The teacher needed him. “You’ve done it before, haven’t you?” And when he just stared at her, she exhaled impatiently. “Well, then, we… I mean…you…” She chewed on her bottom lip and admitted in a fierce undertone, “I’ve never done it before.”
His eyes blazing a promised retribution, Ty turned without another word and walked off.
“Hey!”
He paused and sent her a dark look over his shoulder. “Get going,” he snarled. “I’ll bring what you’re going to need. And sometime, Dr. Carlyle, you’re going to tell me what a pediatrician is doing working in ER.”
Relief made her knees weak as she stumbled towards the troopers pulling fifth graders up by ropes. The whole exchange had taken less than a minute and it was another before she was wrapping her arms around a trooper and clinging to him like a monkey as they were lowered to the wreckage, wedged in by trees and rocks about fifty feet down.
Paige scrambled through the broken window and paused to cast an experienced eye over the children s
till left behind. She murmured encouragement as they clung to her, noting absently that Frankie had already set up triage and was studiously ignoring the man calmly and efficiently organizing the children.
Nate Oliver looked big and capable and just a little dangerous, as though he did this every day. But then again he did. He was a coastie.
“Dr. Cutie,” he greeted her, looping the harness around a child before lifting him through the window. His voice, cheerful and upbeat for the children’s benefit, dropped to a murmur meant for her ears only. “Glad you’re here—she’s barely hanging on.”
Paige slid on the almost vertical floor and was grateful for his easy strength as he steadied her. He nodded to the front of the bus. “It’s real bad,” he reported softly. “T was about to turn me into a field surgeon but I don’t think Grace Parker wants my version of first aid.”
“You’re a medic?”
“Nope, but I can get by in a pinch.” He shook his head. “This is more like a giant squeeze. Have you seen him?”
“He’s bringing med supplies.”
Nate’s eyes widened then sharpened, amusement and approval gleaming in the dark gaze. “He’s coming down…here?”
“Not willingly,” she admitted, and headed towards where a park ranger was crouched beside the teacher. Behind her she heard Nate laugh softly and say beneath his breath, “Well, well. This is going to be very interesting.”
Yeah, well, she wouldn’t exactly use the word “interesting”. Terrifying would be closer to the mark, especially when she saw Grace Parker pinned to the side of the bus by a twisted mess of metal seats. Her white face was sweat-drenched and she had her teeth clenched against the pain.
“Hi,” Paige said, moving as close as she could get, “I’m Paige.”
“Yes,” the woman rasped, her face tightening as she let slip a little moan. “I remember…you came to the school on health day.”
Paige ran her eyes over Grace’s pinned arm and estimated that she’d lost about five hundred ccs of blood—probably when rescuers had attempted to free her.
She squeezed the woman’s free hand and noted that it was icy. They would have to hurry before she went into shock. “I’ve never had so many kids ask me about blood and guts before,” she said, pressing her finger to the area above the injury site to feel for a pulse. “Or want to show me all their scars.”
“They’re a handful, all right.” Grace breathed through another moan and grabbed Paige with her free hand. Her gaze was fever-bright with a dangerous edge of panic. “They’re okay, aren’t they? Please tell me they’re okay.”
“They’re going to be fine, Grace. Scared mostly,” she soothed. “But it’s you we’re all concerned about.”
Her eyes closed briefly and she gave a short sobbing laugh. “I’m going to lose my arm, aren’t I?”
A shadow blocked out the light and even before Ty eased into place beside her, she knew it was him. She had absolutely no idea why her senses were so attuned to him but her entire body went on alert.
Ignoring both it and him, she asked, “Why do you say that?”
“Keith—the ranger—said it was too dangerous to move me,” Grace said tightly. Her eyes filled with tears. “B-but I… I have to tell you that I can’t feel it. My arm, I mean. Tell them, Paige. Tell them to move this thing off me.”
“We can’t, Grace,” Paige began, sparing a brief glance at Ty’s hard, remote expression. He looked a little like he had the night of his attempted B&E, pale, clammy and his mouth set in a tight white line. His posture screamed anger and bad attitude. Whether at the situation or her, Paige couldn’t tell. “The bar is stopping the bleeding.”
“Try to relax,” Ty said, crouching down near Grace’s head and handing a bag to Paige. “And to make sure you don’t move, even a fraction of an inch, Dr. Carlyle is going to give you a mild sedative.”
Grace pressed her lips together and turned her face away. “I… I… It’s bad, isn’t it?”
Paige nibbled on her lip indecisively. Sometimes people wanted you to tell them everything was going to be okay and others needed to hear the bald truth.
Ty chose the truth.
“Yes, it’s bad,” he admitted calmly as Paige pulled on surgical gloves and reached for the sedative. “But it could be a lot worse,” she heard him say. “I don’t want you to worry now. Dr. Carlyle is a specialist and you couldn’t be in safer hands.”
Paige, swabbing an area on Grace’s uninjured arm, glanced up briefly, thinking it was a good thing he’d failed to mention that she wasn’t a trauma specialist or Grace would be as terrified as Paige. Instead of looking terrified, Grace’s gaze was locked on Ty as though he was her lifeline and she was ready to do anything he asked.
Paige gave a mental eye-roll but then reluctantly admitted that she’d probably do anything he wanted if he spoke to her like that.
Which was kind of pathetic if you thought about it.
While she waited for the sedative to take effect, Paige wrapped a pressure cuff around Grace’s arm and kept up a calm chatter when Ty took over.
Out the corner of her eye she saw his mouth tighten as he struggled one-handed but when she tried to help, he growled. She backed off, wondering if she’d done the right thing getting him down here, because it was clearly too much so soon after his accident.
But then his gaze—cool and clear—caught hers. He murmured, “You ready?”
And Paige felt her stomach drop and lift at the same time. Oh, God, she really was going to do this.
She exhaled slowly and nodded just as coolly. “Yes. You?” Look at her, all calm and collected.
Ty’s eyebrow rose, as though he knew she was shaking in her sneakers. “I’m not the one about to perform a ligation in less than ideal conditions.”
Great. So not the way to instill her with heaps of confidence.
“I can do this,” she insisted with a lot more confidence than she felt. She wasn’t a surgeon but she was the only person standing between her patient and death. She paused then said, “I’m ready.”
His gaze searched hers for a long moment before he nodded. “Fine.” His voice was brisk, professional. “The broken bar is gouging into the brachial artery midway up the humerus. Her pulse is weak so I want you to use a surgical glove as a tourniquet. Tie it a couple of inches above the injury site. It’ll stop the bleeding long enough for you to clamp the artery.”
Paige quickly obeyed.
With his left hand he sprayed the area with disinfectant. “Now, you’re going to do an arterial cut-down at the point of impact. Using an eleven blade…no, that’s a thirteen. The other one. Okay, now make an eight-centimeter longitudinal incision distal to the deep brachial confluence.”
Paige positioned the scalpel and noticed her hands were shaking. She sucked in a sharp breath. Dammit, this was why she wasn’t a surgeon. This was why—
A large warm hand engulfed hers.
“Paige.” Ty’s deep calm voice interrupted her mental panic. “Dr. Carlyle,” he said again when she didn’t respond, because she was in full freak-out mode and trying to breathe without passing out.
“Look at me. Good,” he said when she lifted her head. “Don’t think about it. Just follow the sound of my voice and do exactly what I say. Okay?”
She dropped her gaze and tried to swallow past the growing panic in her throat.
“Hey.” He leaned forward to catch her gaze. His eyes were no longer cold and remote but warmly encouraging, full of strength and confidence…in her. Gulp. “You’ll be fine. Now say, ‘I’m okay, Ty, I’ve got this.’”
She sucked in a shaky breath, licked dry lips and repeated, “I’m okay, Ty. I’ve got…” gulp “…this.”
“Good.” He gave her a hand a brief squeeze before letting go. “Without overthinking everything, let your training take over. Make the incision. Not too hard, just enough to cut through skin and muscle.” Repeating his instructions in her head, Paige filtered out everything but the sound of his voice.
“Excellent. Now push your fingers through the muscle until you feel the brachial artery…got it? Okay, gently palpate it to ensure it’s not the cephalic vein or the median nerve. For God’s sake, don’t kink or sever that nerve or—”
“I’ll cause paralysis. Yes, I know. Now what?”
His mouth twitched at her impatient tone. “Have you isolated the artery? Push aside the muscle with one hand and clamp the artery with the other.” Clamps appeared in her field of vision and she fumbled a little as she took them. “Careful…you don’t want it to rip. Have you got it?”
Paige rolled her eyes and looked around. “Yes, I’ve got it. Can we move her now?”
“No,” he said, rising to his feet to beckon Nate and two rangers who’d stayed behind to help. “You can loosen the tourniquet and make sure that arm doesn’t move. We haven’t finished yet.”
Paige twisted her body out of the way and immobilized Grace’s arm while the men moved in. For an interminable moment the crumpled seats refused to budge until Ty muttered beneath his breath. Before Paige could open her mouth to tell him to stop, he gripped metal and pulled. There was a lot of grunting and swearing until the mangled metal finally gave way.
Grace Parker cried out as the pressure on her arm eased and Paige scrambled to cover her with her body. Eyes tightly closed, she waited for the entire mess to come snapping back…but after a couple of beats she heard Ty say, “Dammit, Paige, that was stupid.”
Careful not to jostle the injured teacher, Paige spun around to tell him he was the idiot when she caught his involuntary grimace. Just then Grace gave a low moan and tried to sit up.
“Careful there,” Paige soothed, gently applying pressure to keep her still. “Don’t move. I’m not finished yet.”
The teacher sucked in a sharp breath. “Did…did you have to c-cut it off?” she slurred, more than a little out of it.
“Nope,” Paige said promptly. “It’s still here.” She quickly filled a syringe with pain meds while Nate and Ty moved Grace to a more accessible area. “I’m giving you something for the pain and I want you to close your eyes and relax. We’ve got you.”
