by Lucy Ryder
The question put him inches away. “With the slight jugular vein enlargement, decreased saturation levels, bradycardia and hiccups…dammit, all it can be is a—”
“Tamponade,” they said simultaneously, and Paige’s shoulders slumped. She’d hoped he would come to a different conclusion but wasn’t surprised he hadn’t. Little Joshua was in cardiac tamponade, a dangerous condition that occurred when the sac around the heart filled with fluid, putting pressure on the organ and preventing normal functioning. When that became too much, one or more chambers sometimes collapsed.
It was often fatal.
“Okay. What do you want me to do?” Ty asked quietly, his gaze intent on hers and not offering advice she hadn’t requested in deference to her official status as the doctor in charge.
The question surprised her. For a trauma surgeon who liked taking charge, he was being remarkably restrained. She didn’t have time to wonder why.
Absently rubbing her aching temple, she spied the sonar machine. “I need a better look,” she said, hurrying over to the equipment. “And I don’t have time to wait for an ECHO.”
“Fluoroscope?” Ty asked, referring to a very expensive machine that worked like a real-time X-ray.
Paige snorted. “You’re kidding, right? You do remember that this is the wilds of Washington and not some fancy LA clinic?”
He stared at her for a long moment before sighing. “You’re doing it the old-fashioned way, then.” And Paige stilled.
Oh, yeah, she reminded herself, you’re the primary on this one. It’s up to you to see the Cavendishes get to take their son home.
“You’ve done it before?” he asked quietly.
Paige paused before saying, “Not on an infant. Please, tell me you’ve done this on an infant?”
“Nope, sorry.”
“Oh, boy.” She looked up and their eyes locked, and just for an instant everything fell away. With difficulty she forced herself to ask, “Can you, um…?” but he held up his injured hand and Paige realized how much she’d hoped he would offer to do it.
“I’m also not registered to practice in Washington, Paige. You know that.”
She did. She knew that but they needed someone experienced—preferably with full use of both hands.
“Listen,” he said quietly. “With the NA we have two pairs of hands among us. I’ll talk you through it.”
She paused, knowing that he was right. He had the experience and she had the dominant hand in working order. “Pulse dropping to seventy, Paige,” he announced, with a sharp look that said he was waiting for her decision. “And he’s showing signs of cyanosis.”
Snapping into action, Paige grabbed a tube of gel to squirt a generous amount on her tiny patient’s chest.
“Keep bagging him,” she urged the NA, noting the definite signs that the toddler wasn’t getting enough oxygen as she located his heart with the probe. She sucked in a breath when the organ popped into view on the screen.
“Marked pericardial effusion with evidence of early cardiac tamponade,” Paige muttered. “Dammit, it’s worse than I thought. Maybe we can get him up to OR—”
“There’s no time,” Ty interrupted, pointing to the top of the heart where the right chamber appeared to be slightly squashed. “Do it now before he arrests.”
Paige sucked in a deep breath. “You’re right,” she muttered, before saying briskly, “Stacey, we need twenty-five ug per minute of dopamine and one point two mg furesomide, una tantum, while I prep him for a pc. Where the hell is Beth? Dammit, I need five mils of two percent lidocaine, a twenty-two-gauge pericardiocentesis needle with guide and dilators, a scalpel, pigtail catheter and a vacuum bag.” She sent Ty a quick look. “If you’re serious about assisting, I’m going to need pediatric electrodes and an iodine swab.”
Working quickly, Paige injected a sedative directly into the drip-line port, and opened the line.
“We need a forty-five-degree angle of elevation,” she began, but Ty was already working the levers with his feet. Beth finally returned and Paige instantly directed her to the bed. “Make sure he doesn’t move, Beth. I want him absolutely still for this,” she said, moving into position with a quick prayer.
So many things could go wrong with such a tiny patient.
“You’ll do fine,” Ty said calmly, correctly interpreting her hesitation. “Just breathe deeply and focus. I know your wrist hurts. Block it off and… That’s good,” he said when she’d sucked in a deep breath and let it out. “Now take another and let it out slowly while you decide what you need to do.” He held out the large-gauge needle attached to a twenty-ml syringe and a scalpel.
She reminded herself that he was used to taking control, that he was the one usually giving orders. Yet here he was easily letting her take the lead without attempting to influence her.
Paige took the scalpel with her left hand and gave a wince. “You okay?” he asked as she transferred it to her right hand. She nodded, and spared him a look. “Good,” he said crisply. “That’s good. An incision will make the cannula insertion easier. Make a half-inch incision at the point where the left costal margin meets the xiphisternum. Great,” he added after Paige made the cut.
“Now…introduce the needle and dissect the subcutaneous tissue. You’ll feel a small pop when you pierce the wall,” he murmured calmly, maneuvering the sonar probe to give Paige a clearer image of the heart with its inferior fluid-filled sac.
“Right, now angle it towards the left shoulder at a twenty—no, sharper, Paige, you don’t want to damage the internal mammary artery or the neurovascular bundle on the inferior rib surface. There, that’s it…perfect. Okay, now gently pull back on the plunger as you aim for the left shoulder tip…slowly…there, see on the monitor? The needle tip is about an inch from the sac. Just a fraction more,” he breathed into the tense silence that had settled over the ER room, a silence broken only by his murmured words and the slow, irregular beeping of the heart monitor.
Calm had settled over Paige. She’d pushed the pain to the back of her mind and concentrated instead on breathing as Ty had instructed. Her ribs hurt with every inhalation but she soon realized that her breathing had slowed to sync with his.
She didn’t know if he’d done it purposely but it felt like they’d entered a vacuum where everything—the room, the world and even her abused body—faded. Her hands seemed to be connected to his mind, already doing his bidding before he could voice his thoughts. It was a strange yet exhilarating experience to be so attuned to another person that you knew, even before they spoke, what they were thinking.
“Excellent…perfect positioning. Now…wait for the… Okay, hold steady for the flashback then carefully fill the syringe.”
All eyes watched the monitor as the syringe filled.
“It’s cloudy,” Ty murmured, and though she wanted to look, she kept her eyes on the screen. Any movement on her part could cause the needle to penetrate the heart and put her patient in cardiac arrest.
Then the monitor stopped beeping.
Paige froze. Had she done something wrong?
Ty murmured for her to wait. It had to be the longest seconds of Paige’s life but after a few hair-raising moments, the beeping resumed and she released her breath on a gusty exhalation of relief.
“Cardiac rhythm is already normalizing,” Ty murmured. “What’s next?”
“Guide wire,” she said shakily, trying awkwardly to remove the syringe from the needle. Finally Beth took over, quickly twisting it free. “Thanks. Get it up to the lab, will you? I want a full analysis by morning. Be sure to request a fungal test and I want to check clotting parameters so we can correct any abnormalities while we wait.”
With deft movements, she inserted the guide wire through the needle until it entered the pericardium. Once she’d removed the needle, she passed a soft-tipped pigtail catheter over the wire until it too entered the pericardium. She slid the wire free and connected the vacuum bag, finally securing the incision site with a couple of
small stitches and tape.
When there was nothing more to do, she stepped back to check the monitor. “Looks promising,” she murmured to herself as relief began to flood through her, along with all the myriad aches and pains she’d ignored during the procedure. “Heart and respiration rates rising…sinus rhythm returning…and, wow!” She gusted out a shaky breath as her lips curved involuntarily. “Look at that. His color’s better too.”
They’d done it and it wouldn’t have been possible without Ty and his calming presence—without his firm, quiet instruction. He was too good, too knowledgeable a physician to lose because he was mad at the world.
“Stacey, call upstairs and let them know he’s on his way. I want to keep him sedated until we know more. Beth, put a rush on those samples while I talk to mom and dad.”
When the nurses had left, the only sound in the room was the quiet beeping of the machine and Paige’s heart pounding in her ears. She needed a minute.
No, maybe two, because her head suddenly swam, pounding out of control, along with her heart. Every bruise seemed to have a pulse of its own too and she felt each throb as if for the first time. She must have swayed because Ty was suddenly there, supporting her.
“Dammit, Paige—”
The door opened and, conscious of the picture they made, Paige quickly stepped away and turned to meet Joshua’s parents. They were visibly upset by the sight of their son, hooked up to monitors and with a tube sticking out of his chest. Paige drew them aside to explain and by the time her little patient had been whisked away to ICU it was all she could do to walk to the door.
She hurt. All over. Including her heart.
Ty was waiting outside and the instant she stepped into the corridor he gently took her arm. “You’re done,” he said, slipping the lab coat and stethoscope off her.
She was a little surprised to find him still there. “I have a patient,” she began, only to be interrupted by the shift supervisor.
“He’s right, Paige,” Marc Wallace said, coming up behind her. Her boss looked as though he’d been through the wringer. “You’re done for the day and I don’t want to see you till Monday.”
“But—”
“Look at you,” he said gently but firmly. “You can hardly stay on your feet. I’ll get Kara Grant to take over the boy’s care but from what I hear you did all the hard stuff.” He reached out to squeeze her shoulder, murmuring an apology when she winced. “You saved a little boy’s life, Paige, now let your man take you home.”
Paige wanted to tell him that Ty wasn’t her man but before she could get the words out, Marc was gone and Ty was steering her towards the exit.
Aware of the deep trembling in her core, Paige was silent on the drive home. Other than a few concerned looks, Ty too said nothing. Exhausted and hurting, the last thing she wanted to deal with was his leaving.
He parked and helped her out the SUV but when he tried to steer her towards his unit, Paige shook her head. She wanted to be surrounded by her own stuff and sleep in her own bed tonight. Besides, it was time she got used to being alone again.
Without arguing, Ty let her into her house and switched on the lights. It had been days since she’d actually spent any time there and the place felt empty.
Yep, a little voice drawled in her head. As empty as your heart is going to be when he leaves. But Paige wasn’t going to think about that now. She just wanted to sleep. Maybe until her life got back to normal or she woke up and realized the past couple of months had been nothing but a pleasant dream.
Besides, talking clearly hadn’t got her anywhere so far.
She headed for the stairs and when he came up behind her she turned to stare at him dully. The overhead light cast most of his features in shadow, illuminating only one side of his face. His eyes were dark and unreadable and his mouth unsmiling.
She couldn’t stop her gaze from dropping to study its sculpted lines or keep from recalling exactly how it felt on hers. Especially the kiss in ER. It had confused her as much as it had sent her heart skittering because he’d kissed her as if she was delicate and precious to him. But it was a lie. Like his lie of omission.
“I told you I’m not leaving,” he growled softly. “And I meant it.”
Too tired and heartsick to tell him what she already knew, Paige turned and slowly took the stairs. She concentrated on lifting each foot because her muscles had stiffened and it was an effort to move.
At the landing she headed for the bathroom, vaguely conscious of Ty disappearing into her bedroom. She turned the shower to steaming and had to sit on the bath to remove her shoes. It took a concentrated effort but she’d managed to unlace one sneaker before two masculine hands and a dark head appeared in her vision.
He brushed her hands aside and finished the job of undressing her. Then he stripped and drew her into the shower.
Tears pricked the backs of her eyes and she gulped them down. She couldn’t—just couldn’t—bear memories of him in here too. “Ty,” she began, but he gently soothed her and closed the door.
“Let me, Paige,” he murmured against her temple. “Let me take care of you.”
And though she surrendered—mostly because she didn’t have the energy to resist—Paige knew he didn’t really mean it. But that was okay. She’d had enough experience taking care of herself.
She didn’t know how long he let the hot water work on her abused muscles, but resting against his hard warm body she drifted, only to stir when he carefully ran the soapy sponge over her. Once her skin was pink—where she wasn’t black and blue—he tugged her from the shower, dried her and pulled a huge T-shirt over her head.
She began floating and it took her a couple of seconds to realize that he was carrying her. The comforter had already been pulled back and within seconds of him gently tucking her in, everything slipped away.
Sometime later she was roused from a disturbing dream where she was standing on the rocky shoreline, watching a figure disappear into the fog. She must have been crying because Ty’s hands were soothing and her face was wet.
She pried her eyes open and blinked in the low light. Shirtless and with his hair mussed, he looked big and bad and dangerous in her girly room.
“Hey,” he murmured. “You okay?”
“Yeah,” she croaked, rolling over and wincing when her body protested. “Ouch. Why?”
He helped her up. “You were crying. Bad dream?”
“Hmm,” she said noncommittally, unwilling to recall the devastation she’d felt in her dream or what it might mean. “How’s…um… Joshua?”
“He’s fine. Vitals stable.” He held out his hand. Two small tablets nestled in his palm. “Take these,” he said, handing her a glass of water.
Wordlessly she swallowed them, easing her body down into the bed when he took the glass from her. She was just slipping into sleep when she jolted.
“Ty?”
“Right here,” he murmured from somewhere close.
The sound of his voice had her body relaxing. “But you won’t be,” she murmured sadly.
“Won’t be what, babe?”
Babe. She knew she should be protesting but she liked it. “Be here.”
“I’m right here,” he soothed, running a hand down her arm. “I’m not leaving you tonight.”
But he would. And soon. “I know, you know,” she murmured, feeling her throat close when he smoothed a strand of hair off her face.
“Know what?”
She silently enjoyed the gentle caress for a few moments before admitting, “That you’re leaving.”
*
When Paige next woke, the sun was high and the bed was empty. As empty as the house felt. And when she went next door, she found that empty too and tried not to care.
He’d promised he would be there but he’d lied. Just as her mother had fifteen years ago when she’d promised a frightened pre-teen that she would never leave her.
CHAPTER THIRTEEN
TY STARED AT the rolling lawns of his mo
ther’s manicured gardens and wished he was a thousand miles away. He lifted the wineglass to his mouth and grimaced. The Chablis was perfectly fine but he’d have preferred whiskey or beer. Always had, despite his mother’s efforts to turn him into what she called a “civilized man”.
Somehow she’d found out he was back in LA and had issued a dinner invitation. Ty knew a summons when he heard it and hadn’t been surprised to find she’d invited the daughter of an acquaintance to dinner. The woman was as perfectly nice as the Chablis but Ty kept comparing her to the one woman he couldn’t seem to get out of his head.
What had surprised him was his mother’s latest companion. Paul Richmond was well heeled and well educated but, unlike her previous husbands, he could hardly be called polished, sophisticated and smug. And because he wasn’t, Ty had liked him instantly. However, he wasn’t in the mood for a dinner party and he wasn’t in the mood for his mother’s brand of matchmaking or interrogation—which the evening was actually a cover for.
The week since his return had been jam-packed with meetings and appointments, mostly to keep him from thinking. It hadn’t worked, because all he’d done was think.
About Paige, about her accident, and about the mind-numbing terror he’d felt when he’d thought she’d been seriously hurt.
He shook off the disturbing images that had constantly been on his mind since that day—images that had followed him even in sleep—because if he thought too much about them he might have to admit that he’d been an idiot.
That leaving Paige had been the biggest mistake of his life.
One minute he’d been watching her sleep, the next…
Okay, so maybe he’d freaked out a little. He’d experienced a crushing feeling in his chest that had had him staggering from the room, thinking he’d been having a heart attack. He’d gone looking for brandy and had found a six-pack of his favorite beer instead. Beer she had to have bought for him because she was a wine drinker.
His world had tilted alarmingly and he’d felt as though he’d been rushing towards disaster without a brake. Without a single thought to the consequences.
