The Rebel Surgeon's Proposal

by Margaret McDonagh

  ‘This is Diane, aged fifty-two. She’d been out at a party where there had been a fair bit of drinking and merriment. As it was breaking up, she slipped over in the car park and a vehicle reversed over her hips and pelvis—one wheel. The driver never saw her,’ Robert explained, giving details of Diane’s overall condition since. ‘The initial suggestion is of an open-book fracture of the pelvis but Francesca is doing some detailed X-rays.’

  Luke looked at the monitors displaying Diane’s vital signs, concerned at the deterioration evident there. ‘Internal bleeding?’

  ‘That’s my fear. Diane was conscious on arrival but is fading in and out now. The anaesthetist is on the way down. We’ve sent blood for urgent cross-matching.’

  ‘Any other fractures?’ Luke asked, looking over the notes and examining the area of injury.

  ‘None suspected on first review,’ Robert responded. ‘Her rib cage is clear, femurs feel intact, but we’ll do a thorough secondary assessment once we’ve stemmed this pelvic bleed. We’ve used a splint wrap, hoping it would compress the pelvis and halt the blood loss,’ the consultant continued, his concern and frustration evident, ‘but despite that, and the fluid replacement, nothing we are doing is improving things and her BP continues to drop. She needs surgery now.’

  ‘And all the theatres are in use thanks to the motorway collision earlier tonight.’ Luke delivered the bad news, unsurprised when the consultant cursed in annoyance. He had an idea but he’d need to make arrangements with his boss before proceeding. ‘Maurice is operating but I’ll ask him to spare some help so I can do a temporary fixation here in Resus.’

  Robert indicated his understanding and agreement. ‘Not easy, and not ideal conditions in terms of cleanliness outside an operating room, but unless we do something, Diane won’t last much longer, bleeding out as she is. If you can do it, Luke, you’ll buy her time and save her life.’

  ‘Let’s hope so.’

  ‘Tell me what you need. We’ll give you all the support we can.’

  Grateful for the older man’s faith in him, Luke smiled. ‘Thanks.’

  ‘While you look at the X-rays and gather together your equipment, I’ll send a nurse to the blood bank to chase up the units we need and ask for some more. And I’ll update Diane’s family. I think the shock has rapidly sobered up her poor husband,’ Robert informed him, shaking his head as he moved away.

  Luke waited for Francesca to finish, admiring the way she went about her work with calm efficiency. There had been some awkwardness when they had met up at the hospital after the way they had parted at her flat hours earlier, but they’d both been professional. Whilst he was sorry that anyone had been injured, the fact that the night shift had been so busy had helped them both to focus on the job and had given him less time to brood. And to worry if he’d made the biggest mistake of his life by losing his patience and rushing her.

  He’d done everything he could, had laid his heart on the line, had bared his soul, and now all he could do was wait and see whether it was enough, whether his love could ever compensate for the pain and loneliness and loss that had been all Francesca had known for so long. He didn’t blame her for her lack of trust. He had left. At eighteen he hadn’t understood how that would hurt her and he had never intended to be away so long. At sixteen, she would never have understood why or have known he was coming back. It had been just one more in a long line of betrayals. Could she get past that? They needed each other. Would she see that, or would she reject all he was offering her?

  It was proving harder than he had ever imagined to act normally and to hide his hurt and his fear. He knew she needed time, but she gave no clues about what she was thinking or feeling. He had no one to blame but himself if he’d ruined everything by declaring himself and demanding her surrender before she was ready to contemplate it.

  ‘The pictures are ready.’ Francesca’s words drew him back from his thoughts.

  ‘Thanks.’ Stepping closer to examine the screen also allowed him to enjoy her subtle flowery scent, enough that he was blinded for a moment by the memories of their weekend together, the feel and taste of her. On dangerous ground, he snapped himself back into work mode. ‘Let’s see what we have.’

  ‘It looks like a classic open-book fracture, as Robert suspected.’

  Sure enough, the pelvis had snapped and opened out. Like a polo mint, the rigid ring of the pelvis never broke in just one place. Luke flicked to another image, planning what was necessary and seeing the shadows of fluid in the cavity, which indicated the evidence of the pooling of blood Diane was losing internally.

  ‘What are you going to do?’ Francesca asked, her interest evident.

  ‘With the theatres unavailable, I’m going to have to do a procedure here in Resus. I’ll put screws in and externally fixate the pelvis in place,’ he explained, drawing her a hasty diagram. ‘The plan is to hold the pelvis in position and stop the bleeding so that we can stabilise Diane. That will buy us some time for a permanent repair and also to investigate any other injuries, including assessment of possible complications…for example, her urinary situation in case of damage to her bladder.’

  Word came down from Maurice instructing Luke, as Specialist Registrar, to carry out the procedure. Moments later a couple of the more junior orthopaedic team doctors arrived in Resus to assist, closely followed by matronly A and E nurse Gail, returning somewhat breathlessly from the blood bank with several cross-matched units of blood.

  ‘Blood pressure still falling,’ one of the medical team called out as Robert returned from talking to Diane’s family.

  ‘Right,’ Luke said after scrubbing up, hiding any flicker of nervousness. ‘We’re set to go.’

  With the anaesthetist happy with Diane’s condition, and the blood transfusion being pushed through at full volume, Luke prepared to begin, well aware of the responsibility resting on his shoulders to get this right. Working in the Resus bay was very different from the sterile, fully equipped operating theatre he was used to. It was also more cramped. Knowing that Francesca was nearby, looking on, he glanced up and met her gaze. Her tiny smile of encouragement, signalling her confidence in him, brought an inner calmness as he bent to his task.

  Diane’s skin had been swabbed with antiseptic to disinfect the area and, using the detailed X-ray images Francesca had already taken to guide his positioning, Luke set about making the first of the four small incisions necessary. With each one he cut carefully down through the layers of tissue and muscle to locate the pelvic bones and then prepared to insert the screws. One of the assisting team worked to suction out the blood. When each screw was in place, four rods protruded from Diane’s body to which an external frame was attached, pulling the pelvis back together to keep it rigid and supported.

  ‘Can we have another X-ray please, Francesca?’ Luke asked, straightening and mentally running over all he had done to ensure there had been no mistakes. ‘I want to check that everything is positioned properly.’

  Those not wearing protective lead aprons stepped out of the way as Francesca manoeuvred the imaging machine into place and took the required pictures. Watching the screen, Luke breathed a sigh of relief when it became apparent that the screws were correctly positioned and that the external fixator cradle was already doing its job.

  ‘Her blood pressure is rising and she’s stabilising!’

  The announcement brought a collective sigh of relief, which continued to grow as Diane’s vital signs improved after the emergency operation, the seven units of cross-matched blood and nearly two litres of fluid replacing the blood that had haemorrhaged to fill the pelvic cavity.

  ‘Thanks, everyone, I appreciate your help,’ Luke praised, grateful for the help both of the A and E team and his own orthopaedic colleagues. ‘We’ve closed the ring, stopped things moving around and controlled the bleeding. Now we need to send Diane for a CT scan so we can assess the extent of her pelvic injuries and ensure there are no chest, abdominal or hip problems.’

  A
hand landed on his shoulder. ‘An impressive job, Luke. Well done,’ Robert congratulated him.

  ‘Thank you, sir.’ The older consultant’s opinion meant a lot to him. ‘We still have a long way to go with Diane.’

  ‘Indeed. Let’s get her through to Radiology so we can take a detailed CT scan. You carry on.’

  Robert’s approval and tacit invitation to maintain control of Diane’s care for this stage of the process bolstered Luke’s confidence. Checking that the patient’s condition was stable, Luke gathered the small team together and followed as the trolley bed was wheeled through to the radiology department and into the CT scan room for the next step in Diane’s care.

  For the moment, at least, thoughts of Francesca, and her decision on whether she would accept or reject him were going to have to wait.

  Luke was in Theatre, completing the repair of an elbow fracture to a motorcyclist, when their shift officially ended on Tuesday morning. Francesca had no idea how long he might be but she felt an overwhelming need to see him. She had experienced a rush of pride at his achievements during the early hours with Diane in Resus. His skill had been obvious, the procedure an important one, but he’d worked calmly and shown no sign that the tense atmosphere around the patient had affected him.

  She had accompanied the small group that had gone with Diane for the CT scan. The three-hundred-and-sixty-degree orientation showed slices through the body and the computer assimilated the information and displayed the pictures as 3-D images. Everyone had been relieved that Diane’s injuries were confined to the pelvis, but she was not out of the woods yet. Luke’s temporary repair had saved Diane’s life, but complications remained—there were concerns about her bladder and it was likely she would need further surgery.

  It had been a hectic night shift and Francesca had been glad of work to keep her busy, but it had not stopped her mind from working overtime about Luke. There had been a new awkwardness between them during their working hours, as hard as they had both tried to act normally. And while part of her longed for things to be back the way they had been before, she had not been able to stop thinking about their weekend together—or to regret it.

  Even now her body throbbed with need and she was deliciously tender from the extent of their enjoyment of each other. She had never been desired as Luke desired her. It had been a little alarming at first but soon she had felt a sense of power that his need for her made him lose control, lose himself. Sex—the twice she had tried it before—had never been the joyous, all-consuming, wildly amazing adventure that it was with Luke. She’d never realised what she had missed, had been so careful to never lose control, to never give anyone else a hold on her or power over her again, not after her mother, or her coach. She didn’t want to need anyone. Luke understood that. At least, she thought he did. Now he wanted to change the rules, to change the whole basis of their relationship.

  He had made it clear what he wanted from her—she just wasn’t at all sure she could give it. Confused and troubled, she changed her clothes and then went through to the staffroom that served the radiology and orthopaedic departments to make herself a cup of coffee while she waited. She wasn’t sure what she was going to say to Luke, she just needed to see him, to reassure herself they were still friends, whatever else happened.

  The staffroom was empty when she went in. The coffee-jar was empty, too, so she went into the galley alcove that served as a store to find some more. She was out of sight in there when the staffroom door opened and several people came in, laughing and joking.

  ‘You won’t believe it but rumour is that Luke Devlin bagged the Ice Maiden this weekend,’ one male voice she recognised as that of one of the junior doctors on the orthopaedic team announced.

  Francesca froze, clutching the new full jar of coffee to her chest and staying hidden as the all-male conversation continued.

  ‘No way!’

  ‘Yeah.’

  ‘I have a book running on it,’ another voice chimed in. ‘Want to place a bet?’

  ‘Sure. Here’s my stake. I say Devlin didn’t get past first base.’

  Several people laughed and then she heard the door open again.

  ‘Here he is now,’ the main instigator said. ‘We can ask him. Hey, Luke, give us the details, man, I have a lot of money riding on you.’

  Francesca pressed a hand to her mouth and fought back anger and pain. She felt used, humiliated, unable to believe that Luke would betray her. She had trusted him, had listened to his words that had seemed so sincere. Surely it couldn’t all have been a joke, a bet?

  ‘What are you talking about?’ she heard Luke say.

  ‘Is it true you thawed the Ice Maiden for us over the weekend?’

  The room went quiet.

  ‘What did you say?’ Francesca could hear the chilling malice in Luke’s voice.

  She heard a grunt of surprise and another man called out, ‘Luke! Easy, man. Come on, she’s not worth it.’

  What sounded like a fist meeting flesh echoed in the air.

  ‘Damn you anyway, Devlin. I’ll have you charged, I’ll—’

  ‘Shut the hell up.’ She had never heard Luke so angry. ‘If any one of you ever disrespects Francesca again, you’ll find out firsthand how much of the Devlin blood I have in me. Do I make myself clear? And give me that money. You disgust me.’

  ‘What are you going to do?’

  ‘I’m going to give it to charity, where it might do some good for someone deserving rather than lining the pockets of cowardly scum like you.’

  ‘Look, I’m sorry, man. I didn’t realise you cared about her.’

  ‘You have no idea. I’ve known Francesca nearly all my life. Aside from my mother, she is the only person who ever believed in me. Yeah, I care for her. More than care. I love her, I always have, and you have no idea what an amazing woman she is, what she has overcome, what an incredible person she is. All you can do is see the surface front she wears for protection and mock. That’s your loss. If nothing else you owe her professional respect for the incredible job she does here.’

  ‘Sounds like you’re going to marry her or something.’

  ‘I’d do it in a heartbeat if she’d have me. Whatever makes her happy. Francesca deserves the best of everything and if I had my wish I’d be there every day and every night to make sure she was cherished.’

  Amazement welled inside her at Luke’s words. The truth in them, the emotion and sincerity mirrored all he had said—and the way he had said it—the previous afternoon. Only hearing it now, in the way he defended her and declared himself to a group of their colleagues with no knowledge she was there, somehow set something free inside her. Something that dared to begin to believe.

  She stepped out of the galley and surveyed the scene. Luke had his back to her. One guy was sitting on the floor holding a tissue to his bloodied nose, his partners in crime gathered around him.

  Francesca cleared her throat.

  All gazes swung to her. It was gratifying to see the shame and apology on the faces of her detractors. Then Luke turned round, as if in slow motion, and she saw no one else.

  ‘Chessie. My God…’ His voice was raw, his horror at seeing her there obvious in the shocked, pained expression in his green eyes.

  Before she or anyone else had a chance to speak, however, the door opened yet again.

  ‘What the hell is going on in here?’ a voice boomed.

  Everyone turned once more to stare at Maurice Goodwin, who stood, surveying the scene, Francesca’s immediate superior Dee Miller and one of the hospital administrators by his side. Maurice took one look at the junior doctor with the bloodied nose and one look at Luke and ordered them all to his office. The room cleared quickly, before Francesca had a chance to say anything to Luke or defend him to his boss.

  ‘Are you all right, Francesca?’ Dee asked, her concern apparent.

  ‘I’m fine,’ she lied, masking how shaken she had been by what had happened. She turned to set the jar of coffee aside, then spot
ted a notebook on the floor. ‘What’s this?’

  Bending to pick it up, she found it was the evidence of the junior doctors’ bets on her—and other members of staff.

  ‘You take that along to Maurice’s office,’ Dee advised when she realised what it was. Smiling, her surperior held the door open for her. ‘You might also like to know that Olivia Barr has been reported for her interference with patients—the Mitchells were not the only ones who complained about her. I doubt she’ll avoid an official warning for her behaviour this time.’

  ‘Thank you, Dee.’

  ‘No problem, doll. Off you go, now, and remember how much we all value and respect you.’

  Although grateful for the support and pleased about the news on Olivia, Francesca hurried out, Luke at the forefront of her mind. Filled with a sense of determination, and of déjà vu, she hurried to Maurice Goodwin’s office.

  Ignoring the scary-looking secretary who forbade her to go in, Francesca marched on, knocked once and opened the door before anyone could stop her. She didn’t dare look at Luke who stood before the desk with the junior doctors in a row beside him. Instead, she focused on Maurice, who sat in his chair, the hospital administrator nearby. Walking forward, she handed the senior orthopaedic consultant the book.

  ‘I think you’ll recognise the writing, sir,’ she said, cursing the nervous wobble in her voice. ‘Luke was kindly defending me from gossip about my private life and the insulting bets that were being placed on me by some of the staff. I thought you should know.’

  ‘I’ll speak with you outside, Francesca.’

  Maurice rose to his feet and escorted her out of the door.

  ‘Please, sir, it wasn’t Luke’s fault,’ she tried again once they were alone. ‘I know what some people call me around here and I just want to do my job. Luke was standing up for my professional reputation.’

  ‘Yes, I understand that. Not that I approve of his methods, but I’ll take your views into account.’

  ‘Thank you.’

  A smile stripped the sternness from the older man’s face. ‘Don’t look so worried. I’m more angry at the despicable behaviour of the junior doctors,’ he assured her, waving the book containing names and bets. ‘Neither I nor the hospital administration will tolerate this kind of thing. You are a highly respected colleague, Francesca, and don’t let a few thoughtless idiots give you cause to believe otherwise.’