by Amy Ruttan
“I believe you,” Ella said softly. “It’s been a hard night for you.”
He took a deep breath. “Yeah, it’s been a hard night for a lot of people.”
“The boy is okay.”
“I’m glad.” He relaxed then. The boy was fine.
Ella touched his head, gently brushing his hair back. “Why are you trying to fight it so much? It’s eating you alive. I can see it. I’m here.”
Yes. She was here. He needed her.
He closed his eyes and tried to think about her, when they’d been together, but all he could see were the terrible images that had terrified him when she’d come running out into that storm. The thought of her being washed away or injured. Or even lost in the blizzard and succumbing to the elements. They had been paralyzing.
“Why did you have to follow me out into the storm?” he shouted at her. Angry.
“You needed help, Zac. You and the boy would’ve died if I hadn’t come.”
Zac took another deep breath. She was right and then he would’ve been at fault for killing another child.
You didn’t kill Rojas. Mortar did. Not you.
“A child...” It was hard to get the words out, but he just couldn’t hold it in. He couldn’t shake the ghosts away and he just couldn’t hold it in any more. She knew he was suffering, she wanted to help, but he was terrified to take her hand. Terrified to take the help she was offering.
“A child died on my last mission.” Tears stung his eyes. “I couldn’t save him and with that boy tonight...”
Ella grabbed his good hand. “You saved Josh tonight. He’s alive. Dr. Bennet from Pediatrics said that if it had been twenty minutes later, the boy would’ve died from exposure. You saved him.”
“But I couldn’t save Rojas,” he snapped, then he was angry at himself for snapping at her when she was just trying to help him.
Her expression was empathetic, as if she already knew what was tormenting him. “Tell me about it. Tell me what happened.”
Zac rubbed his eyes. He wasn’t sure that he could tell her. He’d been hiding it for so long because he didn’t want to relive the horror again. Only he was, piece by piece, as it slipped through the cracks in his mind, not all at once.
“There was a natural disaster on the island of Iphita in the Caribbean. The medical frigate I was on was deployed to help. Many locals who were also trained in first aid and medicine assisted us. One nurse named Consuela had a little boy about six years old named Rojas. Rojas went everywhere with her. His father had died a few years back from an infection that would have been preventable had there been clean water.”
Ella nodded. “I heard about the cholera outbreak a few years ago.”
“Rojas took to me. He liked to run errands for me while his mother and I worked, treating the injured. Then a revolution erupted. A guerrilla faction came out of the rainforest. They were armed to the teeth and were coming to drive Americans off their soil. There was so much bloodshed. Rojas was crushed under rubble when a mortar exploded. He died in my arms and there was nothing I could do. That’s where I got this bullet wound. I was shot from behind, a through and through as I was carrying Rojas’s body away from the rubble. When I woke up I was back on the medical frigate. Iphita was on the horizon. About three weeks after we arrived back in Annapolis I heard that Consuela had died from an infected wound.”
He took a breath. There was a rush of emotion going through him but he couldn’t cry. The tears would not come.
“I’m so sorry to hear that,” Ella said softly. “That you had to go through that.”
“Well, it’s part of serving your country.” He couldn’t look at her. And he hated that he was stuck in this hospital bed with a dislocated shoulder.
“The lost boy, Josh, must’ve brought it all back.”
“It did, and Josh’s mother had similar features to Rojas’s mother—the hair, the eyes—but after the fact I saw they didn’t look alike at all. She just triggered the memory. Her panic triggered it.”
“I think a lot of things trigger the memories and you’ve been fighting long and hard to keep them locked away.”
“What is the use of remembering them?” he snapped.
“To accept that what happened was beyond your control and move on.”
“That’s so easy for you to say, but it’s another thing to actually do it. I had to get out of Annapolis. I had to come home and the only way to do that was to bury those nightmares so they would clear me to return to work as a surgeon.”
“Zac, I get your motive, but you need to deal with this.”
“I’m a Davenport. I was taught to hide my emotions. They make you weak. Look what your emotions did to you. You were stung by words, by a lie.”
The moment the hateful words slipped out of his mouth he regretted them. He was a complete monster. He kept hurting Ella.
“You’re wrong,” she said calmly. “I learned from the pain of that moment when you broke my heart. I learned to hold my head up higher, to take what I wanted and to be one of the best trauma surgeons on the eastern seaboard. I never did properly thank you for that.”
It was a slap to him now and he deserved it. He admired her gumption and so he smiled at her. “You’re stronger than I am, then.”
“You’re stronger than you think,” she said softly.
It was kind of her to say that after he’d been so cruel again, but he didn’t want her to pity him. He didn’t want her to get too close. In order for her to stay strong and successful, she had to steer clear of him.
There was too much wrong emotionally.
He had no really good examples to look up to. His parents were bitter toward each other. His father had cheated on his mother.
What about your brothers and sisters? Haven’t they found love?
That may be the case, but he was too broken. Sure, his siblings had had their own trials and tribulations, but none of them had been through what he had. None of them had been in a war zone. None of them understood what he was going through.
It was better that he be alone.
It was better for Ella this way.
“How long am I going to be laid up in here?” he asked, not acknowledging her compliment.
“Dr. Lynne is the one who treated you. You’ll have to ask her, but, given that the storm is still raging and you’ve been on painkillers, probably not until closer to noon. It’s five in the morning. The sun will rise in a while, if we see it through all this snow.”
“It’s been a wild night. I hope Santa made it for all the kiddos.”
“Of course he did,” Ella teased, winking. “He always finds a way, especially with Rudolph guiding the sleigh.”
“Unless you’re a misfit toy.” Zac smiled at her. Then he sighed sadly and closed his eyes, his emotions raw, but for the first time in a long time he felt like a weight had been lifted off his shoulders.
“You saved Josh’s life tonight,” she whispered. “Josh will have many more Christmases because of you, you know.”
“We saved his life. Together.” With his good hand he touched her face. There was much more he wanted to say to her, but he wasn’t sure if he could. He drew his hand back and looked away, wincing. “I think the painkillers are wearing off.”
She sighed, sounding exhausted, and he felt bad for being laid up and for her having to take the brunt of the work. “I’ll let Jen decide if your IV can come out.”
He nodded. “I want to help in some way Even if I’m laid up.”
“Well, right now you just need to stay put.”
Jen Lynne came back into the room. Her lips were pursued and she was visibly stressed. Zac’s heart lurched. He was worried that it was the child.
Jen whispered something to Ella and she frowned, nodding quickly.
“What?�
� Zac asked.
“I have to go and treat the motor vehicle accident patient.” And as if she knew that he was worried about the child she said, “It’s not the boy. He’s stable.”
“I need to help you.”
“You need to stay put,” she said.
“You’re not my doctor.”
“I know.” A strange expression passed over her face, like sadness, and he worried now that she pitied him. He didn’t want her to pity him.
Ella rushed out of the room. He wanted to believe her, but he had to see the child with his own eyes before he really, truly let it sink in.
“Jen, is there any way that you can remove my IV and I can get out of this bed?”
“You should really rest, Zac,” she said.
“I’m fine. Give me a sling and let me at least manage Dispatch while the rest of you work. I can answer the phone with one arm.”
“Okay, but I want you to take it easy.”
Zac lay back on the gurney while Jen worked on discharging him.
* * *
Ella ran into the intensive care unit while the team was working to revive the patient. The police officers stood outside the ICU door. Ella tried to ignore their presence as she went about assessing her patient.
First he’d gone through his splenectomy. Then his kidney had had to be removed because the blood vessels around it had been breaking down. She could only guess that this time the patient’s heart was causing some concerns.
Crystal meth had done a number on this guy. He may have survived the accident because he’d been wearing a seatbelt, but the damage done from the drug was making it impossible to treat him. But treat him she would.
She would keep fighting for his life until the bitter end.
“I need to get another arteriogram done on this patient.” She’d done one earlier when he had first come in, as well as a CT scan. On the first there had been no tear in his aorta, but as there was blood in his drainage tube, he was hemorrhaging somewhere. She was going to repeat the X-ray right here, with a portable X-ray machine.
His veins were friable, paper-thin and a complete mess.
Ella moved quickly. The dye was injected so she could see if there was a tear. She took an X-ray of the patient’s mediastinum. She waited with bated breath as the images came up on the screen.
Don’t be full thickness. Don’t be full thickness.
Of course, if it was full thickness he would be dead right now. When the full thickness of the aorta tore open, all the patient’s blood spilled into the chest cavity, killing him.
As the images came up on the monitor, she could see there was a tear. A small one, but there was a tear nonetheless.
They would have to go back in. Given the nature of the patient’s vessels and tissue, that small tear could turn into a full-thickness one quite quickly. They had to get in there and repair it.
“Prep an OR and page Dr. Bentley from Cardiothoracic.”
“Dr. Bentley is already in the OR with another patient,” a nurse said. “He’s the only cardiothoracic surgeon who made it in, besides his fellow who is in the surgery with him.”
“Okay, well, I can repair it. Prep an OR and let’s get this patient down to the operating room stat.” Ella left the room to get ready to scrub in.
“Excuse me, Doctor?” the police lieutenant said, stepping forward. “What is going on?”
“The patient needs another surgery or he’ll die,” Ella said. “I know you have questions to ask him, but—”
“That’s okay, Doctor. We understand. We’ll go get a cup of coffee. He’s still sedated and unconscious so we’re not too worried about him leaving. Please keep us updated.”
“I will.”
The police walked away from the ICU room and she knew from the way they casually walked away that they didn’t think the patient would live. And for a moment she had her doubts. The percentages were stacked high against this patient, but she was going to try her hardest and make sure that didn’t happen if possible.
She went into the scrub room and began to scrub, while she watched them prep the patient in the operating room. In her head she was working out how to approach this and as she was doing so she couldn’t help but think about Zac.
How when he’d been working on Iphita after a natural disaster, his conditions must’ve been worse.
There would be no negative pressure rooms. Operating in a tent would be hard, especially if a patient was lying open. The chances of infection would be high and she admired him for that. Just like she admired him for finally opening up to her and admitting to her that he had post-traumatic stress disorder, but she had no idea how horrible it was.
How that must’ve affected him.
She couldn’t even begin to imagine a horror like that.
A child dying in your arms because of a revolution breaking out. She’d had patients die before, but she didn’t deal with a lot of children because she worked in the hospital and the pediatric surgeons dealt with child trauma.
And she just couldn’t imagine the horror of losing a child and having to live with that. Zac had no closure either, because he had been wounded and shipped out, only learning the fate of people he’d worked with on the island after the fact.
It explained so much. It explained why he was shutting people out of his life and why he felt the need to leave. Why he felt the need to shut her out of his life.
And why he’d been driven to risk his life like that to save that boy during the snowstorm.
It was too much of a burden for him to carry and she wished he would let her in to help him. She wanted to help him.
She finished scrubbing in and then entered the operating room, where the charge nurse assisted her into her gown and gloves, then fastened a surgical headlamp onto her head.
The patient had been given medication to stop his blood pressure from rising. The bypass machine was ready to go and blood was on standby.
You can do this. You’ve done surgeries like this before. You can tie off an artery. You can repair a small tear in the aorta.
The mediastinum was washed with betadine and she prepped the surgical field, climbing up on her stool.
The door to the scrub room opened and Zac entered. He had on a mask, scrub cap and fresh scrubs, as well as a sling to hold his shoulder in place.
“Dr. Davenport? What’re you doing here? You can’t assist me in this.”
“No, but I’ve done this more times than I care to count in conditions a lot less favorable, with good outcomes. I can guide you. I heard that Dr. Bentley was in surgery.”
Ella let out a sigh of relief behind her surgical mask. “That would be helpful. Are you sure you’re up to this?”
He nodded. “I’m going crazy down there.”
“Okay, stand behind me and I’m open to your suggestions.”
Zac took his place behind her and Ella made her first incision, opening the mediastinum in preparation to open the chest cavity. It went fairly easily and she injected the patient’s heart with cardioplegic solution, which would slow it down while they put him on bypass.
Once the heart slowed down enough she was able get a good look at the small tear. The tissue around the aorta was weak and sewing it up was not an option. Once the patient was off bypass and the heart was beating again then it would just tear through the repair.
“Dacron graft,” Zac said from behind her.
“His tissue is so fragile from the meth use. I’m wondering if it will hold.” She began to suture off the layers of the aortic tissue. “It just won’t hold like this.”
“It will hold. Patients who have high blood pressure and heart problems are able to receive the Dacron graft. It’s your only option.”
The scrub nurse passed her the graft material and she began to place i
t over the tear that she had just sutured up. It was a larger patch over the aortic arch and she sutured it over the tear. Her legs were aching and so was her back from standing there so long and operating on this patient again.
For the third time since he’d come in Christmas Eve morning.
The scrub-room doors opened again and Dr. Bentley came in. “I hear that Dr. Lockwood is repairing an aortic arch dissection?”
“I am finishing a repair on an aortic arch dissection, Dr. Bentley. Would you care to see?”
Dr. Bentley was gowned and gloved first before he approached the operating table. “The tissue is very weak.”
“The patient is addicted to meth. He was involved in a motor vehicle accident and had blunt trauma to the chest. There was no heart bruise or lung bruise when the patient presented,” Ella said as she continued to work.
“Was an arteriogram performed when the patient was first admitted?” Dr. Bentley asked.
“Yes, and there was no tear. I removed his spleen. A couple of hours later he crashed and the artery to his kidney and kidney began to break down. I removed the kidney. Now he has a tear in his aorta. Or did. Thankfully it was not full thickness.”
Dr. Bentley peered over and looked at her work. He was close to her and she felt slightly uncomfortable, but shrugged it off “You’re doing a fine job, Dr. Lockwood. Nicely done on the Dacron graft. You have fine, delicate suturing skills. Do you mind if I assist?”
“Please do,” Ella said, and she was relieved that she had someone helping her with this procedure, especially someone who was used to doing it. They finished repairing the damage and checking the arteries.
The cardioplegic solution was stopped and Dr. Bentley started the heart again with defibrillators as it wouldn’t start on its own after the cardioplegic solution was stopped. It didn’t surprise her, given the nature of this patient’s health.
The heart did start after one shock and the long slender paddles were removed. Now they would know whether her graft work would hold and if there was any other damage.
“Let’s take the patient off bypass,” she said, hoping that her voice didn’t squeak with apprehension as she said it.
