‘He had a terrible pain,’ Mabel told them. ‘In his stomach. He almost couldn’t get out of the car. And then he was sick everywhere and...and...’ She had to gulp in a deep breath. ‘I’ve never seen so much blood...’
Zac caught Olivia’s gaze. They both knew how serious this was. Don was showing the symptoms of hypovolaemic shock from potentially dangerous blood loss.
‘Bruce? Ben?’ Zac sounded calm. ‘Help me carry Don into the procedures room.’
‘I can walk,’ Don protested. ‘Stop making such a fuss.’
‘Stop arguing,’ Zac told him. ‘This time we’re in charge. Me and Liv. Okay?’
Olivia was watching her father’s face so she felt the instant he made eye contact with her. He looked scared, which was understandable because he would be well aware of the significance of vomiting blood like that. He also looked as if there was a lot he wanted to say to her and she could read a plea in his expression. Was that a plea to help him survive? Or that he would have the opportunity to say whatever it was on his mind? Or...it could have been just a plea to stay close. To let her know that he wanted her to be with him.
It didn’t matter.
Olivia wasn’t going anywhere.
* * *
This mattered.
Not just because any life-or-death situation mattered. Or that this patient was a colleague he’d come to respect and like very much. It mattered because he’d seen the fear in Olivia’s eyes. She might not be ready to forgive her father but she was most definitely not ready to lose him, either. She might be conflicted but she cared a lot more than she wanted to admit.
It was Zac who examined Don while Olivia was inserting an IV line and putting up a bag of fluids to start managing his low blood pressure. Debbie put an oxygen mask on their reluctant patient and then some ECG dots to attach him to the monitor.
‘Sharp scratch,’ Olivia warned when she had cleaned the skin above his vein with an alcohol wipe. ‘There we go... Now, don’t move while I get this cannula taped down.’
‘Didn’t feel a thing,’ Don told her.
He could certainly feel Zac’s hand on his abdomen. ‘That hurts, doesn’t it?’
Don couldn’t hide the fact that he was in pain. ‘Of course it does. It’s been hurting for some time. It’s only to be expected with this disease I’ve got.’
Debbie looked shocked. ‘What disease?’ she asked.
Zac gave his head a single shake. ‘Nothing’s been confirmed,’ he told Debbie. Then he looked back at Don. ‘And as far as I know, sudden onset abdominal pain along with vomiting a large amount of blood is not a symptom of pancreatic cancer. It’s far more likely to be a perforated peptic ulcer.’
Don just grunted as Zac palpated another quadrant of his abdomen. ‘Your blood pressure is in your boots and you’re showing other signs of hypovolaemic shock. You must have lost a significant amount of blood.’
‘He’s still tachycardic at one twenty.’ Olivia was watching the ECG trace on the monitor screen. ‘And his blood pressure’s dropped even further. Systolic’s down to ninety. How far away is the nearest blood bank?’
‘Too far,’ Zac admitted. ‘But we do keep a limited supply of blood products here. Some O-negative packed red cells and some plasma. They’re in the second fridge in the staffroom. Debbie, could you go and get a bag of the PRC, please?’ He caught Olivia’s gaze as Debbie left the room and they both acknowledged the real problem they had here. They weren’t going to be able to transport her father to a larger hospital any time soon and they weren’t going to be able to get more blood products delivered. If this was a perforated ulcer Don could still be losing a potentially dangerous amount of blood. Right now it didn’t matter that his self-diagnosis might have been completely wrong because this could still prove to be fatal and even more rapidly.
‘We could do with a CT scan,’ he added. ‘But we’ll have to make do with what we’ve got. An ultrasound and then an upright chest X-ray. If we see any free air under the diaphragm on X-ray then we can be a lot more sure of a perforation.’
And then what?
Surgery?
In an operating theatre that hadn’t been used in a very long time?
Don gave a strangled groan and then tried to turn onto his side. Electrodes popped off his chest and an alarm began to sound on the monitor. Olivia grabbed her father’s shoulders.
‘What’s going on? What’s wrong, Dad?’
Zac barely registered what she had called Don as they both dealt with another vomiting episode. Another several hundred mils of blood lost. But he remembered as they reassessed Don’s condition to find that his level of consciousness was dropping sharply and they worked together to put a central line in so that they could deliver more fluids and the blood products that were obviously needed urgently. It was undoubtedly the first time she had called her father “Dad” since she’d been a small child. There was nothing like a crisis to make it obvious what was really important, was there? Olivia’s anger at her father for her apparent abandonment was irrelevant when she was face to face with the possibility of watching him die.
Surgery was needed urgently if that wasn’t going to happen.
‘How are you with giving a general anaesthetic?’ he asked Olivia quietly a short time later when they had stabilised Don well enough to do the tests that increased Zac’s confidence in his diagnosis.
‘I did a six-month rotation in anaesthetics. It was near the top of my list for a chosen speciality.’ She held his gaze. ‘You said you worked in war zones and on trauma teams but did that include any surgical experience?’
‘I qualified as a specialist trauma surgeon before I went anywhere near a war zone. I’ve worked in major hospitals in the UK and the USA since then and my last position was Chief of Trauma Surgery in the biggest hospital in Chicago.’ He wasn’t telling her his credentials to try and impress her. He simply wanted to reassure Olivia enough for that fear in her eyes to lessen.
‘We can do this,’ he told her. ‘As long as we do it together.’
He saw the way her chin came up and it was a familiar gesture already. A sign that she was gathering her courage and that she was prepared to face a situation she really didn’t want to be in. Once again, he felt proud of her but this time there was also a wash of a much stronger feeling. Of caring. Of feeling as invested in a successful outcome here as she was because the alternative of Olivia being hurt again was unacceptable.
Sterile drapes were rolled around surgical instruments that were kept sterilised so that they could be available in an emergency but no one had ever expected that Cutler’s Creek Hospital would have to deal with trying to save the life of the doctor who’d kept this hospital going almost single-handedly against the risk of closure. The son of the man who’d devoted his entire life to the medical needs of this community.
Don Donaldson was under general anaesthetic now and it was his daughter who was monitoring his vital signs, the blood transfusion and the medications being administered. She nodded in response to Zac’s silent question. They were good to go.
Zac was scrubbed and gowned. So was Debbie, who’d come into Theatre with them to assist.
‘I’m not sure I remember what the names of some of the instruments are,’ Debbie said anxiously. ‘It’s a long time since I did any theatre training.’
‘You’ll be fine,’ Zac told her. ‘I’ll tell you which ones and what to do as we go along. The first thing I need is easy. A scalpel, please.’
There was only one goal on his mind as he made his midline incision and then started a thorough examination of the abdominal cavity, and that was to stop whatever bleeding was going on. Don Donaldson might well have to be taken back to Theatre once he reached an expert in the field at a main hospital but if whatever blood vessel had ruptured wasn’t taken care of right now, he would never get that far.
Zac had to resist the urg
e to work too swiftly, which could mean he might miss what he was looking for. He had to coach Debbie in assisting him, to find the instruments he needed and how to manage the suction. He also had another part of his brain that needed managing and that was his awareness of Olivia at the head of the bed, watching over her father and watching him...
And he was too aware of her.
Their roles were reversed this time but he was strongly reminded of when he’d been the spectator, watching Olivia’s skill in suturing Shayna’s facial laceration. When he’d realised that somehow Olivia Donaldson had almost instantly got past any protective barriers he had in place to prevent himself caring too much about other people. Barriers that had been added to and added to until they were too big and too strong and he’d feared that he would never truly care about anything again.
‘There it is.’
‘A perforation?’
‘Yep. The bleeding’s coming from the gastroduodenal artery.’ Zac adjusted the tilt of the powerful light above them, swabbed the area he had identified and watched the blood well swiftly back into the space. ‘Okay... I need a suture now, Debbie. Yes...that one at the top of the tray. And a needle holder. And then I need you to help keep things visible by using the swabs and suction. How’re things looking at your end, Liv?’
‘Blood pressure’s still on the low side. I’m going to hang that second bag of packed red cells. He’s throwing off a few ectopic beats, too. The sooner you can stop that bleeding the better, Zac.’
‘I’m on it.’
He was. He’d be able to stop this life-threatening blood loss within seconds. With the curved suture needles secure in the holder, Zac moved to ligate the artery before repairing the perforation by excising the ulcer that had created it.
And that’s when it happened.
His hand shook.
Just for a heartbeat, and it was probably imperceptible to those watching what he was doing but it felt huge to Zac and he froze for another heartbeat because he knew why it was happening. There was too much resting on the outcome of what he was about to do. This wasn’t a purely clinical challenge that needed only the best of the abilities he knew he had. Not only did he care a great deal about the man on this operating table, he was desperate to do whatever it took to protect his patient’s daughter.
He cared that much about Olivia Donaldson.
And it felt too much like love...
Too much like the overwhelming emotion he’d felt for Mia and a reminder of the devastation and guilt that had come so close to destroying him. And, while it was a good thing that he had healed from the dead space he’d been in emotionally when he first came to Cutler’s Creek, he’d only wanted to open windows in that barrier that protected his heart—this felt like a door was opening.
One that he might actually want to step through.
He didn’t. He couldn’t. He had to slam that door shut.
Maybe it had only affected him for a split second but that was enough. Zac used every ounce of his determination to get past that blip and focus completely on what he was doing. There would be time later to reflect on the fact that he’d faced his worst fear—that caring too much really would make it impossible to do his job to the best of his ability—and, even though he could get past it, he’d been right to fear it because maybe next time it would be worse. When it was appropriate to think about that, he would take the time and action that was needed to regain control and make sure it never happened again.
But not yet.
‘Gotcha...’ There was huge satisfaction to be found in lifting that swab and seeing no new blood loss. Now he could turn his focus to cleaning out the abdominal cavity as thoroughly as possible before closing up and starting Don on antibiotics. Then they would just need to monitor him and manage anything else until he could be evacuated for more definitive care, hopefully within the next few hours.
‘Blood pressure’s coming up already... Good job, Zac.’
He didn’t look up from what he was doing. He didn’t want to see respect or gratitude or anything else in Olivia’s gaze. He didn’t want to see those extraordinary eyes again right now or feel the connection that he knew would kick him right in the gut. The sooner this was over the better. Not just this emergency surgery but his time with Olivia.
If only he’d known...
He would never have left that voicemail on her phone.
* * *
How extraordinary...
They’d faced a challenge that could have gone very wrong even in a major hospital and they’d done with minimal staff and resources but they had succeeded against the odds.
No wonder the people who had gathered in the reception area of Cutler’s Creek Community Hospital looked like they were collectively holding their breath as Olivia walked in to tell them the news.
‘The surgery was successful,’ she announced. ‘Dr Donaldson is stable for now and we’ll be able to transfer him to Dunedin as soon as the weather allows for a chopper to get here.’
‘Shouldn’t be too far away,’ Bruce said. ‘The storm’s blowing through faster than expected and the wind’s started dropping already. I’ll get a road crew out straight away to start dealing with that slip in the gorge, too, in case we need a Plan B to go by road.’ He cleared his throat and sounded as though emotions were doing their best to break through his professional focus. ‘This is...this is such great news...’
Mabel Donaldson was wiping her eyes with a handful of tissues as she came towards Olivia.
‘Oh, my dear...thank you. I was so worried...’
‘I know. He’s still not completely out of the woods, but we’ve stopped the bleeding and that was the critical thing to do.’
Mabel opened the clasp of the old-fashioned handbag she was clutching. ‘This is for you, Olivia.’ The embossed envelope she pulled out of her bag was sealed and Olivia’s name was written on the front. ‘It’s an invitation to my birthday party. I do hope you’ll be able to come. It’s far enough away for Don to be back home by then, I hope.’
‘I hope so, too.’ Olivia accepted the envelope but didn’t clarify which of those hopes she shared. There was no way she would be heading back here for a party in the near future but her grandmother was clearly a lovely woman and she didn’t deserve to be rejected in public.
‘There’s something else, too.’ Mabel had a wallet in her hands now. ‘This is Don’s,’ she told Olivia, as she opened it and fished inside a small pocket. ‘And this is what he’s carried with him for the last thirty years.’
It was a small photograph of a young girl. A photograph of Olivia taken when she’d been about four or five years old. Golden curls, big blue eyes and the happiest smile ever. Had it been her father who’d taken the photograph? The one who had been on the receiving end of that smile?
‘There’s so much I want to tell you,’ Mabel said quietly. ‘But it’ll have to wait until another time. Bruce is taking me home so I can pack a bag for Don and for myself, if they’ll let me go with him, and get back here before the helicopter arrives, but...could you give him his wallet, please?’ She tucked the photograph back into its pocket. ‘He’ll want to have this with him now, I expect.’
Olivia took the wallet. She had no choice when it was being pressed into her hand like this. How could she refuse when Mabel was looking up at her so trustingly? So lovingly...
‘He loves you, darling,’ her grandmother said. ‘And so do I. We’re family, even though it might not feel like it quite yet. You’ll always have a home here, you know, if you ever need a new one.’
Olivia opened her mouth to say she already had a new home and it was in the country’s biggest city about as far away as you could get from a place like Cutler’s Creek but the words got stuck somewhere in her throat. It might be an unwelcome connection but she had ties to this place that she would be aware of for the rest of her life. Mabel was right about her
having family here.
And Zac was here, as well.
He was in the room with her father when she went in with his wallet. Debbie and Ben had wheeled a comfortable hospital bed into the procedures room and Don was lying propped up on soft pillows, surrounded by the machine monitoring his heart rhythm and blood pressure, the IV poles and lines that were still providing fluids, blood products and medication, and the oxygen tank that was attached to the mask he was wearing. He looked drowsy but his eyelids flickered open as Oliva entered the room and she knew he was watching her.
Zac was also watching her and he held her gaze for a heartbeat before his lips curved into a smile. A tiny moment of time that was enough for Olivia to realise how fierce the connection between the two of them had become in such a very short time.
‘Everything’s stable,’ he told her. ‘But could you stay with your dad for a few minutes, please? I need to write up as detailed a report of the surgery as I can for the team he’s going to be transferred to.’
‘Sure.’
‘I’ll be in my office if you need me. That’s next door to your dad’s office, if you remember where that is?’
Olivia gave a single nod. She hadn’t forgotten where she’d had that horribly awkward meeting with her father for the first time in decades. Her hand tightened around the shape of the wallet she was holding. So many years and he’d been carrying a photograph of her in his wallet for that entire time?
‘I’ll be in Theatre for a bit,’ Debbie said. ‘I need to start cleaning up in there.’ She tilted her head at Ben as if encouraging him to leave the room, as well.
‘I’d better make sure the ambulance is ready,’ he said hurriedly. ‘Just in case we need to meet land transport for Dr Donaldson halfway or something—if a chopper can’t get here.’
If they’d agreed on a plan to try and leave Olivia alone with her father, it had worked remarkably well.
‘Your...um... Mabel gave me this to give to you.’ She put the wallet on the table beside the bed. ‘She’s gone to get a bag packed for you to take to hospital but she thought you might want to keep this with you.’
Melting the Trauma Doc's Heart Page 10
