by Radclyffe
“The usual Saturday afternoon stuff—a few broken bones, colds, and belly pain.” He shrugged. “I don’t think we’ve got anything surgical, though.”
“Well, there’s always something to do, right?” She grinned. “I’ll be around for a while.”
He shook his head. “I don’t know if I want you hanging around. You might bring us bad luck.”
At that moment, the radio on his belt beeped and he hit the on button. “This is Rivers base, go ahead.”
“Rivers, this is Medevac 2-1-5. We’re inbound fifteen minutes with a fifty-four-year-old male, partial traumatic amputation, right hand.”
Emery looked at Grady, pointed a finger, and mouthed, See what I mean?
He toggled the radio again. “Roger that. Do you have any amputated parts?”
“Several partial digits. Secured in an ice bath,” came the reply.
“Roger that.”
“So who’s on call for surgery?” Grady asked when Emery signed off.
“Matt Hinkle,” Emery said. “I’ll give him a call.”
“I’m right here—will he care if I check the patient first?”
Emory raised a shoulder. “Matt’s really easygoing and not territorial. Plus, if it’s a possible replant, he’ll probably want ortho or plastics to take it.”
“Who’s covering trauma?”
“That would be Sheila McConnell. She’s not gonna want to keep it. The evaluation will just tie up the trauma unit, and they won’t want that if something big comes in.”
“I better check.”
“You know where they are,” Emery said. “I’ll clear things with Matt.”
The trauma unit adjoined the regular emergency room but, unlike the ER, had a full operating room as well as a separate entrance, a turnaround for the emergency vehicles outside, and the closest access to the elevators to the rooftop helipad. Grady went through the connecting doors and walked over to a slim guy with close-cropped gray hair, in scrubs and a blue cover gown, sitting at a countertop computer adjacent to trauma bay one.
“Hey,” Grady said when he looked up questioningly, “I’m Grady McClure, one of the surgical attendings. The ER just got a call there’s a hand amputation coming in. Are you guys gonna want to see it?”
The guy held out a hand. “Jerry Kwan. I’m a PA on the trauma team. Nice to meet you. I’ll give the trauma fellow a page—she might want to stick her head in for a look, but doesn’t sound like it’s going to be anything for us.”
“Sounds good to me. I’ll make sure somebody gives you a shout when he arrives.”
“Will do, and welcome aboard. I’m sure I’ll be seeing you down here.”
“Roger that.” Grady hustled back to the ER and pulled a green cover gown on over her street clothes.
Emery passed her on the way to check another new patient. “Matt said he’s got a septic patient in the SICU, so you’ll be doing him a favor if you triage this guy. He’s sending his resident down.”
“Great,” Grady said.
Ten minutes later, Brody and another member of the flight crew brought in a heavyset guy with thinning brown hair, dressed in khaki shirt and pants and work boots, off the elevator. Grady went to help steer the gurney to a treatment room.
“Hi, Brody,” she said as she grabbed a corner of the stretcher.
“Hey, Grady. This is Fred Murtaugh, fifty-four, a mechanics foreman at a boxing plant in Whitehall. Crush injury to the right dominant hand, partial amputation of the third, fourth, and fifth digits.” Brody gestured to a plastic bag filled with ice at the foot of the bed. Inside was another bag with several portions of digits.
From what Grady could see at a quick glance, the amputated portions were fairly mangled. She turned to the patient as Emery met them to transfer the patient to a treatment table.
“I’m Dr. McClure,” Grady said. “As soon as we get you settled, I’ll need to get a look at that hand.”
“Sooner the better. It’s a mess.” He glanced down at his bandaged hand where a white gauze wrap completely obscured the injury. All except the bright red blood soaking through the bandage.
“Has he had anything for pain?” Grady asked Brody, who was busy handing lines off to Emery and another ER staff member.
“Two mg. of morphine, IV, thirty minutes ago,” Brody said.
“Let’s give him another four,” Grady said to Emery.
“On it,” he said and disappeared into the hall.
A young blonde with striking deep brown eyes appeared behind Brody’s shoulder. “I’m the surgery resident on call. How about I check the digits while we wait?”
Grady recognized the resident who’d been in the OR last night. Courtney something.
“Sure,” Grady said. “Then unwrap this wound.”
Her eyes glinted. “Absolutely.”
“Do you have any medical problems?” Grady asked Mr. Murtaugh while Emery pushed the morphine. The flight medics would’ve already gotten all that information, but besides wanting to hear for herself, the more she talked to him, the faster she could establish a relationship with him.
“Healthy as they come. Don’t smoke, don’t drink.”
“No vices, huh?”
He grinned a little weakly and patted his middle. “Just food.”
Courtney returned and adroitly stepped around Grady into the patient’s field of vision. “Hi. I’m Dr. Courtney Valentine. You ought to be feeling a little more comfortable now, so I’m going to unwrap your hand.”
“Sure thing.”
Grady smiled to herself. She was pretty sure Valentine was a first year, but she had the moves down already. She’d be all elbows in the OR, pushing her way to the best position to see and assist. The mark of a good resident—only time would tell if she’d be a good surgeon.
Grady leaned over Courtney’s shoulder to watch while Courtney donned gloves, carefully cut the bandage, and eased the dressing off Mr. Murtaugh’s right hand.
He was right—it was a mess.
Neither she nor Courtney made any comments. Grady waited a beat, and sure enough, Courtney spoke.
“So how did this happen?” she asked as she began to irrigate the wound with sterile saline to wash away clots and fragments of what looked like metal.
“I was fixing one of the box presses. Power was off, I’m sure of that. But the gears must’ve been caught halfway through a revolution and the damn things jumped forward while my hand was inside. Rolled right over it.”
“Are these little bits of metal?” Courtney asked neutrally.
“Yeah, that’s pretty common inside the presses, just from wear and tear.” He craned his head and looked down. “Those don’t look too good.”
Courtney didn’t say anything this time. Someone had trained her well.
“The problem,” Grady said calmly, “is that the parts of your fingers that were lost are crushed. That makes it really hard to reattach them. It doesn’t help that all those little bits of metal are contaminating the wound, either. They’re kind of an invitation for infection.”
“So if you reattached my fingers, they’re not gonna do very well, right?”
“There’s a good chance that they won’t survive if we do. The surgery itself could take as much as twenty-four hours. That’s not great for the blood supply to the rest of your hand either.”
“What about going back to work?” he asked. “I’m mostly a supervisor—I was just on the floor today because one of my guys was out sick.”
“If we attempt to replant and it goes perfectly, you’re looking at six months of rehab minimum. If things don’t work and you need a revision, longer.”
He swallowed. “And if you don’t do anything?”
“The good news,” Grady said, “is that your thumb is fine, and that’s ninety percent of your hand function. With your index finger and your thumb, you can do pretty much anything you need with that hand except carry much of anything.”
Murtagh’s face visibly relaxed. “So then what are we
looking at in terms of recovery?”
“We’ll clean things up and close all the wounds. Six weeks, maybe. Light duty only when you go back, for three months after that.”
“Well, that’s easy,” he said. “Just get me back to work. I can tell just from looking at those things they’re not gonna work right, so what’s the point.”
“We can get one of the hand specialists in here if you want another opinion.”
“They’re not going to tell me anything different, are they.”
“I don’t believe so.”
“Then let’s just do it.”
Grady said, “You want to talk to anybody before you decide?”
He hesitated. “Well, I got a guy.”
“I think you better call him first, then.”
He grinned a little sheepishly. “Yeah, I guess I better.”
Grady glanced at Courtney. “You interested in scrubbing?”
Courtney tilted her head and gave her a long half disdainful, half teasing look. “Is that a trick question?”
Grady laughed.
Chapter Ten
“Why don’t you go ahead and get him prepped and draped while I scrub,” Grady said after they got Mr. Murtaugh situated in the operating room.
“Will do.” Courtney kneed the plate on the stainless OR sink to turn off the water, let the water drip from her elbows, and shouldered open the door to the operating room.
Grady watched her through the windows over the scrub sinks as Courtney worked with the OR nurses, techs, and anesthesia to get Mr. Murtaugh ready to go. You could tell a lot about a young resident by the way they interacted with the other staff. The ones who were the least confident internally often projected just the opposite, their self-assurance frequently tinged with an air of superiority or arrogance. Just from watching her, Grady could tell Courtney was at ease with her role on the team and knew what she was doing. Grady didn’t know anything about her personally, but if she had to put money on it, she’d bet Courtney was a local. Everyone in the OR knew her, and the easy banter flowing between team members was clear, even through the glass. That kind of interaction usually took a lot longer to develop, especially where junior residents were concerned. Hell, she’d probably have to work pretty hard at it herself to achieve that level of camaraderie, although she’d always had a natural ability to get along with people. On the surface, at any rate. That was enough for her, those surface connections. Usually. And just like that, she thought of Blaise.
Easy banter, true. Effortless conversation, true. Simple pleasant time spent together. All true. But this time, with this woman, she wanted more than surface familiarity. She couldn’t remember the last time she’d wanted to know a woman the way she wanted to know Blaise. Inside, where it mattered. Maybe the urge was so strong simply because Blaise so obviously didn’t want Grady to know her. Or maybe Blaise didn’t want anyone close. And that appealed to Grady on some deeply primal level—one she could scarcely verbalize. But the feeling was clear. She wanted a woman who was hers.
The thought was like an ice-water shower. Where the hell did that thought even come from? That was not her—no way. Sure, she liked women. Loved women. Enjoyed them as people, and especially enjoyed them in bed, and why not. But for hers and all that meant? The very thought made her chest tighten.
Grady let out a breath of relief. Thank God for surgery. When she was in the operating room, there was nothing else in her mind but the case. The OR was an oasis of peace, despite the ever-present tension of making sure everything went right for someone who’d entrusted themselves to her.
And right now, she had a case to supervise and a reprieve from thoughts she couldn’t begin to untangle. She finished her scrub and backed into the OR, hands out in front of her. A scrub tech draped a sterile towel over her hands, and she dried them off. By the time she was done, the tech had her gown open and was holding it up for her to slide into. As she went through the automatic motions of being gowned and gloved, she glanced over at the table where Courtney waited, and took in the patient’s draped form. Courtney had positioned him with his arm extended on an arm board with a stool on either side. The tubes from a compression cuff snaked out from under the sterile sheets and towels. Good. Courtney’d remembered they’d need a tourniquet in order to see what they were doing once they started to clean up the mangled mess of his hand.
“Everybody set?” Grady asked, walking over to join Courtney.
The anesthetist, a young guy with a thin face whose almond-shaped brown eyes were the only things visible above his mask, nodded. “He’s steady as a rock. Let me know when you want the tourniquet up.”
“Right.” Grady sat down across from Courtney. “Go ahead, Dr. Valentine, let’s get started.”
Courtney cut the sterile sleeve over Mr. Murtaugh’s hand, and one of the circulating techs focused the overhead light down into the field.
“Tourniquet up,” Courtney said with a glance at the clock. “5:05 p.m. Give us a heads-up in an hour, David.”
“You got it, Court.”
Forty-five minutes later, Courtney said, “I think that about does it except for his middle digit. What are we going to do about that exposed bone?”
Grady laughed. “Shouldn’t that be my question?”
“It was kind of rhetorical. I do have a plan.”
Grady held back another chuckle. Courtney was too damn confident for words, but she’d done a really good job. Still, not wise to encourage her hotdogging too much. Training programs were years long for good reason. Even the most natural surgeons like Courtney Valentine needed to see lots of cases with lots of potential complications before they would have enough experience to handle emergencies or the routine cases that suddenly went south.
“Well, rhetorically speaking,” Grady said, “what are the options?”
Courtney was silent for a moment, thinking things over, and that was a good sign. The young ones—and some of the not-so-young ones, unfortunately—who tended to shoot from the hip often picked the flashy course of action because it was fun or challenging to do. That didn’t always mean it was the best thing for the patient.
“Ordinarily,” Courtney said after a minute, “you’d want to maintain length in order to leave him as much function as possible. Considering the loss of the fourth and fifth, and the injury to this one, his index finger is going to be his only working finger besides his thumb. Rather than swing a flap and immobilize his remaining good digit, I would just go ahead and shorten this back to the first available joint.”
“Agreed. Why don’t you draw out the incisions,” Grady said.
Courtney used a sterile surgical marker to draw some lines on the tip of Mr. Murtaugh’s partially amputated digit.
Grady pointed out a slight correction that would allow her a little bit more skin coverage and said, “Go for it.”
Before the hour of tourniquet time was up, his hand was rewrapped, and he was on his way to the recovery room. Once Courtney got him settled, Grady said, “Nice job, Dr. Valentine.”
“Thanks, that was great.”
“Weren’t you on call last night?” Grady said as they walked toward the surgeons’ lounge.
“Uh, yes,” Courtney said as she busied herself opening her locker.
“I thought you were supposed to be off call after a night on call.”
“Well, yeah, but you know, if you’re not here, you can’t get the good cases, right?”
Grady paused in front of her locker. “Flann Rivers know you’re working extra hours?”
“Maybe.” Courtney hesitated. “Probably not. Are you going to tell her?”
“Well, I’m not the residency program director or the chief of surgery.” Grady opened her locker and pulled off her scrub shirt. “I get where you’re coming from. But,” she said as she shrugged into her polo shirt, “if I thought it was affecting your work, I certainly would. You’re right, if you not here, you can’t get the good cases, but if you’re too tired, you won’t learn from them,
and you might make mistakes.”
“I’m off until Monday,” Courtney said, facing Grady with her back to her open locker, “so I figured hanging around the ER for a couple hours wouldn’t be a big deal, and it paid off. But I’m done for the weekend.”
“Good.”
“So, how are you liking life in town?” Courtney stripped off her scrub top and dropped it on the long, low bench between them.
Grady had a second’s worth of seeing the lacy black bra that covered Courtney’s full breasts before she turned her back. She’d been changing her clothes in locker rooms with other women for a decade, and some of them were women she’d been intimate with. Sex never came into the equation in these circumstances, regardless of how the other women identified sexually. But she didn’t know Courtney, and while Courtney might not know she was a lesbian now, she surely would soon, since Grady didn’t keep it a secret. The last thing she wanted was to give any hint of impropriety. As she shucked her scrub pants and pulled on her jeans, her back still turned, she said, “Living here is definitely different. Nothing like the city. But so far, I like it. What about you—you from around here?”
“Mmm. Close by. I grew up in Saratoga, but I went to high school here. I was a volunteer at the Rivers when I was young, so I’m pretty much part of the place, yeah.”
“And you came back,” Grady said, turning around as she closed her locker.
“Never considered anything else. Who wouldn’t want to work here?”
“Beats me,” Grady said.
Courtney had donned a short-sleeve white top that scooped low, but not so low Grady wanted to avert her gaze, and tight black jeans. She’d unclasped the gold barrette that had pinned her tawny curls up while she was operating and let her shoulder-length waves flow free. Grady guessed she was twenty-six or twenty-seven, not really all that much younger than her in age, but years younger in terms of experience. Courtney might not be interested in women, and even if she was, she was a resident. Not that Grady wasn’t used to seeing residents and attendings getting involved, especially considering they were all adults, but if she had been interested, which she wasn’t, she was new here, and the last thing she wanted to do was start in on a new reputation.