Second Chance with Her Island Doc

by Marion Lennox

  Code blue.

  He was out the nursery before he realised.

  Room Twelve. Anna’s room.

  Code blue meant cardiac or respiratory arrest, or similar medical emergency.

  Anna?

  What had he missed? Internal bleed? What?

  He didn’t run—he didn’t need to. He’d pretty much perfected his hospital stride, so running would make him no faster.

  He turned the corner to Room Twelve and Maria was in front of him, pushing the crash cart.

  ‘Anna...’ he said, and he couldn’t keep the fear from his voice.

  ‘Worse,’ Maria managed. ‘It’s Carla.’

  * * *

  She’d hit the call button and then she’d yelled. The junior nurse who’d helped shower her had arrived in seconds, taken one look and bolted for help.

  Carla vomited as she reached the floor. The first couple of moments were frantic, clearing Carla’s airway, getting her into the recovery position, trying to assess her breathing. Anna was crouched on the floor, willing help to arrive. Trying to see what she was coping with. Cardiac arrest? No? Headache, pain, collapse...

  And then blessedly Leo was kneeling beside her. The crash cart was being wheeled in behind him.

  ‘Carla...’ Leo said, and she heard his voice break.

  Carla’s eyes were open but she wasn’t seeing.

  ‘I don’t think it’s her heart.’ Anna said it intentionally loudly, making her voice clipped and professional. Leo and this woman must be friends. She’d heard Leo’s instinctive distress, but she needed a doctor here, not someone emotionally involved.

  And he got it. She felt the moment he hauled himself together. The moment he became one of a medical team.

  ‘Fall?’

  ‘Collapse,’ she told him. She glanced up at Maria, and Maria anticipated her needs by handing down a towel. Two. She used one to sweep the mess away from Carla’s head, the other to help clear her face. ‘She looked like her head hurt. She put her hand to her head like there was intense pain and then she passed out.’

  ‘The headache... Hell...’ He had his hand on her wrist.

  ‘It’s still strong,’ Anna told him.

  They were squashed together. Maria started working around them, shoving the bed back, heaving the bedside table onto the bed to give them more room.

  ‘Defibrillator?’ Maria asked.

  ‘No.’ Leo was moving to the next stage. He checked her eyes, and Anna saw the slight sag of his shoulders, relief that he’d seen a corneal reflex. He’d seen her clear Carla’s mouth. He’d seen the gag reflex as well.

  She wasn’t comatose, then, but the speed of the drop from alert to where she was now implied she soon would be.

  ‘It’s okay, Carla, we’ve got you,’ Leo said, loudly and firmly. ‘Relax, love, don’t fight it.’

  That made Anna blink. He was assuming Carla could hear. It was good medicine, the assumption, unlikely as it was, that Carla would comprehend what was going on. But not all doctors did it, especially under the stress of an emergency like this one.

  ‘We need to stabilise your airway and get a scan,’ Leo said. ‘Carla, have you had a head injury? Banged your head?’ She didn’t respond—how could she?—but once again Anna knew the words had been said to reassure Carla that she was included in this conversation. ‘Carla didn’t say anything about an injury, Anna? Maria?’

  ‘Nothing,’ Maria said, and Anna heard her distress, too.

  ‘Just a headache,’ Anna said. ‘Leo, this looks like an internal bleed.’

  ‘You must have had a bump.’ Leo was back to speaking to Carla. ‘You told me you took aspirin last night.’

  ‘She has been taking aspirin,’ Maria ventured. ‘She’s been getting it from the hospital pharmacy. I saw her take a couple of boxes last week. She said she has a bit of arthritis. We were busy and I didn’t follow it up.’

  ‘Aspirin won’t have done this, though it might have made it worse,’ Leo said. ‘But if there’s a bleed it won’t help now. Carla, we’re going to have to have a look-see. Get a trolley, Maria. We’ll take her through for scans. Now.’

  ‘What can I do?’ Anna asked.

  ‘You’re a patient,’ Leo said roughly. ‘Thanks for your help, Anna. You should be right to go.’

  * * *

  The scan showed a bleed.

  A big one.

  The hairline skull fracture was bad enough. What was worse was the dark shadow underneath the fracture. A subdural haemorrhage. Blood vessels near the surface of the brain had obviously ruptured.

  How the hell...?

  But the cause of the injury was the least of his concerns. What was crucial was time. Blood had collected immediately beneath the three-layer protective covering of the brain. The brain was being compressed.

  In young people a bleed like this was usually triggered by a significant impact. Older people could bleed after only a minor trauma.

  Carla was hardly elderly but she’d been taking aspirin. The aspirin would have been thinning the blood.

  The greater the pressure on the brain, the worse the bleeding would become. For her to lose consciousness so quickly...

  ‘I’m going in.’ He was talking to Carla, and to the nurse beside him. Maria was looking as terrified as he felt. ‘Carla, there’s a bleed under the surface. We need to get the pressure off.’ He needed to say no more. If Carla was aware enough to take it in then she’d know, and Maria had been a nurse long enough to realise the ramifications of a cranial bleed. Pressure on the brain caused brain damage, and it caused it fast. They had to get the pressure off now.

  ‘Leo, I’m asking again. What can I do?’

  The voice came from the doorway. Anna still looked very much the patient. She was dressed in jeans and a T-shirt, but the white dressing showed starkly against her burnt-red hair.

  ‘You need to leave, Anna.’ It was an instinctive response.

  ‘I’m a doctor, Leo,’ she snapped. ‘Get over yourself. Let me help.’

  ‘You’re injured.’

  ‘I have stitches from a bump on my head. I imagine Carla’s haemorrhaging. Am I right?’

  ‘You’re not well. I can’t—’

  ‘Do you have another doctor on staff? An anaesthetist?’

  He needed headspace and she was messing with it. He opened his mouth to snap back but sense prevailed.

  His instinctive reaction to Anna had been that of a doctor to a patient. The internal war, how he was feeling about Carla’s illness, physician versus friend, could allow no other distractions.

  Anna’s question, though, had cut through.

  There was no other doctor within hours of travel. Carla collapsing so dramatically meant that the bleed was sudden and severe. The pool of blood under the dura must be causing damage.

  Carla usually assumed the role of anaesthetist if he needed to operate. What now?

  ‘There’s no other doctor,’ he admitted.

  ‘Evacuation?’

  ‘It’ll take hours.’

  ‘Then she needs emergency craniotomy and drainage,’ Anna said. Her curt, professional tone helped. ‘If there’s no one else... Leo, can you operate if I do the anaesthetic? I’ve done additional anaesthetic training. The village where I work isn’t big enough to support medical specialists and there’s occasional urgent need.’

  She had anaesthetic training? It was like a gift from the heavens. A colleague with anaesthetic skills...

  ‘You have a head injury yourself.’

  ‘I have stitches and bruising. I may also still suffer a bit of dizziness if I stand up fast, but I think I’m over it and I can cover it. I know it’s not ideal but given the circumstances... Give me a stool in Theatre and let’s move.’

  He gazed down at Carla and saw no response. No glimmer of recognition. He looked ag
ain at Anna and she met his gaze with a determination that was almost steely. Treat me as a doctor, her gaze said. Get over your prejudices.

  She was still a patient. He could hardly ask.

  There was no choice.

  ‘Thank you,’ he said simply. ‘If you’re sure.’

  ‘I’m sure. Let’s move.’

  * * *

  The surgery sounded simple. Anyone with a decent handyman’s drill should be able to do it—in fact, Leo had heard of doctors in emergency situations using just such an implement.

  Luckily he didn’t have to resort to such measures. Most of their of equipment was second-hand but it was functional. Leo had kept up with a lot of doctors he’d met during training, and when they had been purchasing shiny new medical toys they often remembered him and sent on usable older things. The X-ray department had been set up almost completely via donations from a friend he’d met in final year med school. For the rest they’d scraped and saved and cajoled the community, which meant the theatre he was working in was fully equipped.

  And he had excellent staff. Maria, his chief nurse, was rigid about standards and ongoing training, and she ruled her nursing staff with a softly gloved fist of iron.

  The only hole in the team was his lack of a trained anaesthetist and that hole had been plugged. In Anna he had an anaesthetist he could trust. From the moment he’d nodded his acceptance of her offer she’d turned almost instantly from patient, from heir to the powers of Castlavara, from his past lover—into a crisp, competent professional.

  ‘Do you have access to Carla’s medical history? I need to know what she’s taken, allergies... Family? Is someone on their way?’

  ‘Her husband died ten years back,’ he told her. ‘Her son’s in Italy. But we have her history. Maria...’

  ‘Onto it,’ Maria said, and so was Anna. Ten minutes later they were in Theatre.

  ‘Glasgow scale deteriorating,’ Anna told him. ‘I’m losing any eye response.’

  He didn’t need telling. He knew the pressure would be building.

  He needed to focus.

  A handyman might be able to operate a drill but what was needed here was precision, care, knowledge. And confidence.

  Confidence that Anna could keep Carla alive while he worked.

  And strangely the trust was there.

  If another doctor had walked in right now, someone he didn’t know... If they’d offered to help... Yes, he’d have had to accept their help but there’d be caution. He’d be checking all the time. He’d be torn, though, because the procedure he was performing was out of his comfort zone. He needed to work fast with skills he hardly knew he had.

  Anna helped. Somehow just knowing she was here helped.

  Carla was in the supine position, facing up. As soon as Anna had the IV line in, as soon as she was sure Carla was under, Maria did a quick shave.

  Then it was over to Leo. Two small holes to expose the dura, then careful, painstakingly draining. Hell! The scan had showed a build-up but it shook him to see just how much fluid was in there.

  He inserted a temporary drain to prevent more build-up. He’d rather not have—it increased the chance of infection—but with this amount of fluid and with the speed of onset of symptoms, he had little choice.

  Then closing.

  It sounded straightforward. It seemed the hardest surgery he’d ever undertaken. Why? Because the huge unknown was how much damage had already been done. Had they been fast enough? Had the pressure already caused irreparable harm?

  He fixed the drainage tube, dressed the wound and finally stood back from the table.

  He’d done all he could do.

  Carla was his friend and he felt ill.

  What would have happened if Anna hadn’t been here? Would he have had to administer the anaesthetic himself? Have Maria do it?

  Or wait for evacuation?

  He was under no illusion as to what waiting would have meant. Even now, as Anna reversed the anaesthetic, he was aware that they might have been too late. Cerebral haemorrhage was the most frightening of medical emergencies.

  ‘We’ve done everything we can,’ he said wearily. ‘A neurosurgeon will need to take over. We’ve put in a call for evacuation but that’s still hours away. Meanwhile, we just have to hope.’

  Anna had finished reversing the anaesthetic. She’d removed the intubation tube. Carla was breathing for herself again, but would she wake up? And if she did, what damage had been done?

  ‘You went in as fast as you could,’ she said, maybe sensing just how close to the edge he was. ‘She has the best chance you could possibly have given her.’

  ‘Partly thanks to you.’ Then, almost huskily, ‘Thank you.’

  ‘Don’t thank me.’

  He nodded, dumbly, as the imperatives of surgery faded and the fear for his friend flooded back. What if the damage from pressure was irreversible? What if Carla didn’t open her eyes again, or, if she did, what life would she be facing?

  Surely they’d moved fast enough.

  With this level of bleeding, with the speed with which things had overtaken Carla, there was no way of knowing.

  There was nothing more he could do but wait. The pain he was feeling was fathoms deep.

  ‘The Italian neurosurgeons will take over,’ he said roughly. ‘We don’t have the facilities to do more.’ While there’d been medical need, he’d been able to put distress aside, but now there was little to do for Carla but wait, that distress was impossible to hide. ‘I need to speak to her son. Our receptionist will have contacted him already and he may well be on his way. But enough. Anna, you need to go home.’

  ‘Leaving you alone.’

  ‘Bruno will be back later today. He’s one of our nurse-practitioners but his six-year-old fell out of a tree last week. Comminuted fracture of his femur. He needed specialist orthopaedic care.’

  ‘So he was evacuated, too?’

  ‘Yes, but Bruno should be back.’

  ‘But he’s not a doctor.’

  ‘He’s good. Anna, you need to leave. I’ll take over here.’

  ‘And leave you to worry about Glasgow scores on your own.’

  ‘You’re a patient, Anna,’ he said, reminding himself as well as her. ‘Your place isn’t here.’

  He saw her wince, but there was nothing he could do about it. He had room for nothing but distress for his friend.

  And she seemed to accept it. She looked at him for a long moment and then nodded.

  ‘Okay. But you will call me if Carla needs me. If you need me.’

  ‘I will.’ He hesitated. ‘But the castle won’t necessarily put my calls through.’

  ‘What the...? Of course they will.’

  ‘Try and see,’ he said wearily. ‘The outside world isn’t permitted to intrude on the castle and its occupants.’

  ‘That might have been then,’ she said briskly. ‘This is now. If there’s any problem, I have my own phone and it’s on international roaming. I’ll leave my number at the desk. Call me. Promise?’

  And he looked at her, a long look where questions were being asked that he didn’t understand and maybe she couldn’t respond to.

  ‘I promise,’ he said at last. ‘Not that I think it’ll happen, but I promise. Thank you, Anna, but you need to remember you’ve been injured yourself. It’s time for you to leave.’

  CHAPTER FOUR

  TO SAY VICTOIR was annoyed was an understatement. He’d come to collect her in one of the castle’s limousines. He’d been left kicking his heels for hours.

  When she finally joined him he was leaning on the beautiful auto, glowering, looking almost startlingly out of place. The entrance to the hospital was serviceable but that was all that could be said about it. It was a narrow driveway, crammed with people coming and going, mothers and babies, the elderly in wheelchairs or Zimm
er frames, people visiting with bunches of flowers or bags of washing.

  The ambulance that had transported Anna to hospital the day before had backed into the entrance parking bay, in front of the limo. The limo was practically taking up the entire bay. Paramedics were trying to manoeuvre an elderly lady on a stretcher around Victoir. Victoir, in his immaculate dark suit and crisp white linen, with his hair sleeked back, a man in his forties in charge of his world, wasn’t about to move for anyone, not even a patient on a stretcher.

  The sight made Anna wince. Not for the first time she thought helplessly about the terms of the castle Trust. Yes, she’d inherited but she had no power. Once upon a time one of her ancestors had mistrusted his heir and made the entailment bulletproof. It would be twenty years before she had any control over funds. She owned it all and yet she didn’t own it.

  Her cousin hadn’t survived his inheritance for the twenty years needed to break the Trust. Her uncle and her grandfather...clearly by the time their twenty years had been up they hadn’t bothered. After all, why should they? All their needs were being met.

  Men like Victoir had no doubt been lining their own pockets, but to find out how, to explore the complexities of things she probably could do nothing about...

  ‘Leave it and come home,’ Martin had suggested. ‘A decent legal team can look after your interests from over here. If in twenty years you wish to do something more, you can think about options then.’

  It made sense. She knew little about this place except that she now—sort of—owned it. And it was poverty-stricken. And Leo was here and he was struggling.

  Victoir was opening the car door for her. ‘You should have asked the nurses to carry your gear. That’s what they’re here for.’

  Really? It was a small holdall. To ask one of the overworked medical staff to abandon their work to carry it...

  ‘I can’t believe they let you just walk out with it,’ he continued. ‘If they think they can treat a Castlavaran like—’

  ‘They treated me well.’

  ‘They asked you to work! When you’re ill yourself?’

  ‘I’m not ill and I asked to work.’