‘Get in there,’ she shouted, jabbing her finger in the direction of the kitchen. ‘If you so much as put a foot back in this room while we’re looking after your wife, I’ll have the police here so fast you won’t know what’s hit you. And, believe me, they’ll make sure you don’t get to cause any more trouble for anyone for a very, very long time. Now...move...’
* * *
Wow...
Ari had his stethoscope in his ears because, having seen the alarming amount of blood Vicky had already lost, it was a matter of urgency to check on the baby’s status, but there was no missing the absolute authority in that voice. This paramedic—Kelly—might be blonde, pretty and as “girly” as they came, but she was not about to get messed with and that was exactly the kind of medical back-up he had hoped would arrive. He moved the rounded bell side of his stethoscope to pick up the baby’s heartbeat, which was reassuringly rapid and steady...for now.
‘Have you been feeling the baby move today, Vicky?’
‘Yes.’
‘How long ago did the pain start?’
‘I dunno. Maybe an hour. Or maybe a bit longer. The fight started because Brendan didn’t like what I was making for lunch and he...he...’
Ari lowered his voice, even though the kitchen door had been slammed behind Brendan. He knew that Kelly was coming back to this side of the room and would be able to hear him.
‘Did he hit you, Vicky? Is that how the pain started?’
‘N-no...he just...shook me a bit, that’s all.’
Again, his gaze met that of the paramedic for a heartbeat. He could see that Kelly, as a frontline member of the emergency services, had seen it all before. He could also see a fierce determination to help a vulnerable mother-to-be. He recognised that determination easily because it was something Ari had lived with himself for almost as long as he could remember. A need to protect and care for those more vulnerable than himself. Especially babies. Including babies that hadn’t been born yet and had no idea how tough life could be.
Kelly had her fingers on Vicky’s wrist but Ari knew she wouldn’t be able to locate a radial pulse because that had been the first thing he’d tried to assess. The tiny frown that appeared between her eyes was confirmation that she’d taken on board the warning that they needed to move fast. An absent radial pulse was an indication that the blood pressure was far too low.
‘Vicky?’ Kelly’s tone was reassuring. ‘I’m going to put a mask on you so that we can give you some oxygen. And I’m going to put an IV line into your arm, love. You’ve lost a bit of blood and we need to give you some fluids to get your blood pressure back up again. Then we’re going to get you into hospital. Is that okay with you?’
Vicky nodded wearily, lying back as she closed her eyes, her response no more than a mumbled assent. Kelly must have noticed that Ari was watching her rather intently because she flicked him a sideways glance. One that acknowledged what they both suspected—that Vicky’s placenta could be separating from the uterine wall and the amount of blood she was losing could put her into haemorrhagic shock that could be life threatening—both for this young mother and her baby.
There was a question in Kelly’s eyes. ‘You okay with staying here?’ she asked quietly as she opened her backpack and took out an equipment roll. ‘Want me to call for police back-up? There’s an ambulance on its way but we could try and get Vicky next door in the meantime.’
Ari kept his voice just as low—no more than a murmur that Vicky probably couldn’t catch. ‘I’d prefer to get her stable before we move her. Her GCS is dropping already. I reckon we can handle this between us...’ He tilted his head towards the kitchen door. ‘In fact, I think you could handle it all by yourself.’
A brief curl of one side of Kelly’s mouth acknowledged the compliment but her nod was an agreement with his preference to stay put and get some fluid resuscitation started. Movement could make the loss of blood more rapid and Vicky’s condition could deteriorate rapidly, tipping her into a possibly irreversible state of shock. Kelly had the tourniquet and the foil packet containing an alcohol wipe in her hands, ready to start establishing an intravenous line.
Ari reached for a cannula, peeling back the plastic cover before holding it out for Kelly to take as soon as she cleaned the skin over the vein she’d chosen in Vicky’s forearm. In that moment, they became even more of a team than they had when they’d agreed to stay here and try to stabilise their patient’s condition.
‘Vicky? Sharp scratch, love, but it’s only for a second.’ She slid the needle in, slid the cannula into place and released the catch on the tourniquet so swiftly and smoothly it looked like a single action.
Impressive.
‘There’s a bag of zero point nine percent saline in the kit. Top pocket.’
Ari pulled it out. Then he read out the expiry date for her.
‘Thanks...’ Kelly paused, a finger pressed onto the vein above the small, plastic tube in Vicky’s vein as she reached for the Luer plug he’d left beside her knee. ‘Sorry... I didn’t catch your name.’
‘We didn’t exactly get the chance for introductions.’ Ari was unwinding the giving set to poke the spike into the bag and then run enough fluid through the tubing to remove any air bubbles. ‘I’m Ari. Ari Lawson. I’m a midwife attached to Kensington Hospital.’ He held the end of the tubing out to Kelly who took it to attach to the Luer plug. With the IV line securely taped, she worked just as swiftly and smoothly to attach ECG electrodes to Vicky’s chest and flick the defibrillator into monitoring mode. Almost immediately, an alarm started sounding.
‘She’s tachycardic,’ Kelly noted. ‘And look...’ She pointed at the screen, where the bizarre shapes of ectopic beats were interrupting a trace that was rapid enough to have tripped the alarm. She silenced the alarm but it seemed like it had triggered a new wave of tension. Chaos, even?
The kitchen door was flung open behind them.
Ari could feel the surge of adrenaline that made every muscle in his body tense as he started to get to his feet. He could sense the same reaction from Kelly as she gathered her inner resources to face whatever new threat might be coming. After what he’d seen earlier, Ari had every confidence that she could deal with it but, this time, he was going to be the one in front. Protecting her.
Or maybe he didn’t need to. He could hear a commotion coming from the hallway of this small house. Loud shouting that told him that the police had apparently responded to the neighbour’s call—perhaps because they knew an ambulance officer had been dispatched and might be in need of back-up?
He could also tell that the arriving officers were both male because it felt like the wave of testosterone arrived in this room before they burst in, and although their equipment like telescopic batons, pepper spray and handcuffs were still attached to their belts or stab-proof vests, it felt like they were demanding attention and advertising their ability to enforce authority. Ari found himself turning his glance towards Kelly again. She’d had the authority to command respect without any kind of weapon, hadn’t she?
Except...
She looked different now that these male officers had arrived. Okay, her head was probably dipped because she leaning in to try and calm Vicky, who was trying to sit up and pull her oxygen mask off at the same time, but, for a split second, it almost seemed to Ari that Kelly was ducking her head for another reason. Trying not to be seen, even?
‘Brendan...’ Vicky was still trying to push past Kelly’s hands. ‘Don’t do anything stupid...’
Ari moved to help Kelly keep Vicky still. The last thing they wanted was an increase in the rate at which she was losing blood.
‘It’s really important that you keep still, sweetheart,’ he said. ‘We’ve got this, okay?’
Even if Brendan hadn’t been drunk enough to make it difficult to stand up straight, he would have been incapacitated within seconds by the two police officers
.
Ari wondered if one of them, in particular, was enjoying the opportunity to use physical force to restrain someone a little too much as he flourished his baton and raised his voice. He was a big man with buzz-cut blond hair that accentuated uncompromising features, including a very square jaw. Kelly was watching as well as the officer twisted Brendan’s arm behind him with enough force to make him cry out in pain.
Kelly’s expression made Ari suspect that she shared his opinion that too much force was being used here. It certainly looked like her desire to protect an underdog was automatically overriding any desire to remain in the background. She jumped to her feet, although her words were almost tentative.
‘H-he hasn’t hurt anybody,’ she told the police officers. ‘He’s drunk, that’s all. Noisy. He was just...making some verbal threats.’
She was being ignored as the officer issued a rapid, almost bored-sounding caution.
‘You do not have to say anything. But it may harm your defence if you do not mention when questioned something which you later rely on in court...’
What Kelly had said wasn’t exactly true, Ari thought as he reached for Vicky’s wrist to feel for her pulse again. Throwing a full beer can as a weapon was definitely assault. But ambulance staff often got to know local police officers pretty well when they were working in the same area of a city. Was she minimising what had happened here as a form of protection because she knew what this officer might be capable of in the heat of the moment?
Finishing the caution, the big, blond officer pushed Brendan towards his partner and then stepped closer to Kelly. Rather too close in Ari’s opinion. Any further and he would have been able to touch her ear with his lips but Ari could still hear what he said.
‘You called for us, Cowbell. So why don’t you just let us do our thing and look after you, okay?’
* * *
Oh, man...
How humiliating was this?
Kelly could actually feel the bright flash of colour that was heating her cheeks. She certainly couldn’t miss the way Ari’s jaw dropped as he heard that patronising tone and the dismissive nickname either. Or the expression in his eyes, even though his gaze only grazed hers for a heartbeat. He didn’t understand, did he? He’d seen her stand up to an aggressive, obnoxious drunk with no more than her voice and determination as weapons so why was she letting another bully take charge?
Kelly didn’t understand it herself. It was more than two years since her relationship with this man had ended. She should have been over it long ago. She had proved she was strong enough to keep herself completely safe from any other disastrous entanglement. Stupid nicknames should have lost any power long ago as well but, apparently, they could still sting.
Cowbell... Or maybe Kettlebell, because that’s all you are, sweetheart. A useless lump...
At least it was chaotic enough for anyone’s impressions or embarrassment to be so fleeting that they were unlikely to be remembered. Brendan was being dragged, shouting, from the room at the same moment that paramedics were coming in with a stretcher laden with more equipment. Vicky was crying and another alarm was sounding on the defibrillator. The focus needed on her patient was welcome. Kelly knew that treating a critically ill person was at the top of that list of things she was not useless at and she was going to use every one of those skills right now, for the sake of Vicky and her unborn baby.
Vicky’s heart rate was climbing. Her blood pressure, oxygen saturation and level of consciousness were dropping. They needed to increase the rate of fluid resuscitation with another IV line. They also needed to get this patient to hospital. Fast.
Only minutes later, Kelly was making sure that all her monitoring equipment for continuous measurements of blood pressure, oxygen saturation and heart rhythm were functioning. One of the back-up paramedics was going to drive her SUV back to the hospital so that she could stay in the ambulance with her patient.
Ari had gathered his own equipment while they’d got Vicky ready for transport. He appeared at the back of the ambulance just before the doors were slammed shut. The flashing lights had already been activated.
‘Where are you heading?’ he asked.
‘Kensington. It’s the nearest hospital set up for obstetric and neonatal emergencies.’
‘Great. I’m heading that way myself. I’ll be able to check up on Vicky later, then.’
Kelly could see him kicking his bike into life and starting to follow them before the ambulance reached the end of the street. She cleared her throat as she received acknowledgment from her radio handset that she’d been patched through to Kensington’s emergency department.
‘We’re coming to you with a thirty-seven-year-old woman—Vicky Tomkins,’ she told them. ‘Pregnant, almost thirty weeks gestation, sudden onset of acute abdominal pain and bleeding approximately ninety minutes ago. Suspected placental abruption. She’s on her second unit of saline but her blood pressure’s dropped to ninety over forty and her GCS has dropped from fifteen to twelve in the last ten minutes or so. Estimated blood loss of at least a litre. We’ll be with you in about six minutes...’
Another glance through the rear window showed Kelly that her rapid response SUV was right behind the ambulance. Just beyond the SUV was a large bike with a tall man in a dark leather jacket and a black helmet.
Ari Lawson—the astonishingly different midwife who had unexpectedly dropped into her life less than an hour ago—was riding shotgun.
For some inexplicable reason that she wasn’t going to allow any brain space to analyse, knowing he was close by was making Kelly feel safer. Protected, even.
And it was a good feeling.
CHAPTER TWO
THE FLASHING BLUE lights and the fluorescent red and yellow stripes on the back of the ambulance were easy enough to keep in sight. Weaving his way through the gaps available to a motorbike in the heavy London traffic was so automatic for Ari he was able to think about other things at the same time and, as he noticed the ambulance turning a corner ahead, he was thinking about what was going to happen to Vicky when she arrived at Kensington’s emergency department.
He had plenty of background knowledge to draw on. Ari had trained as a nurse before going into midwifery and he had particularly enjoyed his time in Emergency. His fascination with medicine in general continued to fuel his need for further postgraduate study and so far he’d clocked up qualifications in managing high-risk pregnancies and dealing with complications of childbirth and he was currently enrolled in a part-time course on the out-of-hospital care of premature newborns.
By the time he had the ambulance in his line of sight again, having turned the same corner, Ari had decided that Vicky would have as much time as needed in Emergency to support her circulation with aggressive fluid resuscitation and she might be given a blood transfusion as well. If a placental abruption was confirmed, the specialist obstetrician might want to take some fluid from her uterus to reduce the pressure but it was more likely that they would go ahead and deliver the baby by Caesarean section as quickly as possible and then deal with any complications that might follow.
Yvonne would want an update on her client and Ari should have just enough time to duck into the delivery ward on his way to the outpatient department of Kensington’s maternity ward where he was due to start an antenatal clinic at three p.m. It was going to be a busy one, with about six women at various stages of pregnancy who needed clinical assessment, any questions answered, reassurance given if needed and advice for the next stage of the journey they were on.
If there was anything abnormal found, he would need to arrange further care and he’d be fielding phone calls as well—from an obstetrician who’d decided to induce a client, perhaps, or from someone who needed to cancel or change an appointment or home visit. Like Yvonne, he could have a client who went into labour unexpectedly and that would throw his schedule into complete chaos, but the prospect didn�
�t bother Ari. He thrived under that kind of pressure and somehow making it work.
Something was bothering him, however, as he had to wait and watch the ambulance go through the red light of an intersection ahead of him. As the emergency vehicle got further ahead, Ari realised what it was that was niggling at the back of his head. Something about Kelly—the paramedic in that ambulance—had got completely under his skin.
He’d been blown away by her courage in subduing an angry, intoxicated man who outweighed her enough to have been dangerous. He’d already felt a beat of connection with her when Brendan had been so dismissive of any authority or skill either of them might have in their chosen professions. The recognition of the kind of determination to protect the vulnerable that, given the right circumstances, could make you much braver than you might think you were or that others might think you were was another connection that tapped into parts of Ari’s life that nobody he worked with knew about.
He’d also been seriously impressed with her calm confidence and obvious skill in her job to stabilise a patient whose condition was clearly deteriorating. But—and this was what was really bothering him—the way she’d visibly shrunk into herself when that macho idiot of a cop had turned up. He knew the type. A big ego, a bit of a bully. Capable of making sure the people around him behaved the way he wanted them to and to use whatever means necessary to do so.
But Ari had also learned long ago what even the faintest smell of fear was like. He’d seen, all too often, the effects that were the aftermath of trauma, whether it was physical or emotional, and he also knew, all too well, what it was like to feel vulnerable. And he’d been aware of all of that in Kelly’s body language when that cop had pushed himself into her personal space and put her down with such biting efficiency.
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