New Surgeon at Ashvale A&E

by Joanna Neil

  ‘You’re an eternal optimist,’ Ruby said. ‘You always were inclined that way.’

  ‘Better that than the opposite,’ Craig murmured. ‘I like to think that Sophie will come back into our lives at any moment. Anything else is too worrying to contemplate.’

  ‘Yes, you’re right, though she did send me a brief text message, so I know that nothing terrible has happened to her. I just wish I knew where she was, so that I could go and bring her home.’

  ‘At least you know she must be reasonably safe,’ Craig commented. ‘Did she give any clue as to what was wrong?’

  Ruby shook her head. ‘All she said was that she’s sorry she had to leave and that she’s missing Becky. I had the impression she felt she wasn’t able to look after her properly because she was unwell. It’s all so unsettling. It could be that she’s going through a bad case of postnatal depression, but I tend to think there’s more to it than that. I sent a message in return, begging her to come home, but there’s been nothing since.’

  She finished feeding the animals and then walked back with him towards the house. Becky was spending the day with her parents, which left her free for a while, and gave her a chance to catch her breath. These last few weeks it had felt as if her world was spinning out of control and she had been powerless to stop it.

  ‘I’d better go on with my house calls,’ Craig said, pausing to give her a goodbye hug. ‘Keep your chin up. You’re not on your own in this. Remember, I’m just a phone call away…and if you hear anything more of Sophie, let me know, won’t you?’

  ‘I will. Thanks, Craig.’ She saw him out and then went back to the kitchen, where she looked around and contemplated the stack of chores that still needed to be done. She switched on the radio before setting about loading the washing machine, and the sound of a haunting melody filled the room. Somehow, it made her think of Sam, and perhaps that was because there was a brooding quality to the music, a restrained theme that reminded her of the way he held his thoughts close to his chest. It must have taken a lot for him to seek her out and ask her to come back. He wasn’t the sort of man who would be comfortable showing any sign of vulnerability.

  Some half an hour later, she was putting the finishing touches to her weekly magazine feature when snatches of the local news bulletin filtered through to her from the radio. ‘Ambulances are being called out to a major accident on the motorway. It is feared that there are many casualties as a result of the incident, which occurred when a lorry collided with a camper van and crossed the central reservation. It is believed that several people are still trapped in their vehicles. Local hospitals have been put on standby.’

  Ruby stopped what she was doing and felt a cold shiver run through her. This was bad. An accident of that kind meant that all the emergency units would be under pressure, and lives were at risk. How could she sit here and do nothing? It was unthinkable.

  A few minutes later, after a brief phone conversation with the triage nurse on duty, she was on her way to the hospital.

  ‘Ruby, thank heavens you’re here,’ Olivia greeted her. ‘You don’t know how much we’ve missed you. It’s so good to have you back—though I wish it could have been under different circumstances.’ The senior house officer was dressed in green scrubs, ready to receive the first of the casualties as they came in by ambulance.

  Ruby nodded. ‘Me too. I wish it didn’t have to be this way, but I suppose things will never change. We’ll always be needed here. I’ll go and get ready.’

  She changed in the locker room, emerging just as Sam was passing by on his way towards the ambulance bay.

  ‘Hi there,’ he said with a smile, lightly touching her arm and sending a surge of instant heat racing through her veins. ‘It’s great to have you here. Is Becky in the creche?’

  ‘No. She’s with my parents for the day. When I heard the news of the accident, it was a question of whether to finish off my magazine article, gather in the last of the crop of raspberries…or come here. Not much of a choice, really.’

  He smiled. ‘It was a good decision. We’re expecting at least a dozen injured people to arrive, including a young child—a five-year-old who was in the back seat of his parents’ car. Would you take care of the boy? As far as we know, he suffered a chest trauma. He’s still conscious, but he’s complaining of chest pain, and he’s having difficulty breathing and talking. There’s a swelling in his throat, according to the paramedic who phoned in a report. His mother has shoulder and leg fractures, while the father has multiple injuries. James and I will supervise their treatment in the same resus room as the boy. There’s also a little girl, two years old…but she came out of it unscathed, apparently.’

  ‘That was something of a miracle, given what I’ve heard about the pile up,’ she murmured. ‘Of course I’ll take care of the boy.’

  ‘Good. Let’s go, then. They should be arriving at any minute now.’

  The boy was in a very bad way, she discovered, when the paramedics wheeled him into A&E a short time later. He was already turning blue from lack of oxygen, his breathing was noisy and laboured, and he was making moaning sounds.

  ‘I’m going to intubate him,’ Ruby told Michelle, who came to assist her. ‘As soon as I have the tube in place in his throat, and we have him back on oxygen, we’ll get a chest X-ray.’

  She worked swiftly, securing the child’s airway and examining him thoroughly to ensure that she missed nothing.

  ‘Jason—my son—how is he?’ his mother asked from the next bed. ‘He couldn’t breathe properly. He wasn’t talking. What’s happening to him?’ The woman was in a lot of pain, but her thoughts were centred on her child and her husband. Beside her, still in her baby car seat, her two-year-old daughter was screaming loudly as a doctor tried to examine her.

  ‘We’re looking after him,’ Ruby told her. ‘I’m going to put a tube in his arm so that we can replace any fluids that he’s losing. Be reassured that we’re doing everything we can for him.’

  She was desperately worried about this boy, who was failing fast, but nothing would be served by causing his mother more anxiety. She suspected that his condition was worsening because of internal bleeding, but the problem was in finding where the blood loss was coming from. As it was, his heart rate was sky high, his peripheral pulse was weak, and his breathing difficulties were increasing by the minute.

  Michelle wheeled the portable X-ray machine into place, and Ruby checked the images on screen. ‘There’s a contusion to his lung,’ she told the nurse, ‘and air has leaked out from both lungs into the chest cavity. I’ll put in drainage tubes to see if that will clear the problem.’

  As soon as that was done, she left the boy in Michelle’s care, under intense observation, and went to assist with the rest of the injured.

  Sam was still working with the boy’s father, and now he called for a trauma team to assist as the man went into cardiac arrest. His patient’s injuries were severe, but up to now Sam had managed to deal with the various fractures he’d presented with, and he had done what he could to stop the bleeding. Now, though, the man’s heart had given out under the strain.

  Sam remained calm and efficient the whole time, doing his utmost to save the man’s life, and using the defibrillator to shock his heart back into a normal rhythm. It didn’t work.

  ‘Asystole,’ James said, checking the monitor, and Ruby was dismayed to see the flat line across the screen that showed no output from the heart.

  The team was deflated. All their efforts were for nothing, and this man, who had a young wife and children, was unlikely to survive.

  ‘Continue with the chest compressions,’ Sam said tersely. ‘Ruby, intubate him and put him on the ventilator. Olivia, we’ll give him intravenous adrenaline. Check the monitor every two minutes. I need to figure out if he’s bleeding internally.’

  ‘An abdominal bleed?’ Ruby asked, and he nodded.

  ‘That’s the most likely cause of his problems.’

  They worked with him for the
next few minutes, and then, just as they were beginning to think all was lost, the monitor bleeped. ‘We have a rhythm,’ Olivia said. ‘He’s back.’

  There were smiles of relief all round, but Sam was on the move. ‘I’m going to do an ultrasound scan of the abdomen to see if I can find the source of the bleeding. With any luck I can use an endoscope to seal the leaking blood vessel.’

  Ruby would have liked to stay and help with that, but Michelle came hurrying towards her from across the room. ‘You need to take a look at little Jason. His vital signs are worsening.’ Her expression was concerned, and Ruby realised that the situation was urgent.

  ‘All right, let’s get a CT scan,’ Ruby said after examining the child once more. ‘It’s possible that he has a ruptured bronchus and that he’s bleeding into his airways. We need to find out for sure.’

  ‘That’s very rare, isn’t it—a rupture to the main branch of the airway?’ Michelle frowned.

  ‘Yes, it is, but it’s something we need to check, all the same.’

  Sam glanced at her. ‘Are you going to be okay dealing with that?’ he asked, and she nodded.

  ‘If I have any problems, I’ll call you,’ she said, though he looked as if he had enough on his hands right now.

  The CT scan confirmed her worst fears. ‘We need to get him up to theatre,’ she told Michelle. ‘I’ll do a thoracotomy—open up his chest and stop the bleeding that way, otherwise he has little or no chance of survival. You’ll need to scrub in…and find me an anaesthetist, will you?’

  A little more than an hour later, Ruby came out of the operating room, tossed her protective overgarments into the bin, cleaned up and went into the annexe. She was suddenly bone weary, the last of her adrenaline draining out of her, and she leaned back against the wall for a moment or two, sucking in air.

  ‘Are you okay?’ Sam said, walking into the room and coming to stand beside her. ‘I came to see how you were doing. You’re very pale.’

  ‘I’m fine,’ she told him. ‘I don’t usually react this way when we’re under pressure, but somehow the thought of that small family being torn apart is beginning to get to me.’

  ‘How is the boy?’ His brows drew together as he watched her mouth flatten.

  ‘He’s on life support, and we need to get him into Intensive Care. I’ve done everything I can for him. I repaired a massive tear in the bronchus, and I’m hoping the chest drainage tubes will gradually ease the pressure in the chest cavity and elsewhere. Air has even collected under his skin, so that you can hear the crackles when you touch him. That poor child…’

  ‘He was fortunate that he had you here to look after him.’ Sam’s voice was matter of fact, not allowing any shred of wasteful emotion. ‘I doubt anyone else would have thought to look for a ruptured bronchus in such quick time. That’s where skill and experience come into play.’

  She sent him a weary look. ‘That, and the fact that this A&E department is still in existence. Though that could end any time soon, couldn’t it?’ She sighed. ‘How’s his father bearing up? Did you find out the cause of his trouble?’

  He nodded. ‘There was a laceration in his liver. I managed to repair it. He should pull through all right, with any luck.’

  She smiled at that. ‘I don’t think luck comes into it. You’re a good surgeon, one of the best, from what I’ve seen and heard.’ She straightened up. ‘I really hope this family come out of this disaster safe and sound. I want to think of them having a future together, a wonderful family unit, sharing good times, supporting one another through all of life’s ups and downs. That’s what families are all about, isn’t it?’

  Her eyes misted a little as she thought back to her own past. ‘I remember when I was Jason’s age, we all went to spend a long weekend at the seaside. Sophie was two years old, like Jason’s little sister, and she spent the days telling everyone who would listen that she was going to make a huge sandcastle on the beach and when it was finished she would decorate it to make it fit for a princess. Little as she was, she made everyone hunt along the water’s edge for shells, and they had to be just right, the perfect shape and colour, or she would reject them.’

  She might have expected him to smile at that, but his gaze was solemn, smoke grey, with a brooding quality that made her wonder what kind of experiences he’d had in life. He made no comment.

  ‘She told me that she wanted to take Becky to that same place when she was a little older, and she was going to show her where she built the castle. She wanted her to have the same glorious memories that she did.’

  ‘And yet she walked out on her daughter and left you to pick up the pieces. That doesn’t say a great deal for the family spirit, does it?’ He gave her that same no-nonsense look that he had given her before.

  She sent him a long, thoughtful glance. He had such a practical, straightforward way of looking at things, and he was so dismissive of sentiment, of emotional ties. How could she begin to understand a man like him?

  ‘It says that people have their ups and downs, and you need to stick together in order to get over them. I know that my sister loves her daughter, and that it must have taken something disastrous to make her stay away. It grieves me that I can’t find her or do anything to help her.’ She hesitated. ‘You have a younger brother, don’t you? Didn’t you have good times together…or weren’t there occasions when you helped each other out?’

  ‘We enjoyed long breaks by the sea,’ he said, ‘sometimes with our parents, and other times with our grandparents.’

  His expression sobered, a bleak quality coming into his eyes. ‘As to helping each other out, it’s probably best not to think too deeply about that. We had to rely on each other a good deal because we were at boarding school together for the major part of the year.’

  He leaned back against the wall, his long legs crossed over at the ankles, his hands thrust into the pockets of his scrubs. ‘My brother had a hard time settling, and since I had been there for a couple of years before him, I did what I could to make him feel that he wasn’t alone. Up until then he’d been with our grandparents.’

  He looked at her, sensing her frown. ‘It wasn’t that our parents wanted to leave us…it was more that they had the pressure of international business interests swamping them. Alongside that, they were trying to bring medical facilities to countries that wouldn’t otherwise have the benefit. Who am I to argue with that kind of altruism?’

  ‘But they did it at the expense of their children’s happiness, didn’t they?’

  ‘I don’t see it that way, and nor did they. They wanted us to have a good education, the best, and they succeeded in that. We both went on to carve out satisfying careers for ourselves. My brother has done well. He set up his own financial consultancy in Scotland. His wife works with him, and his boys enjoy living in a beautiful house surrounded by moorland and lochs.’

  ‘It sounds idyllic.’ She slanted him a questioning glance. ‘Didn’t you ever feel that you wanted to have that kind of life for yourself?’

  ‘With a wife and family, you mean?’ He shook his head. ‘It isn’t something I’ve ever really thought about—or wanted, for that matter. I don’t have time for that sort of commitment, or any long-term, all-or-nothing kind of relationship with strings attached. I know it’s not easy for any woman to settle for what I would be prepared to offer, but that’s how it is. I have too much still to do getting to where I want to be.’

  He looked around. ‘This is just the start—I want to be there in the setting up of state-of-the-art units. It means everything to me to see to it that people have the best care we can give them…and that includes keeping this place going. It doesn’t have to be new, just working at full capacity, bringing the best we have in people and resources to serve the local area.’

  She gave a wry smile. ‘And there’s no room in all that for meaningful relationships?’ It seemed strange to her that he could rule out the prospect of finding and appreciating enduring love. ‘Don’t you feel you’re missing
out in some way?’

  His dark brows shot up. ‘I’m not missing out. What makes you think that?’ He straightened up, moving to face her, closing in and winding an arm around her waist. ‘I’m here with you,’ he said softly, ‘and that has to be good, doesn’t it? You’re beautiful, lovely to hold…and alongside all that you have a glorious, laid-back attitude to life, and you’re not afraid to speak your mind.’ His mouth curved, his long body shielding hers, blocking her escape by the simple means of an outstretched arm, palm flat against the wall at the side of her neck. ‘How much better could it be?’

  ‘Um…I should tell you,’ she said, gazing up at him and feeling the lure of those eyes that were blue-grey like the depths of the ocean, ‘that from the sound of it, I’m really not your type. I’m an all-or-nothing kind of girl. I wouldn’t like you to get the wrong idea.’

  ‘I won’t,’ he murmured, his head lowering, his lips moving ever closer to hers. ‘I’m just glad that you came here today.’

  By now his lips had settled on hers, nudging them softly so that they parted in a gentle sigh of delicious response, and the heart-melting kiss that followed took her breath away. He captivated her with his sensuous demand, drawing from her every drop of sweet, feverish yearning that was pent up inside her.

  How was it that he could make her feel this way? The question came to her through the mists of warm, heady sensation. They had nothing in common except for a deep, abiding sense of commitment to their patients. Even in that she had fallen by the wayside, but it was as if none of that mattered now. All she cared about was that he was kissing her, and her entire body was on fire, the blood pulsing through her veins in ecstatic, hectic response.