by Dianne Drake
This wasn’t easy for Dermott, none of it was. It seemed like life was slamming down on him from every direction and he was so good about dealing with it. Her solution was to simply run away when life got tough, and she truly wished she had some of his determination. “My orthopedic experience is pretty limited, but I’ll do the best I can.” It was nice to be trusted, and even nicer that Dermott was the one trusting her.
When they pulled into the driveway at the Charney house, every light inside the house was lit, and to someone passing by it might have appeared that they were having a party or family reunion inside that quaint little house. What Jenna found when she entered was anything but that, however. Joshua Charney was indeed large for his age. He could have passed for two or three years older than his six years. But he was every bit a six-yearold boy, and as Jenna bent over his bed to check his broken leg, what she discovered was that he was a critically ill six-year-old boy with serious compromise, and a home-made treatment that could do further damage. His leg was wrapped, elevated, had ice on the swelling. All the worst things to do if what she suspected turned out to be the case…things she immediately corrected. “I need Dermott in here,” she yelled to the people in the hall.
“That man’s not going near my son!” Alisa physically stepped into the doorway to prevent Dermott from entering. Her brother, the sheriff, took the same stance directly behind her.
“Is it compartmentalized?” Dermott asked from the hall. “Can you tell, Jenna?”
“I think it is. His blood pressure’s low, his pulse fast and thready.” She turned away from Joshua to face his mother. “How long as he been going in and out of consciousness?”
“He’s sleeping!” she defended. “A couple of hours now.”
“Dermott, he’s not sleeping,” Jenna said, bending over the boy to check the pupils in his eyes. She flashed a light directly in and looked for changes. Then moved the light back and forth to see if his eyes followed it. What she saw wasn’t good. The boy did have a sluggish response to the light, but he wasn’t rousing the way he should.
“Dermott,” she called, “he’s non-responsive, and my best guess is that he’s either suffered internal injuries his parents don’t know about, or it’s compartmental syndrome, like you suspected.” Which meant the swelling was literally cutting off circulation to the bone and, effectively, killing it. Either way this played out, this boy needed a doctor. “Your son needs Dr. Callahan,” she said to Mrs. Charney.
“If he needs a doctor, we’ll take him over to Muledeer, if that’s what we have to do. They have a nice clinic there, and—”
“The drive will hurt him even more.” Jenna hated being blunt but she was left with no recourse. Alisa Charney was a fierce woman when it came to her son’s care. In this case, though, fierce wasn’t good.
“I’ll take care of him, Alisa,” Dermott practically whispered.
“The way you took care of Nancy?” She shook her head frantically and clamped both her hands to the doorframe. “No!” she wailed. “I won’t let you!”
Jenna knew Alisa Charney wasn’t a bad mother. Just a very frightened one. Nothing in their house gave her any reason to believe that the Charneys weren’t anything but good parents. Except they were stubborn and misguided which, in the end, would hurt their son. So she had to get through to them. “He needs a doctor now, and he’s in no shape for a two-hour drive to Muledeer.” Jenna turned her next plea to Joshua’s father, a big, burly man with much kinder eyes than his wife’s. “No matter how careful you are driving him to Muledeer, Mr. Charney, you’re going to put your son at risk. Right now he’s in critical condition and he needs Dermott to take care of him. It’s about Joshua, not about your wife’s feelings about Dermott.” She lowered her voice. “And your wife’s feelings, Mr. Charney, could kill your son.”
That had the impact she needed because Ron Charney looked like he’d been slapped. “Do what you need to, Dermott. I don’t have a fight with you, and I’m trusting you to help my boy.”
“No!” Alisa wailed. She spun around to her husband. “How could you?”
In that moment Dermott brushed past her and went straight to the bed where Joshua was now experiencing compromised breathing. He was struggling for air, no doubt effecting the blood-gas balances. “I’ve got emergency oxygen in the truck, behind the seat,” he told Jenna. “And have the sheriff call Edmonton for air transport. We need to get Joshua into a major trauma center as soon as possible.”
Meanwhile, Alisa crumpled into Ron’s arms and was weeping, and Ron was saying something to her in quiet tones as he stroked her hair. Jenna’s heart went out to them as she ran past, so she stopped for a moment. “I know it’s not an easy thing for you to do, letting Dermott take care of your son, but he’s a good doctor, Alisa. Deep down I think you know that or else you’d have already taken Joshua to Muledeer. I’m sorry for your loss with Nancy, but please understand that Dermott and I will do whatever’s necessary here, and if I had a son there’s no doctor in the world I’d trust him to as much as I would Dermott.”
“Then you don’t know him,” Alisa snapped.
“Actually, I do. For a very long time now.” That’s where she left it, as Alisa pulled away from her husband and ran into the bedroom to stand over Dermott’s shoulder. Within another few minutes Jenna had oxygen on the boy, and Dermott was in the process of inserting an IV. Thank goodness, Alisa had stepped back to allow them to do their job.
He was taking another blood-pressure reading, trying to fight back the anger. What were these people thinking? That he’d hurt Joshua, or do something medically wrong on purpose? “How long has he been this way?” he called out to nobody in particular. “Tell me how he was injured.”
“About four hours total now,” Ron said. The man stepped into the doorway, filling up most of it, and had to grab hold for support when he saw the hard way his son’s chest was lurching now. “He got his leg caught in the tractor wheel. Don’t know how. Didn’t even know he was playing out there until I heard the screaming.”
“When did he start having problems?” Dermott asked.
“Not for a little while. He was crying, but I didn’t see any blood. I thought it might be broken, but I figured that could keep until we could get over to the clinic in Muledeer tomorrow…” He broke off, sucked in a sharp breath. “You know how it is, Doc. I would have called about this, but Alisa still has some mighty strong feelings.”
Dermott didn’t acknowledge that verbally, but he nodded, extending a half-smile to the man. Compartmental syndrome, without a doubt. Of all the bad luck for the boy! It made Dermott want to go home and hold Max for the rest of the night. “Lee,” he called to the sheriff. “When you arrange for the air transport, tell them to expect a compartment fracture.” And possible amputation if they didn’t do something fast.
“But no internal injuries?” Jenna asked Dermott.
“I don’t think so. I think it’s just his leg.” He lowered his voice. “We may need to do a fasciotomy, right here, though. Could you start to prep the area? I have gauze, but not enough antiseptic.”
“That bad?” she whispered.
He nodded. “We’re out of time. They waited so long…” He turned to Ron as Jenna took some gauze pads from his medical bag and went running to the bathroom to look for some kind of antiseptic agent—alcohol, peroxide, anything to sterilize the area. “So after you found Joshua with his leg caught in the tire, what happened next?”
“Brought him into the house, did some first-aid things. You know, the regular kind…elevated his leg, put ice on it, wrapped it up.”
Dear God! Wrapping the leg kept the swelling compressed, which was the first worst thing that could happen because it put undue pressure on the nerves and blood vessels. The second worst thing was elevating it when what his leg really needed was to stay level with the heart so the heart wouldn’t strain so much in pumping blood to it. To a leg that was literally starving for that blood circulation, depriving it in any way could resu
lt in amputation. Dermott did an immediate probe of the injured area and winced. There was a tight feel to the muscle compartment there. Too tight. “When did you remove the wrap and quit elevating his leg?”
“Your nurse did, the minute she came into the room. She took one look and pulled it off. Was that a bad thing? Did she hurt my boy doing that?”
“No. She probably saved his leg.” That impressed him. Jenna had good instincts. He’d always admired that in her but, to be honest, back in the day he’d been admiring, it hadn’t been focused so much on her medical skills. He glanced up at her as she came running into the room with a bottle of rubbing alcohol, amazed even more that in the middle of so much turmoil this one bright spot had come into his life.
“Like I figured, the muscle compartment’s constricted,” he whispered to her. “And since Joshua’s not conscious I can’t evaluate his sensation. Which puts us in a bad position here.” The fasciotomy he was about to do would remove the fascia, a thin connective tissue covering, or separating, the muscles and internal organs of the body. The procedure was a relatively simple one, although not done outside the operating theater too often. “If we wait much longer he loses a leg. Yet if we risk an emergency procedure here you know what that could turn into if something goes bad, and we don’t have the proper equipment.”
Jenna sucked in a sharp breath and held it a moment before letting it out. “I’m ready.”
“You’re not going to argue me out of it?” he asked, halfteasing.
“I think you’ll get enough of that from everybody else.” She nodded toward the door where the Charneys, as well as the police chief, were all glaring at them. “Look, Dermott. How about I go deal with the people while you get him ready?”
“I really should have paid more attention to your medical skills back when we were…well, whatever the hell it was we were.”
She laughed. “Well, as it turned out, I paid attention to your medical skills back then, but I was paying attention to something else even more.” She reached over and gave his hand an affectionate squeeze, then went to face off with the people who would in no way want Dermott taking a knife to Joshua.
Funny how some things worked out, he thought. Maybe more like, amazing. Or meant to be?
“There’s no other choice,” Jenna said, after her third attempt to explain the procedure to Joshua’s parents. She had to get their permission, or Dermott couldn’t start.
“There’s one,” Alisa snapped. “And that’s to wait for the air transport. Because I’m not letting that man cut my son. I let him take a look and now he wants to operate?” She gave her husband a pleading look. “We can’t do that, Ron. We can’t let him.”
“Why do you hate him so much?” Jenna asked. “He’s in there, trying to save your boy’s leg, and maybe his life, yet you hate him so much you’re not being rational about this.”
“Oh, I’m being rational,” the other woman argued. “Protecting my son from a man like that is being very rational.”
“He can’t wait. If Dermott says—”
“If Dermott says…” Alisa mocked. “I’ve heard what Dermott says, and it killed my best friend. How can you ask me to trust someone like that?”
Jenna’s heart went out to her, and given any other circumstance she would have backed off, but right now she couldn’t do that. Dermott was ready to start, and Joshua wasn’t getting any better. Sure, it was a judgment call, but most emergency procedures were. So it all came down to trust, and she trusted Dermott. Implicitly. She reached out and took hold of Alisa’s trembling hand. “I understand your conflicts with Dermott. You loved Nancy, and she died, and you blame Dermott for that.
“Blame him? I accuse him!”
Jenna lowered her voice. “Because his wife got herself addicted to drugs?”
“Because he didn’t know. If anyone should have seen what was happening…”
Jenna understood that. Alisa was hurt. Angry. She blamed herself because a best friend should have noticed, and she took it out on Dermott because a husband should have noticed too. It was all so sad and there was always so much blame to go around when none was deserved. Hadn’t she blamed herself when she’d been abused? And hidden her own truths so very well, concealing the bruises her father had left after he’d hit her? Hadn’t she done a fine job of applying make-up to the tell-tale evidence and wearing long sleeves even in the sweltering heat, then explaining away the odd attire quite convincingly?
Yes, she understood, and she did feel sorry for Alisa. But people who didn’t want to be found out went to extraordinary lengths to hide the truth. Jenna had. So had Nancy Callahan.
“Dermott should have known!” Alisa snarled. “He should have…” There were no more words for Alisa. Her anger was white hot and so painful Jenna doubted it would be quelled for a long, long time.
Jenna sighed, fighting to stay calm. “Look, Alisa. Don’t let your feelings for Dermott get in the way of what he’s trying to do for Joshua. Your son needs this procedure right now if he’s going to have any chance at all of keeping his leg.”
“I don’t know,” Alisa sobbed. She looked up at her husband for help, then went limp and collapsed in his arms.
“Just do it,” Ron said, still not looking at Jenna. “Just do whatever the hell you have to do to help my boy.” He pulled Alisa even closer to his huge barrel chest, and she looked dwarfed against the large man. “It’s our son, for God’s sake, Alisa! I know you hate Dermott, but he’s the only one here who can do this.” Together, Alisa and Ron turned away from Jenna as she rushed back into the bedroom to take Dermott’s side. The hatred ran so deep it was virulent. And sad for everyone.
“Good to go,” she said, and without reply Dermott made his incision over the swollen area of Joshua’s leg, cut through the fatty tissue, the surgery commenced.
“None of it’s necrotic yet,” Dermott said, on a sigh of relief. Meaning the leg wasn’t yet dying for a lack of blood. “Although the compromise is pretty pronounced. But I think we might get lucky here and this boy will keep his leg.”
“How long before it would have gone necrotic?” she asked, as she retracted the edges of skin while Dermott continued his work.
“Hard to say. Maybe as long as an hour, or just a few more minutes. He was getting pretty close to the point where we couldn’t have corrected the compromise.”
“He wouldn’t have made it to the hospital, then.” And Joshua’s chances of keeping his leg would have been practically non-existent. Dermott was so good, and she wanted Alisa to acknowledge that, but to Dermott it was all about the work, about taking care of the patient, not the accolades that should have gone with it. Still, it hurt her that Dermott was so despised by that woman. It made her feel sad, too.
Once he’d cut all the way through the fatty layer, Dermott removed a tiny piece of the fascia, just enough to let the swelling expand to relieve the pressure, then he swabbed the area with sterile gauze, bandaged it, and they were done. He pulled off his surgical gloves, tossed them into a trash can at the side of Joshua’s bed, and simply took a blood-pressure reading like this was any other routine physical.
“Better,” he said, pulling the stethoscope from his ears.
“That was amazing, Dermott.”
He shrugged, trying to be modest, but his eyes fairly sparkled with the success as he continued to do the routine assessments—pulse, pupils, blood pressure again. And maybe that’s when she knew…In just that tiniest moment when the realization that Joshua Charney was going to be up and playing with the other little boys again, another realization hit her that maybe, just maybe, she was falling a little bit in love with Dermott. It wouldn’t work, of course, and she’d never admit it aloud, but a tiny speck of her heart felt it. Just a tiny speck, that’s all. At least, that’s what she was telling herself when she went out to tell the Charneys the good news.
“Then it’s over?” Alisa asked, rushing to her son’s side and dropping to her knees to hug him.
“It’s ov
er,” Dermott assured. “He’ll be fine until we can get him to the hospital and fix his leg. What I did was just temporary.”
“But enough that you don’t need to do anything else to him?” Alisa asked.
“Nothing else, except watch him until the helicopter gets here.”
“And your nurse can do that?”
“Yes,” he said. “She can.”
“Then I’ll be asking you to leave, Dermott. You’re not welcome in my house.”
Jenna was too stunned to speak. Stunned not only by Alisa’s cruelty toward a man who’d just saved her son’s life, but by Dermott’s reaction. He merely nodded, then packed his medical bag and walked out.
No one thanked him. No one acknowledged him. No one even looked at him. He simply took his medical bag, left the house, then he sat outside in front, in his truck, waiting, until the air transport arrived.
An hour later, after the police chief had gone his own way, Joshua had been packed into a helicopter and sent off to Edmonton, and his parents had taken to the road to drive there, nothing had changed. Not one single thing. Except on the trip back home there was no talk between the two of them. In fact, Dermott didn’t say a word. Neither did Jenna, although she wanted to.
CHAPTER SIX
IT HAD been three days since they’d sent Joshua to hospital. Reports on his progress were encouraging and, in all likelihood, he’d be home within the week. So far Dermott hadn’t spoken to Jenna about what had happened out at the Charney farm, and she hadn’t mentioned it to him. For that matter, the Charneys had been strangely quiet, with not one word of gratitude forthcoming, which bothered her. Did it bother Dermott, too? If it did, he didn’t let on. When people approached him, giving him that congratulatory slap on the back for saving Joshua Charney’s life, and when Mrs. Brighton baked a cake and brought it in because somebody needed to bake a cake for such an occasion, Dermott was all smiles and charm. But when the door shut to those people, she saw it on his face…the strain, the frustration. There wasn’t a thing she could do about it because Dermott shrugged it off…shrugged her off when she tried approaching him.