One hand fluttered to his abdomen. “Stomach. My chest.”
They rolled the gurney into the trauma room, and an instant later they’d moved Tommy, still strapped to the backboard with his head immobilized, to a hospital bed.
“Just hang on a little bit longer while we run some tests and take a few pictures,” Ethan told the youngster kindly. “Can you do that for me, sport?”
Tommy’s lower lip trembled. “I’ll…I’ll try.”
Ethan stroked a wayward lock of hair out of Tommy’s eyes. “Fair enough.”
Ivy had been afraid Ethan didn’t have a compassionate cell in his body, but his simple, kindly actions blasted away her lingering doubts. He might be gruff, but he cared about his patients.
What in the world was he doing in Danton? Even if he wanted an extended vacation, she would have guessed a more exotic, touristy place would have been his choice.
“If you don’t need me anymore, Doc,” Ben said to Ethan, “I gotta go back. They were using the Jaws of Life to extricate the driver of the van when we left, and because they aren’t back yet…”
“Marybeth?”
Ben looked surprised. “Do you know her?”
“Only what Nancy told us before you arrived. And if Nancy says we can manage on our own, then we’ll see you later.”
The nurse looked surprised, but pleased he’d consulted her. “We’ll be OK. See you later, Ben.”
“Thanks for your help,” Ethan seconded, before he addressed Nancy. “Start another IV, large bore needle with lactated Ringer’s.”
An instant later he patted the boy’s hand and began examining his abdomen and chest. Suddenly he cocked his head and frowned, as if he’d heard something he didn’t like.
Ivy listened, too, and recognized the distinctive wail of babies—the same noise she’d blocked out earlier.
“Still here, Dr. Harris?” Ethan mentioned idly.
Caught in the act! But it had been worth it, because she’d seen enough to rest easier in the abilities of her temporary partner. “I’m leaving now,” she promised, doing just that.
Yet as she examined the twins, ordered a few precautionary X-rays and lab tests, as well as a bottle of formula for each, she found herself impatient to return.
Funny thing how Ethan’s training and previous experience as a general pediatrician seemed to surface from out of nowhere as he examined his young patient. Apparently it was true that some things, like riding a bike, just weren’t forgotten, because from the moment Ethan saw the bruises on Tommy’s torso, the abdominal rigidity, cool clammy skin and shocky vital signs, he knew what to do. Grateful that he wasn’t in over his head as much as he’d feared, he relaxed a bit and mentally ran through the diagnostic protocol.
“I want cervical and lumbar spine X-rays, as well as chest and abdominal films,” he told Nancy, guessing that the two people lingering in the background were the lab and X-ray techs. “A CBC, basic chemistries, liver enzymes, renal function, amylase, type and cross-match for two units, coag studies, and a urinalysis. Stat. Any chance we can get a CT scan?”
Nancy shook her head. “Sorry. We’ve been trying to raise money for a scanner, but haven’t yet.”
The scan would have ruled out intra-abdominal or peritoneal bleeding, but if one wasn’t available then he’d have to depend on other tests to make his diagnosis. For the first time since he’d left St. Louis he realized how fortunate he’d been to have every resource available.
He stepped aside to allow the techs to work, remaining nearby to watch Tommy’s monitors, guess at his weight and double-check his mental calculations for the amount of fluid replacement.
By the time Ivy rematerialized he’d run a nasogastric tube and ruled out a stomach injury, gotten a baseline hemoglobin level from the lab, studied the films and decided the spine immobilization could be discontinued—although he’d feel better if a radiologist had given his seal of approval.
“Reinforcements have arrived,” she said cheerfully. “What can I do?”
“Find a surgeon in the next thirty minutes.”
“I wish. What’s the problem? Internal bleeding?”
Ethan pulled her aside. “I think his spleen’s ruptured. I don’t have a second hemoglobin level yet, but he has all the signs, especially abdominal pain and tenderness, pain in his left shoulder, and being shocky. The question is, do you want to observe him here and then Medevac him out when we know for certain, or move him close to an O.R. now, before he needs one?”
“Do you really have to ask?” Her tone was wry.
“I’d vote to move him out now, but this is my first day on the job,” he reminded her. “I’m still learning your protocol.”
“The only protocol I have is that I make a point never to gamble with my patients’ lives. I’d rather give them an unnecessary helicopter ride than hold them here until it’s too late.” She met his gaze. “Do you have a problem with that?”
“Not at all,” he admitted. “I’d hoped you’d agree with me.”
“Then I’ll make the arrangements.”
“As an FYI,” Ethan mentioned before Ivy got too far, “Ben said they were using the Jaws of Life to free this Marybeth person, so she might need to catch a chopper ride, too.”
“I’ll notify the air dispatch.”
After making the flight arrangements, Ivy ran into Jed outside the trauma room. The same age as Walt, Jed was looking as haggard as Ivy felt.
“Busy day for you, too?” she commiserated.
He smiled. “I haven’t worked this hard in years. How Walt did it all by himself is a mystery. Not to mention downright miraculous.”
Ivy chuckled. “I have to agree.”
The ambulance bay doors whooshed open and the E.M.T. crew wheeled in another victim. At the same time the main doors at the other end of the department flew open, and a crowd of frantic adults rushed through.
“Have fun with that group,” Jed murmured, before he sprinted toward the incoming gurney and disappeared inside the trauma room where Ethan and Tommy already were.
Immediately Ivy was surrounded by parents asking after their children. After trying unsuccessfully to get a word in edgewise, she gave an unladylike whistle.
Complete and utter silence followed.
“Who belongs with Suzy and/or Emma?”
A young couple and a single woman raised their hands.
“Tommy?”
“He’s our son,” another couple said.
Ivy smiled. “Dr. Ethan is with him right now, but I’ll let him know you’re here. The rest of you—” she glanced at the other parents “—come with me.”
She led her group to a nearby treatment room, where she paused in the hall. “Both Suzy and Emma are fine,” she told them. “They have some bruises and bumps, and will be sore for a couple of days, but nothing that a few hot baths and plenty of rest won’t cure.”
“Are you sure?” The woman who’d identified herself as Emma’s mother asked.
“Absolutely. But if they complain about anything new in the next couple of days, be sure you bring them in. In the meantime they can have acetaminophen to ease their aches and pains.”
“Thanks, Dr. Ivy.” Suzy’s father pumped her hand. “We appreciate this.”
“Can we take our girls home now?” Emma’s mother asked.
“Absolutely.” Ivy opened the door and the two girls inside jumped up and ran to their parents. Amid hugs and tears and sniffles, the two chattered like a pair of blue jays as they described the accident.
Happy to send those two on their way, Ivy peeked into the room where the twins slept in the baby beds that someone had robbed from the medical ward, clearly worn out from their experience.
Determined to let Ethan handle the other set of waiting parents, she found him next to Tommy’s bed. “How’s he doing?” she asked, ignoring Jed and the nurses surrounding his patient for the moment.
“Stable, for the moment. His second hemoglobin level has dropped, though.”
“Good.”
“His parents are waiting outside. I thought you should talk to them as you know his condition better than I do.”
He hesitated, as if hating to leave Tommy’s side.
“I’ll stay,” Nancy offered. “His vital signs haven’t changed in the last fifteen minutes. I’ll let you know if they do.”
Ivy accompanied Ethan to the nurses’ station, where the Weathers were still waiting. From the worry on their faces, they obviously expected to hear the worst.
“How is Tommy?” his father asked. “Can we see him?”
“In just a minute,” Ethan said, before he introduced himself. “Tommy’s suffered abdominal trauma and I believe he has a ruptured spleen.”
At Mrs. Weathers’s gasp, he continued, “He’s stable for the moment, but he’s going to need surgery and soon.”
“How soon?”
“Within hours, I’d say,” Ethan admitted. “Dr. Harris has called for an air ambulance. It should be here any minute now to fly him to Wichita, where a surgeon is already waiting for him.”
“Is that the only thing wrong?” Mrs. Weathers’s voice and mouth trembled. “His spleen?”
“As far as I can tell. His X-rays didn’t show any problems with his spine, although we’ll have a radiologist read them to be absolutely certain. He can also wiggle his fingers and toes, so I think it’s safe to say he’ll be running around before long. As for other conditions—his liver and kidney function tests all look good, but the surgeon will know more after he takes a look inside. Afterward they’ll continue to monitor him closely. Sometimes problems crop up a day or two after the accident. For now, the immediate problem is to stop the internal bleeding.”
“Won’t it stop on its own?” Mr. Weathers asked.
“The spleen is a highly vascular organ, which means it’s full of blood vessels. Its function is to filter all the blood as it enters the circulation. The only way to stop Tommy’s bleeding is to remove the organ.”
His parents’ faces blanched. “If his spleen is a filter, won’t he need it?”
“As important as it is,” Ethan explained, “one can live without it.”
“Can we see him, Doctor?”
“For a few minutes—until the air crew gets here. Don’t worry, they’ll send a nurse and an E.M.T., so Tommy will have excellent care while he’s flying. Mind you, though, when you see him he’ll be groggy, and may not make much sense,” he warned. “And don’t be alarmed by the tubes and monitors.” He smiled. “Your son has been a real trooper. He’s a tough little character.”
Throughout Ethan’s conversation Ivy had hung in the background. She gave him high marks for his bedside manner. Once again she wondered why a physician of his apparent caliber had been so reluctant to answer her first call for help. She was equally curious as to why he’d changed his mind. But, whatever his reasons, she was glad that he had. Considering how Tommy was the only one who’d been critically injured, she probably could have managed on her own while Walt’s nurse practitioner dealt with the twins and the two older girls. However, it was nice having another physician available. As Jed had said, it was nothing short of miraculous how Walt had managed singlehandedly.
Idly, she wondered if she could talk Ethan into sticking around to help them as long as he remained in the area. It certainly wouldn’t hurt to ask, or at least to plant that seed of an idea and see what germinated. After all, what did she have to lose?
CHAPTER THREE
ALTHOUGH Tommy’s case was textbook, and Ethan didn’t harbor any doubts about his treatment decisions, he didn’t breathe easier until the flight crew arrived and hauled the seven-year-old away with conscientious precision. So much could have gone wrong, and without a local surgeon to intervene, the consequences could have been dire.
To his relief, everything had run smoothly, and by the time his part in tonight’s drama had ended, pride and a sense of accomplishment that he hadn’t experienced in a long time stirred inside of him. A shrink would probably psychoanalyze his response and suggest some nonsense about how it signaled he was ready to return to medicine full-time, but Ethan didn’t believe in signs or hidden meanings. Wearing a stethoscope again was due to a fluke, not a conscious decision to return to the profession he’d walked away from without a backward glance. No, he was here in Danton’s hospital because he was simply trying to prevent another load of guilt from settling on his overburdened shoulders.
Surprisingly enough, though, for a few hours his first foray back into medicine had held his personal demons at bay, but he knew better than to believe they would be gone forever. After his son had died, he’d carried on as usual, believing that long hours and hard work were the best way to cope with his grief and feelings of inadequacy.
He’d been wrong. His relief had come when he’d walked out of the neonatal ICU for the last time.
Demons or not, though, he had to admit the Danton hospital staff’s efficiency in assembling all of Tommy’s X-rays, lab reports, and the temperature-controlled box containing extra units of cross-matched blood were impressive. Shipping critically ill patients might be a routine situation for them, but, routine or not, the staff had been as organized as any he’d seen in a major hospital.
They’d done the same less than hour later, when another helicopter had arrived to take Marybeth Ellerbe.
He planned to comment to Ivy about the group’s performance, but when she appeared with one of the twins tucked against her shoulder, his good intentions fled as he concentrated on ignoring the baby.
“How did it go?” he asked, referring to her conversation with Marybeth Ellerbe’s husband, Allen.
“He’s numb,” she admitted. “I’m not certain anything we said soaked in. After Jed and I told him we’d sent her on because of a dislocated hip, broken femur and perforated lung, he got this dazed look in his eyes.”
“He surely knows he needs to pull himself together for his daughters’ sake?”
“Barely,” she said on a sigh. “For a minute there I wondered if he even remembered he had twins, but he finally phoned his mother. She’s on her way to get them as we speak.”
He glanced around. “So where is he?”
She rubbed the baby’s back. “He’s on his way to Wichita. I only hope he doesn’t do something stupid, like try to break speed records.” She paused. “Still charting?”
“Just finishing.” He scrawled his name, then tucked the pen in the pencil cup with the others. “What about you?”
“Mine’s done, too. Or it will be as soon as I discharge the twins into their grandmother’s care.” She swayed a little to rock the baby. “Thanks again for helping out. Things went rather well, if I say so myself. We stabilized both of our critical patients and no one died. I still can’t believe the guy in the truck walked away without a scratch.”
“It happens more often than not.” He leaned back in his chair and stretched to ease the ache between his shoulder blades. “I wish we would have had a surgeon on staff, though.”
“Someday we will. Walt’s been working on bringing in more doctors for years. He’s got a lead on a young internist who’s interested in getting away from the city to raise his family, and he’s actively looking for an OB-GYN to either move here or at least establish prenatal clinics. If all goes well, before long we’ll be able to deliver more than basic medical care.”
“Optimistic, are you?”
She laughed. “I am, so I’ll take that as a compliment.” She turned slightly away from him. “Is she asleep?” she whispered.
He had no choice but to look, to notice the downy-soft skin, the rosebud mouth, and the little fingers that were just large enough to wrap trustingly around a finger. This little one seemed like a giant when he compared her to the two-pound neonates he’d once held in the palm of one hand, but it wasn’t the size that got to him. It was the helplessness a
nd the inherent trust they placed in the ones who cared for them.
And he’d failed.
“Yes,” he said shortly.
“Good. Her sister is already asleep, but Tory has been fighting it. Isn’t she the sweetest thing?” Ivy cooed.
“Yeah, sure.” Desperate to escape before she suggested he do something inconceivable, like hold the baby, he rose. “If you don’t mind, I’m going to call it a day.”
“Good idea. I’ll see you tomorrow morning at eight?”
She’d stated it as a question, as if she were afraid he’d suffered a change of heart. “Afraid I won’t show up?” he asked.
Her face matched the pink blanket covering the baby. “The thought crossed my mind.” She sounded defensive.
He couldn’t fault her for worrying. Ivy didn’t know him well enough to have any faith in him, and it was probably a good thing she didn’t. Otherwise she’d know she shouldn’t trust a man who’d given up medicine some six months and six hundred miles ago.
“I’ll be there,” he said gruffly.
To Ivy’s surprise, she saw Ethan much sooner than she’d expected.
After placing the twins into the care of their grandmother, Barbara Ellerbe, Ivy drove to her dad’s diner. The Tuesday Night Roast Beef Special might be gone, but she was hungry enough to eat some of his trademark five-alarm chili.
She pulled into the restaurant’s gravel parking lot, hardly noticing that the neon sign proclaiming “Don’s Diner” was missing the R. Instead, she noticed a late-model saloon surrounded by the well-used pickup trucks and economy cars.
There was only one person in town who might own such a pricey vehicle, and seeing Ethan Locke seated alone at a booth in the far right corner confirmed her suspicions.
Her father apparently had counter duty, because he was pouring coffee for the customers at one end, so Ivy wound her way past the occupied tables toward a free barstool at the opposite end. It took her longer than her aching feet wanted, because everyone she walked by greeted her and struck up a conversation, but she finally reached her destination and sank onto the vinyl-cushioned seat with a heartfelt sigh.
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