A Doctor's Trust (Lifeline Air Rescue Book 4)

by Scott, Laura

  “Are you all right?” Zane’s gaze searched hers. “You look like you don’t feel very well.”

  Zane’s concern only made her feel worse. For a brief moment, she wished she could lean against him and soak up some his strength. But she was too used to being alone to give in to the need to confide in someone.

  “I’m fine. Just tired.” With an effort, she glanced at Nate, their pilot for the day. “So how are the weather conditions?”

  “Good. There’s a chance of rain this afternoon, but nothing major. No thunderstorms or anything.”

  The Lifeline phone rang, and since she was closest, she picked it up. “Lifeline Air Rescue.”

  “Lifeline, this is dispatch. We just received a call from Somerset Hospital. They’re requesting an ICU transfer to Trinity Medical Center. We’re just waiting to hear from Trinity whether or not a physician there has accepted the patient.”

  “Can you give me the patient’s name and diagnosis?” Jenna took the phone in the hollow between her shoulder and ear, then picked up a pen to jot down the specifics. After getting the name and the diagnosis, she pushed the paper aside. “Okay, let us know as soon as you hear from Trinity.”

  “We have a flight?” Zane asked.

  “Told you.” Ethan sighed. “Good luck. You’re going to have a long day.”

  Jenna ignored him. “Yes, Margaret Ponches, a 24-year-old woman, apparently delivered a baby in the middle of the night. During the birth, she suffered an amniotic fluid embolus.” She glanced at Zane curiously. “Is that what it sounds like? Some of the amniotic fluid actually got into the mother’s bloodstream during birth?”

  Zane nodded. “Exactly. It’s a pretty rare phenomenon, but it carries a high mortality rate.” He stood. “Nate, we better get the chopper ready to roll.”

  “It’s already out of the hangar,” Nate drawled. “Figured we’d be busy today.”

  It did seem as if the trend from the previous night would continue. Jenna knew she should be glad of anything that would help keep her from dwelling about Rae. But a woman suffering from complications of giving birth didn’t exactly help keep the fear of Rae being pregnant out of her mind.

  “Did something happen with your sister?” Zane drilled her with a look as they walked through the lounge into the hangar. “You don’t look tired, you look upset. The same way you looked when Damien was sick.”

  “Oh, speaking of Damien, he’s doing great.” Jenna was determined to change the subject. “He was discharged home yesterday and should be fine as long as he continues taking his beta-blockers.”

  Their pagers went off simultaneously. The text message informed them Trinity had accepted the transfer. More information followed, specifically mentioning the patient was on a ventilator and vasopressor support.

  “Let’s go.” Jenna grabbed the flight bag and climbed into the chopper.

  Once they were settled, Zane leaned toward her. “If something is bothering you, Jenna, tell me. Maybe if you tell someone, you can clear your mind to concentrate on work.”

  “There’s nothing to talk about.” Jenna couldn’t bear to think about Rae being pregnant, much less tell Zane what she found. Besides, she could already imagine how he would respond. Rae is an adult, responsible for her own behavior. If she wants to have a child, it’s not your problem. Let your sister live her own life.

  Easy for him to say. Jenna swallowed hard, panic starting to overwhelm her. Taking a deep breath, she cued her microphone. “Nate, how far is it to Somerset Hospital?”

  “Not too far. We should be there in less than twenty minutes.”

  “Good.” Jenna was amazed at how hospitals located more than fifty miles away could be so close by air. To keep busy, she pulled out the flight record and began to fill out the form. “You’d better call for a more in-depth report on our patient,” she warned Zane. “She sounds pretty sick.”

  Zane looked as if he was about to argue, but instead he cued his mic, asking for the dispatch to put him through to the hospital for an update on their patient’s condition.

  The conversation kept him occupied, and as the conversation went on, his expression grew grim. She knew they were looking at a potentially unstable transfer.

  “ETA five minutes,” Nate drawled.

  Jenna reached down to double-check the flight bag, then sat back, watching through the window as Nate landed. Within a few minutes, they were cleared to disembark.

  Inside Somerset Hospital, she and Zane found the ICU without trouble. There were only a few patients, but several staff members stood around one particular bedside, each person wearing a grave expression.

  “Thanks for coming so quickly.” An older guy, whose name tag indicated he was Dr. Morris, shook Zane’s hand. “We’ve tried our best to stabilize her, but we don’t have much experience with this type of thing. We thought her best chance of survival was to send her to Trinity.”

  “I understand.” Zane gestured to the monitor. “Fill me in.”

  Jenna listened as they discussed the patient’s condition while she connected their portable equipment. Margaret looked younger than her reported twenty-four years of age, and Jenna tried not to think about Rae as she switched the numerous medications to their IV pumps.

  Zane joined her, and between them, they managed to get Margaret into the chopper well within their twenty-minute timeframe. Once they were in the air, Zane took control of the situation.

  “She’s bucking the vent, trying to overbreathe the machine. Let’s try a little sedation. I think they were afraid to give her any because of her low blood pressure.”

  “Do you want Versed? Or something else?” Jenna open the flight bag.

  “Give me five milligrams of Versed to start.”

  She pulled out the syringe and handed it to him. Nate hit an air pocket, and the chopper jerked. Jenna glanced down at the patient, wondering about Margaret’s baby. Had she given birth to a little boy or a girl?

  “Jenna?” Zane frowned as he pulled the syringe from its port on the IV. “I asked for Versed, you gave me Verapamil.”

  Her eyes widened in horror. “Did you give it?”

  “No.”

  She grabbed the syringe from his hand. Her stomach clenched when she read the label. She’d made a big mistake, saved only by Zane’s keen attention to detail. “I’m so sorry.”

  “It’s all right. Just hand me the Versed.”

  Her fingers trembled as she replaced the Verapamil in the bag and removed the Versed instead. She looked at the label twice to make sure she’d pulled the correct medication before handing it over to him. The two drugs were completely different—one was a sedative while the other was given to treat a heart arrhythmia. Thankfully, Zane had noticed her mistake before injecting the medication, or the patient could’ve suffered dire consequences.

  Zane was right. She should have confided in him, should have talked through what was bothering her. She needed to stop worrying about Rae and concentrate on what she was doing.

  Before she killed someone.

  9

  “She’s bleeding from numerous sites—her IVs, her nose and mouth.” Concerned, Jenna glanced at Zane. “I don’t understand. Is this a result of something we gave her?”

  “No. She’s in DIC, disseminated intravascular coagulopathy. It causes either extreme bleeding or excessive blood clots to be thrown through a patient’s system.”

  Jenna wasn’t convinced. “And you’re sure it’s not anything I did?” Just to be safe, she double-checked the ventilator settings to make sure she hadn’t missed something.

  “DIC is the result of her sepsis from the amniotic fluid embolus—nothing you did.” Zane’s confident tone reassured her. “Give both units of fresh frozen plasma they sent with us.”

  “All right.” Jenna did as he’d asked, although she’d never actually hung fresh frozen plasma before. She knew it was a blood product, though, so she followed the same procedure, wondering if he watched to make sure she didn’t screw up again. But no
, Zane took the clipboard from her hand and reviewed her notes, not paying attention to her actions.

  “There isn’t much else we can do, except to get her to Trinity as soon as possible.” Zane handed the clipboard back to her, lines of frustration marring his forehead. “So far sedating her hasn’t worked, her pulse ox is still low. The constant bleeding isn’t helping her blood pressure any.”

  “Should I increase the drip?” Jenna glanced at the monitor. “Her mean arterial pressure has dropped below sixty.”

  Zane appeared surprised. “I didn’t notice—good catch. Yeah, titrate her dopamine until you’re able to keep her MAP at sixty or higher. Once you get the maximum dose, let me know. We may need to start another vasopressor.”

  No mistakes this time. She increased the infusion rate on the dopamine, then double-checked the dose. She knew she’d be double-checking herself nonstop now. “I’m at eight micrograms per kilo per minute, but you might want to do the calculations yourself, just to be sure.”

  He frowned. “Jenna, I trust you. Stop beating yourself up, I’m sure it’s fine.”

  Since he wasn’t going to double-check her math, she did the calculation again using the calculator on her phone just to be sure. It was correct. She stared at the monitor. When the patient’s blood pressure dropped again, Jenna increased the dopamine.

  The next few minutes passed in silence.

  “I’m at the maximum dose.” Jenna met Zane’s gaze, trying not to show the depths of her concern. “What medication do you want to hang next?”

  “ETA five minutes.” Nate’s deep voice broke into their conversation. “Is everything all right back there?”

  “We’re fine. Although we’ll be better once we get to Trinity.” Zane nodded at her. “Hang the norepinephrine.”

  “Do I need to request a hot unload?” Nate asked.

  “No, we’re going directly to the ICU. The medical critical care team is waiting for us.”

  Jenna pulled out the bag of norepinephrine, but she couldn’t remember what the normal starting dose was. Her mind went totally blank.

  Zane must’ve noticed her hesitation and quickly came to her rescue. “Start at point zero two micrograms per kilo per minute. You can titrate in increments of point zero two from there.”

  Swallowing a flash of nervousness, she hung the medication and programmed the pump. She was still verifying her math when Nate landed the chopper on the helipad. Zane waited until she was finished, then opened his door to jump down.

  Once they’d gotten Margaret off the helicopter, they wheeled her into the elevator and headed for the fourth-floor MICU. As Zane had promised, the critical care team was waiting for them.

  Relieved to be at the hospital, Jenna helped to disconnect the Lifeline equipment, then assisted with reconnecting Margaret to the ICU monitors. A tall, broad-shouldered male nurse joined in to help, grinning widely at her.

  “Hi. My name is Paul Anderson, I’m one of the nurses here in the MICU. You must be new, it’s nice to meet you.”

  “Jenna Reed, Lifeline paramedic.” She managed a polite tone, although she wasn’t in the mood for idle chitchat. This guy was acting interested in her on a personal level, and all she wanted to do was throw up. “It’s nice to meet you, too.”

  Paul looked as if he wanted to say more, but Zane and the critical care physician approached the bedside.

  “We gave her two units of FFP and added norepinephrine after we maxed out on the dopamine.” Zane glanced at the clipboard to provide the accepting physician an update on their patient’s condition. “She’s in full-blown DIC from her sepsis.”

  Jenna had learned from a previous flight that DIC stood for Disseminated Intravascular Coagulation which was basically a clotting disorder. It happened when the massive infection made the blood clot, which often caused loss of circulation in a patient’s extremities.

  Clots could go to the lungs, the heart or the brain, causing death.

  “Got it. Paul, will you draw another DIC panel?” the critical care physician asked as they shifted Margaret off the gurney and onto the ICU bed.

  “Right away,” Paul agreed.

  Jenna shoved the gurney out of the way to give them more room. Zane discussed the care with the physician for a few more minutes while she gathered their equipment, then they were ready to go.

  Outside, Nate had the helicopter blades rotating, ready to take off. The trip was short; they landed back at the Lifeline hangar in record time. Jenna was never so glad to finish a transfer. Zane’s job was to finalize the flight report from a medical perspective, so she took the flight bag into the storeroom to restock supplies.

  When that minor task was completed, Zane surprised her by taking the flight bag from her grip and steering her into the lounge. A quick glance around confirmed they were alone. Nate must have returned to the debriefing room.

  “Sit down.” Small hairs bristled along the back of her neck at Zane’s stern tone, but she sat. He dropped into the seat next to her and clasped both of her hands in his. “Talk to me, Jenna. You’ve never made a mistake before, although we are all human. A simple slipup can happen to anyone.” His imploring gaze tugged at her conscience. “But ever since you showed up this morning, I could tell something was bothering you.”

  She wanted to deny it, but she couldn’t. Her shoulders slumped. Lying would get her nowhere. Better to confess. “You’re right, Zane. I’ve been too preoccupied over my sister. That’s why I made such a stupid mistake. I couldn’t stop thinking about Rae, and I put our patient’s life in jeopardy as a result of my carelessness.”

  “You weren’t careless, but preoccupied.” Zane tugged on her hands, pulling her closer until he could wrap an arm around her shoulder. ”Tell me what happened.”

  She knew being with him like this wasn’t right, at least not here at work, but she couldn’t force herself to move away. He smelled so good, the deep woodsy scent called to her in a way no other had. She spoke before she even realized what she was saying. “I found a home pregnancy kit in the bathroom garbage bin at home.” She swallowed hard against the lump in her throat. “I’m sure it’s Rae’s.”

  He grimaced. “Oh, boy, I can see why you’re upset. Rae’s pregnancy would be a strain, no doubt about it. But worrying whether she is or isn’t won’t change the outcome.”

  “I know.” Being logical sounded easy, but she found it impossible to separate the facts from her feelings. She leaned against him. Being held by Zane felt right. Sharing her concern with someone who cared, even for a brief moment, made the burden a little easier to bear. For so long now, she had been solely responsible for Rae.

  A baby would push her over the edge.

  Selfish. That was a totally selfish thought. Babies were a blessing. Maybe Rae wanted the baby. Maybe her boyfriend did, too. Heavens, what if Nelson wanted to move in with them? She tightened her grip. Now she really felt as if she were falling over the edge.

  “Is there anything I can do to help?”  Zane asked.

  Stunned by his unexpected offer, she pulled away just far enough to look at him. His expression was full of compassion and concern. “Believe me, Zane, you already have. Just by listening.”

  “You’re not alone, Jenna.” His voice was low, and he lightly brushed a strand of hair from her cheek. “I know what it’s like to worry over someone you love.”

  She tried to smile. “Bet you’ve never had to worry about something like this.”

  His expression turned serious. “I have. My parents divorced during my senior year of high school. My dad had always been strict. After mom left, he was much worse. Especially for my sister, Eve, who was a year younger than me.” He paused, cleared his throat, his eyes clouded with remembered pain. “Eve responded by rebelling, which only made my dad more controlling. One night she ran away from home. We thought she’d come back within a day or so, but she didn’t. We searched everywhere, hired private investigators, the whole works. We didn’t find her until four long months later.” />
  “Oh, Zane.” Jenna couldn’t even imagine what he’d gone through. A teenage girl on the streets alone and vulnerable. The horrible possibilities were endless. “I’m so sorry.”

  “Yeah.” His smile was crooked. “When we found her, she wasn’t the same girl I remembered. It was as if her eyes had aged overnight. Although she never would tell me exactly what happened, I always suspected the worst.”

  Jenna didn’t know what to say. She, too, could easily imagine the worst.

  “Anyway, my point is, I couldn’t change what happened. All I could do was help Eve move forward with her life from that point forward. I couldn’t change her decision to run away, she had to find a way to accept it.”

  “So, what you’re saying is that I have to allow Rae to come to terms with her decision to be foolish enough to get pregnant.” Jenna battled a wave of helplessness. “I don’t understand. She had her whole life ahead of her. Why would she take such a stupid risk? Obviously, I’m a lousy parent.”

  “No, you’re doing fine, but I do think you should hold Rae accountable for her decisions,” Zane advised. “Don’t keep bailing her out of her problems. Next time she doesn’t follow the rules, tell her you won’t pay for her college tuition.”

  What he suggested sounded so simple, but it wasn’t. “Her college tuition is a moot point now. She can’t go on to college if she’s pregnant. What’s the point of finishing one semester? Who’s going to pay for childcare while she’s in class? My salary is stretched to the max simply supporting the two of us. I can’t pay for childcare and for her college tuition, too.”

  “Don’t torture yourself over the possibilities, especially if you don’t even know for sure she is pregnant.” Zane slid a finger under her chin and lifted it until she met his gaze. “I know you like to prepare for the worst, but cut yourself some slack, okay?”

  She wanted to argue, but she knew deep down he was right. She did need to cut herself some slack or she wouldn’t have a job to fall back on. Another mistake like the one Zane had caught would be the end of her career.