The Royal Doctor’s Bride

by Jessica Matthews

  She’d treated patients who couldn’t scrounge together enough money for bus fare, much less their medication. She’d lost track of the number of families she’d fed, either in the cafeteria or a nearby restaurant. As much as she wanted to help them all, she couldn’t take responsibility for everyone who walked through Belmont’s doors.

  “I sympathize with your situation, but the last time I checked, my credentials were limited to medicine, not détente. You’ll have to ask someone else.”

  “There is no one else to ask. You’re my only option.”

  “I’m sorry, but my answer is still no.” She tried to nudge him aside, but he didn’t budge.

  “You’re a coward.”

  She stared at him, incredulous. “Because I choose not to immerse myself in the politics that sent my father away from the home he loved, I’m a coward?”

  “You don’t even know what we’re asking,” he accused. “The least you can do is listen to the unabridged story before you decide. Refusing to do that is either a show of cowardice or being self-centered. Take your pick.”

  For a terse moment, the silence became so complete, only the distant ringing of a telephone could be heard.

  “I’m sorry Avelogne and Marestonia are suffering a diplomatic crisis,” she said quietly. “But I’m just an average woman on the street, so to speak. I work in a hospital in a relatively bad part of town and deal with drug addicts and gang members on a daily basis. I don’t know what you or my grandmother think I can accomplish. I can’t undo the past and I don’t run in lofty social or political circles of influence, so you’re only wasting your time.”

  “I disagree. You are not an ‘average’ woman. If you reestablished ties with your family, you would enter influential circles,” he pointed out. “You are, after all, a countess.”

  “What if I like my life the way it is? I don’t want to be known as Countess. Anonymity suits me just fine.”

  “You can remain anonymous and still become reacquainted with your family. The point is, life is too short to bear grudges.”

  Thinking of her father, who’d died as much from heartache as heart disease, Gina’s eyes burned with unexpected moisture.

  “Aren’t you the least bit interested in hearing their side of the story?” he coaxed, as if hoping curiosity would sway her.

  “Will it change anything?” she demanded. “Rewrite the past? Restore my father to the family he loved? Take away my mother’s sorrow and guilt for causing him to choose between her and his family? I think not.”

  “I agree those wrongs can’t be undone, but we have to resolve this crisis.”

  “I don’t have to do anything,” she retorted, blinking away her unshed tears. “My father left Avelogne and his family long ago. I don’t intend to get involved with either now.”

  He fell silent for a moment, then nodded slowly. “If you don’t want to deal with the royal family, you don’t have to.”

  “I don’t?”

  He shook his head. “The real solution lies between the two of us anyway.”

  She stared at him, puzzled. “You’ve lost me.”

  “While it would help matters if Avelogne could show the world a reunited royal house—namely that Arthur’s daughter has been reinstated into the fold—it isn’t required. Your relationship with me is the important thing.”

  “Because of your aunt?” she guessed.

  “Yes. On behalf of my entire family, I’d like to apologize for her selfish actions.”

  She tapped one foot on the floor. “What exactly was her motive for ruining my parents’ lives?”

  He didn’t comment, although he heaved a great sigh. “Margret fell in love with your father and believed that if your mother, Lizbet, disappeared from the scene, she would be able to earn Arthur’s affections.” He paused. “She was quite shocked when he relinquished his claim to the throne and moved to America. The situation didn’t play out quite as she’d planned.”

  “I’ll say,” she said wryly. “Whatever her reasons, though, I don’t hold you responsible. Neither the past nor your royal connections will interfere with our employer-employee status. As far as I’m concerned, we’re simply two physicians who happen to work together in the same department, in the same hospital. So you can call whomever you need to and announce the good news. Then life for everyone can return to normal.”

  He smiled, as if she’d amused him with her simplistic solution. “It’s a start, but, as I’ve already said, your people demand more than an apology. They want their prince back.”

  Do you hear that, Dad? A pain shot through her heart. If only he’d lived long enough to see this day. “Impossible,” she said flatly.

  He nodded. “Which is why the situation is complicated.”

  “I was afraid you would say that,” she said dryly. “But, complicated or not, I can’t help you.”

  He started to speak, but the door edged open and Lucy poked her head inside.

  “We’re getting a couple of traumas in about five minutes. Two stabbing victims.”

  Gina had never been so relieved to have patients coming into the ED before. She could deal with medical situations far better than she could sort out diplomatic problems of countries she’d only seen on the map and in occasional family photos.

  “Thanks, Lucy,” she said. “We’ll be right there.”

  Lucy vanished, apparently without noticing the tension in the office. From the look on Ruark’s face, he was clearly glad for the reprieve as well.

  “We’ll discuss this further tonight,” he said. “When we won’t be interrupted or distracted.”

  “There isn’t anything to discuss,” she protested.

  “You need to hear everything,” he insisted. “The least you can do is listen.”

  She wanted to refuse but, after seeing the fierce determination on his face, she knew he wouldn’t give up.

  She faced him squarely. “OK, but in the meantime you will not breathe a syllable of this conversation to anyone. No one knows my background and I prefer to keep it that way.”

  “You have my word,” he agreed. Immediately, he opened the door. “After you, Dr Sutton.”

  Setting aside her host of questions to mentally gear up for her patients, Gina hurried toward the centrally located nurses’ station. “Page Frank,” she told Ruby, the desk clerk, referring to their surgical resident, Frank Horton.

  With the phone tucked under one ear, Ruby mouthed, “I’m already on it.” Then she spoke into the receiver. “I don’t care where you have to find him, just do it. We need him in the ER, stat!”

  Gina rushed into the opposite hallway to check if Trauma Room One was available, and found Ruark following her like a shadow. “What are you doing here? Bill didn’t—”

  “It’s a new day. Bill isn’t here any longer,” he pointed out. “As I understand the job, I’m supposed to be available for traumas, and here I am.”

  Only if I need you, she wanted to protest. But then, with two patients coming in and not knowing the condition of either, she might need an extra pair of hands. The only question was, would he function like Bill and be more hindrance than help?

  “Afraid I’ll find your department doesn’t run smoothly?” he asked.

  “We run just fine,” she defended tartly. “Feel free to observe for yourself.” Already dismissing him, she asked no one in particular, “Where’s Casey?”

  Another nurse scurried past. “Dr Casey left for his dentist appointment ten minutes ago. Remember?”

  How could she have forgotten? Of all the days for him to lose a temporary filling. But considering what had happened so far this morning, she would count herself fortunate if a natural disaster didn’t occur.

  “Dr Powers is supposed to cover, but he can’t come until one-thirty.” Toby Powers was a physician who was close to retirement and worked two shifts a week.

  “Staff problems?” Ruark asked.

  “Nothing we can’t work around.”

  The ambulance bay d
oors near the nurses’ station swooshed open and she rushed forward to greet the two paramedics and the gurney carrying her first patient.

  “Twenty-five-year-old male with multiple wounds to the chest,” one of the paramedics, Tim Abbott, reported. “Open pneumothorax. BP is one ten over sixty-five…”

  Gina listened to his recitation as she donned her protective gear, including a face shield, while following the gurney into the trauma room. Not only was the man’s blood pressure low and his heart rate increased, but his skin was cold and clammy and he appeared restless in spite of his cervical and thoracic spine immobilization. Tim had already inserted an endotracheal tube in the field, but her patient still struggled to breathe and showed jugular vein distension.

  She raised the large bandage covering his bloody chest and saw eight puncture wounds, with the largest one near the heart showing frothy blood. Because air and blood were leaking into his thoracic cavity, his lungs couldn’t inflate properly. Her work was cut out for her.

  To her surprise, a similarly gowned and gloved Ruark appeared in the room. “I’ve got it under control,” she said as she, Tim, Lucy, another nurse and now Ruark prepared to move her patient from the ambulance gurney to a hospital bed.

  “Are you warning me away from your patient, Dr Sutton?” he asked coolly.

  She mentally noted that she didn’t need to take charge, but old habits were hard to break. While she’d have to defer to him for the time being, she’d maintain a watchful eye until she assured herself that the royal doctor truly knew what he was doing.

  “Not at all,” she answered. “One, two, three, lift!” On Gina’s command, their patient made the transition with minimal jostling. Seconds later, she began barking her orders to the nurses who were busy affixing a pulse oximeter, monitoring the IV and taking over ventilation duties. “Get me a chest tube on the double, a CBC and type and cross-match for four units. Where’s Horton?”

  Becky answered. “He’s not here yet.”

  “Page him again. If he doesn’t answer in the next sixty seconds, page Dr Ahmadi too.” Ahmadi was Frank Horton’s supervisor.

  Gina wiped blood away from the largest and most worrisome puncture and revealed heavily tattooed skin. A closer look at his torso showed her what she’d missed before—his entire body was tattooed with mythical creatures. The detailed dragon which was prominently featured on his left bicep was quite distinctive.

  “I see we’ve gotten another one of Picasso’s customers.”

  “Who?” Ruark asked.

  “Pablo Picasso. Pablo’s his real name and being a local tattoo artist, he calls his parlor Picasso’s,” she said as she began to palpate along the man’s rib cage to determine the chest tube placement site. “He thought the famous name would give his place some class. We see a lot of his work in here.”

  “Doesn’t say much for his choice of clientele,” Ruark remarked.

  “Pablo is interested in his art, not in people’s lifestyle choices,” she defended.

  “How did you meet him? I wouldn’t think a physician and a tattooist would have much in common.”

  “He came into the ER with pneumonia when I was an intern and we started to talk about all sorts of things. He invited me to his workplace—he dared me to visit, actually, and I did. His drawings are fantastic.”

  “Did you pick one for yourself?” Lucy asked.

  “Sure did. Lidocaine.”

  Lucy slapped the required syringe into Gina’s hand. “Oh, my gosh. You have a tattoo?”

  Conscious of Ruark listening intently, Gina wished she hadn’t said a word. Her tattoo was none of his business, even if she wasn’t ashamed of it. “Yeah.”

  “You’re kidding.”

  “Come on, Lucy, it isn’t that big a deal,” Gina defended.

  “Hey, any time you veer off the straight and narrow path of respectability to walk on the wild side, it’s interesting,” Lucy announced. “So what did you choose, and where is it? Don’t keep us in suspense.”

  “It’s a frog,” Gina snapped. “On my foot. Scalpel.”

  “I should have guessed. You collect them, don’t you?” Lucy slapped the instrument into her hand.

  “Yeah.” From the sheer volume of inked skin, Gina suspected her patient took as much pride in his body art as Pablo did, so she made the smallest incision possible to accomplish what had to be done. As she punctured the pleura with a Kelly clamp, blood spurted from the hole.

  Working frantically, she hardly noticed the appearance of another nurse, and two more paramedics as they wheeled in a second victim who, like the first, had an IV line established and wore an oxygen mask.

  “We’ve got problems here, Doc,” Andy Carter, one of the paramedics, announced.

  “Tell me about it,” she muttered.

  “What’s wrong?” Ruark abandoned Gina’s patient for the new arrival.

  “He’s got a pneumothorax and I couldn’t intubate him before we brought him in. I tried, but couldn’t get through and I didn’t want to waste more time trying in the field.”

  Gina inserted the tube into her John Doe’s chest. Immediately blood filled the line and ran into the attached drainage bag. “Hang on, buddy,” she told her patient. “We’re taking good care of you.”

  “Give me an endotrachael tube,” Ruark ordered as he moved to the head of his patient’s gurney.

  Andy glanced between her and Ruark. “Doc?”

  “Where’s Frank?” she asked no one in particular.

  “I asked for an endotrach tube,” Ruark ground out. “Must I get one myself?”

  Everyone froze, including Gina. “What do you think you’re doing?” she asked.

  “Trying to save this man’s life, if someone will give me a damn tube!” he roared as he stood over the second man, who was audibly rasping for breath.

  Immediately, the nurses sprang into action.

  Gina exchanged a brief glance with Lucy. Ruark would be furious that no one had instantly obeyed his orders. Apparently her days as staff liaison hadn’t ended yet but, in all fairness, what could he expect? No one knew of the official leadership change—it all had happened so fast. If he’d called his staff meeting instead of springing international problems on her that were beyond her control, none of this would have happened, she thought uncharitably.

  “By the way,” Gina announced offhandedly as she tended her patient, “I’m afraid none of you have met our new emergency director, Dr Ruark Thomas. In case you haven’t figured it out yet, he’s replaced Bill.”

  Under the wary greetings offered by the subdued staff, Gina muttered to Lucy, “Keep an eye on him and signal me if you notice he’s in over his head.”

  Lucy obeyed, quietly trading places with the other nurse.

  While Gina finished securing the chest tube with sutures and dressed the wound she’d created, she listened to the quiet conversation over the second gurney.

  “We can’t get through,” Ruark declared. “His larynx is fractured and the upper airway is blocked.”

  “Then he needs a cricothyroidotomy,” she interrupted from across the room. Having worked with her share of unseasoned physicians, she was accustomed to sharing her opinions during the trickier situations. “Can we get by with—?”

  Ruark must have read her mind. “Ventilating him with only a needle and catheter is a temporary measure. The surgical method will make it easier for placement of a tracheostomy tube later, which he will definitely need.”

  “OK. I’ll be there in a few seconds.” But as she watched the blood pour out of her patient’s chest into the drainage bag and heard only muffled heart sounds, she knew she couldn’t leave his side.

  She hated to ask, but she had no choice. “Can you do it on your own?”

  “I’m two steps ahead of you,” he answered. “Never fear. I’ve done this once or twice.”

  Once or twice? Gina mentally groaned. Yet, for a man with such limited experience, he didn’t seem flustered or act out of his depth. And while she was reli
eved by his calm, matter-of-fact manner, she couldn’t squelch the irrational notion that he might need the benefit of her expertise. After all, a patient’s life was at stake.

  “Find the cricoid cartilage, which is approximately two to three centimeters below the thyroid notch,” she instructed. “Once the membrane is exposed, puncture it midline. Be careful of the vocal cords and don’t puncture—”

  “The back wall of the larynx and enter the esophagus. Yes, Gina, I know, but thanks for the reminder.”

  He didn’t sound upset and wasn’t yelling at the nurses for not providing the proper supplies at the exact moment he wanted them, which was a one-eighty-degree change from working alongside Bill. Her fears that he was simply a more polished version of their previous director slowly faded as she listened to his calm voice ask questions and give directions. No, it was obvious she didn’t need to review his curriculum vitae—his actions spoke of his abilities far better than a list of positions held ever would. If he could handle his current patient’s condition, he was a colleague she could trust.

  Within seconds, Ruark’s patient’s audible symptoms of respiratory stridor disappeared, and with it all of her fears about his medical skills. Suddenly, a burden she hadn’t realized she’d been carrying lifted.

  “Airway’s in,” he said, sounding quite pleased. “His pneumothorax is next on the agenda.”

  The activity on the other side of the room faded into the background as the nurse at her side interrupted with a terse “BP is falling”.

  Gina immediately noticed her patient’s visibly distended jugular veins and muffled heart sounds—Beck’s triad—and knew the man’s heart was failing. “His pericardium or coronary artery must have been nicked,” she said aloud. “He needs his chest opened, but…”

  “But what?” Ruark asked from across the room. Apparently he also had the ability to listen in on two conversations at once.