by Fiona Lowe
“Line in,” Will said, pulling out the trocar, and she quickly connected the IV, hanging the bag on the gurney’s stand. “Run it fast.” He didn’t need to say, God knows how much blood he’s lost; it was written all over his face.
“You feeling dizzy, Ed?” she asked as Will proceeded to do a quick visual check of his chest and abdomen before commencing a thorough palpation.
“No. Just my leg.”
But she knew the dizziness would come, because there was only so long the human body could keep a fast-diminishing blood supply diverted to vital organs. “Wriggle your fingers for me then your toes.”
Ed did as instructed, easily moving his fingers on both hands and thankfully the toes of his right leg. “Has she . . . found Jade?”
Millie glimpsed the EMT across the pasture talking earnestly with another paramedic who was running his hands through his hair. Her throat tightened at the sight—it didn’t look good. “As soon as we know anything, we’ll tell you.” Although, if it was really bad news, they’d be keeping that information from Ed until he was a lot more stable.
Will leaned over Ed’s hips and said quietly into her ear, “No chest injuries, no complaints of abdominal pain and his abdomen is soft, so that’s the good news. The bad news is the crushing injury to his leg, his plummeting BP, his risk of a fat embolism and his agitation. Treatment plan?”
Even in the midst of this carnage, he was still teaching her. “We need to protect his airway in case he arrests so, um, IM ketamine to sedate him? Then rapid sequence intubation?”
“Exactly.” He gave her a tight smile. “Well done.”
She drew up the anesthetic. “This is going to help, Ed,” she said as she quickly administered it into his thigh. The guy didn’t even flinch, which was a sure sign of the extreme pain he was experiencing from what was left of his leg.
“Let’s do this.” Will put out his hand for the laryngoscope. The moment he gripped it, he flicked it open and inserted it into Ed’s mouth. “Visualizing the vocal cords. Tube.” His fingers closed around the offered ET tube. A moment later it was inserted into Ed’s trachea.
Millie was inflating the cuff with saline when one of the Billings team ran up wearing similar protective gear.
“Hey, Will,” the guy said with easy familiarity. “We’ve secured the field.”
“Tom.” Will nodded his hello. “Is it as bad as it looks?”
“Pretty much. There’s one severe head injury. A girl went straight through the windshield and it’s not looking good. She’s got CSF draining from her nose.”
“Is she a teenage girl? Do you know her name?” Will asked abruptly.
Tom shook his head. “No, sorry. She’s one of two teen girls. The other one has a flail chest and crush fractures to the left arm. We’ve also got two rigid abdomens, both with suspected ruptured spleens and one with a possible liver lac. There’s one spinal cord injury with no sensation below the waist, a bilateral fractured femur with possible fractured pelvis and a male totally off his face on a mix of meth and alcohol.”
“Let me guess?” Will said bitterly. “He’s got minor cuts and abrasions and a possible concussion.”
Tom sighed. “Sadly, you’re right on the money. What have you got here?”
“Hypovolemic shock, risk of bleeding out and facing a probable above-knee amputation,” Will said grimly as Millie took over bagging Ed. “I’ve got a surgeon on standby at Bear Paw Hospital, so we’ll take the two rigid abdomens. You take this guy and the severe head injury to Billings. How bad is the flail chest?”
“We’re inserting a chest tube, which will stabilize her for the second evacuation.”
“Good. We’ll pick her up on our second run along with the spinal injury and take her to Great Falls. That leaves you with the broken bones for your second trip.” Will’s voice suddenly got hard. “The police can take the meth head to the local hospital.”
If Tom was shocked or surprised by Will’s unprofessional use of derivative slang, he didn’t show it. “Sounds like a plan.”
“Great. The faster this bloke gets into the OR the better. Millie, meet me over at the other patients as fast as you can.” Will stood and ran.
Millie quickly handed over Ed to the Billings flight nurse, and six minutes later she was back in the air with patients—Colton, a guy in his early twenties, and Lewis, a teenage boy. The trip to Bear Paw took four minutes, but as she bolused fluid into both of them in an attempt to maintain their blood pressure, it seemed like the longest four minutes of her life.
Will was multitasking—putting up another bag of Hartmann’s solution while talking to Kelli on the radio, giving the surgeon an update on their patients. Millie tried not to think about the Hello, I’m yours if you want me look the female surgeon had given him just before they’d left. It had burst the beautiful bubble she’d been living in for almost a week—the bubble where only she and Will existed—and it had allowed the traitorous question of Why does he want me? to sneak back in and play havoc in Dolby sound.
I’m choosing to get lucky with you. She tried latching on to Will’s words but immediately lost them to the duplicitous thought He could choose to get lucky with other women.
“We’re coming in to land,” Jay the pilot said, his voice loud in the headphones.
Through the swirling dust raised by the chopper’s rotors, Millie saw the hospital’s helipad with its distinctive red H. They touched down, the doors opened and Katrina’s and Josh’s anxious faces greeted them. The moment she’d handed over her patient to Josh, she ran and got new emergency packs and took half a minute to test her blood sugar. It was holding steady, but she unwrapped a protein bar anyway. She met Will at the front of the ER, and his eyes immediately narrowed at the protein bar in her hand.
She didn’t need him suggesting she wasn’t up to coming, and as much as she hated discussing her blood sugar with him or with anyone, she didn’t want him kicking her off the flight. “All good.” She thrust a bar at him. “Eat this.”
He pushed it back at her as his long legs covered the short distance back to the helicopter. “I’m not hungry.”
“Welcome to my world,” she said wryly as she shoved it into his hand again. “You’re probably hungry but the adrenaline’s masking it.”
He gave her an odd look as if she’d just solved a mystery for him. “You know, I’m always famished at the end of these retrievals.”
She rolled her eyes. “So eat the bar.” The irony of being a diabetic was that despite her body not always doing what it was supposed to do, she was tuned in to how it worked in a way other people never considered. Not that she wouldn’t trade that knowledge in a heartbeat for a functioning pancreas.
Jay talked through his checks, the chopper rose and it seemed no time at all before they were landing again on the grassy plain. By now, some of the local community had arrived, their faces white with shock at the mess in front of them. The car, which looked like someone had taken a can opener to it and sheared off the side, told of the speed of the impact. A police officer was talking to a cluster of people and writing in his notebook. Some men stood stoically, shielding their eyes from the glare of the sun and holding weeping women close, while others wiped tears from their eyes when they felt no one was looking.
Millie’s heart ached for them. An accident like this blasted through a small town like an explosion, leaving a crater of pain and a lot of very hard questions. As expected, they’d beaten the Billings crew back, and the EMTs had their two patients ready for loading.
A woman was sobbing over a teen girl who was propped up high on the gurney—a sure sign she needed help breathing.
Millie heard Will mutter softly to himself, “Jesus, are they all kids?”
It was true. The car seemed to have been full of teens out for a joyride—a ride that had turned tragic not just for them but also for the couple on the motorcycle.
“I’m Doctor Bartlett,” Will said to the hysterical woman who was gripping the side of the
gurney like it was a lifeline. “We need to load your daughter onto the chopper.”
“Lily’s a good girl,” the woman said frantically, transferring her viselike grip to Will’s arm. “She works hard. She’s a good student, she helps out at the nursing home, she never acts up. She doesn’t deserve to die.”
Millie heard the fear in the woman’s voice and recognized the start of the bargaining that always happened in traumatic situations. Bargains with God—If she lives, I’ll come back to church. If she lives, I’ll give more to charity. If she lives . . .
“Promise me, Doctor, that she’ll be okay.”
Will carefully and gently unfolded the woman’s fingers from his arm. “We’re doing our absolute best, and that means getting Lily to Great Falls as fast as possible.”
“I have to come with her. She needs me.”
Millie put her arm around the woman’s shoulders and turned her toward the gathering crowd. “Can someone help us out here? Lily’s mother needs to get to Great Falls.”
The police officer came over and took the woman by the hand. “Leave it with me. I’m organizing transport for people to get to three different hospitals. Mary, don’t you worry. We’re gonna get you to Great Falls.”
Millie turned her attention back to her patient where it belonged, and five minutes later, they were in the air again. Millie rechecked all of Lily’s vital signs and then checked them against the EMT’s last check. None of them made sense.
“Will?”
He turned from their paraplegic patient, who was sedated and still to best protect his spinal cord. “Problem?”
“Despite the chest tube, Lily’s respirations are increasingly rapid. She’s agitated and her BP’s low, but I don’t get it, because there are no signs of any internal bleeding.”
He automatically checked the underwater sealed drainage, which was bubbling exactly like it was supposed to be doing, and then he looked at the Lifepak, reading the EKG. “Any abnormal heart sounds?”
“It’s hard to hear over the noise of the chopper, but it’s not a clear lub-dub.”
A run of ectopic beats flashed across the Lifepak screen, backing up her words.
He ripped off his headset and grabbed a stethoscope. “Lily, honey, I just want to listen to your heart.”
The girl nodded, her eyes wide above the oxygen mask.
Millie watched Will’s brows snap down and deep lines of intense concentration dig into his forehead as he moved the stethoscope. She wondered what he could hear.
“Muffled heart sounds,” he finally said, and his long fingers proceeded to explore Lily’s neck. “Extended jugular vein.”
“So her shortness of breath has nothing to do with her flail chest?” she asked, knowing she was one step behind him and hating it.
“That’s right, which is why we missed this.”
“What this?” she asked desperately.
His mouth twisted grimly. “She’s in cardiac tamponade.”
“Oh God.” The sac around Lily’s heart was filled with fluid and squashing her heart. “Thank goodness we’re close to Great Falls.”
Beep, beep beep. Another run of ectopic beats raced across the screen. The fluid around Lily’s heart was compressing and stressing her heart.
He shook his head. “She could arrest on us before then. I need to do a pericardiocentesis and drain the fluid.”
“Now?” Millie heard her voice squeak as she looked at their cramped space.
“Right now,” he said in a voice that brooked no argument. “You find the heart on the portable ultrasound and I’ll get a syringe and a large bore needle.”
“Lily, this will feel cold, but it’s all good, okay?” she said to the barely conscious girl. She squirted gel onto her chest and located the heart. She looked at Will. “Are you going to intubate first?” she asked softly.
His mouth flattened. “It’s a catch-twenty-two. I’m calling removing the fluid first and hoping that’s gonna work for us.” He put his hand on their patient’s shoulder. “Lily,” he said gently, “stay with me. I have to put a needle in your chest to make you feel better.”
“Preparing to land,” Jay said routinely.
“No,” Will said urgently. “I need a couple of minutes.”
With the steadiest hand Millie had ever seen, Will carefully inserted the needle into the young girl’s chest, his eyes fixed on the grainy black-and-white image of the ultrasound. “There, see?” He tilted his head toward the black image that the needle was reaching. “That’s fluid.”
“It seems back to front. I expected fluid to be white.”
“Yeah, it’s funny that way.” He slowly withdrew the syringe’s plunger, and blood filled the plastic. The EKG stopped screaming, and Will grinned at her, relief and the buzz of a win clear on his face.
A beautiful line of sinus rhythm beats with their neat and perfect PQRST sequences traced reassuringly across the screen. “That’s incredible, Will.”
He shrugged almost dismissively, and a dark look crossed his face. “It wouldn’t have been necessary if a drug-affected moron hadn’t gotten behind the wheel of a car.”
Again, his intensity startled her. “Amen to that, but sadly it happens.”
Will ignored her. “Jay, we can land when you’re ready.”
“Going down now, Doc.”
The chopper banked, and Millie blew out a breath, never more thrilled to see the roof of the level two trauma unit and a team of waiting clinicians.
The Lifepak warning beep screamed again as Lily’s heartbeat quivered.
Will swore. “She’s in VF. Defib at one-fifty.”
As Millie discharged the life-saving volts into Lily’s body, the chopper touched down.
The Lifepak kept screaming. “Lily, don’t you dare die on me,” Will said as he grabbed the paddles off Millie. He discharged two hundred and fifty volts into the teen, her body jerking under the assault.
“Sinus rhythm,” Millie said as she sent up a thank you into the ether.
The chopper doors opened and Will yelled, “We need a cardiologist. She’s in tamponade and she’s already arrested once.”
“We’re on it,” someone yelled, and then Lily was out of the chopper and being transferred onto an ER gurney and surrounded by the first Great Falls team. The second team took the handover of their paraplegic patient, and then Millie started walking toward the hospital doors, wanting to check on Lily.
Will’s hand gripped her shoulder, stalling her progress. “Kelli needs us back in Bear Paw to transfer Colton to the ICU here. Apparently, when she opened him up, she found half his circulating volume in his peritoneum.”
“What about Lily?”
He gave her a sympathetic look. “Our job was to get her here alive, and we did that.” He shuddered. “Just. We’ll check on her when we come back with Colton.”
She wasn’t used to such short patient contact, and she wasn’t sure she liked having to hand them over so quickly. “What about Jade and Ed?”
“Both in theater in Billings,” he said, sounding very Australian. “Sorry, they’re both in the OR. We’ll get an update when they’re out. Come on.” He spun around and marched straight back to the chopper with his shoulders rigidly straight—one hundred percent the ER physician.
She shoved a handful of fruit snacks into her mouth, along with some almonds and raisins, and ran back to the chopper.
“DO we dare believe it’s over?” Millie asked Will, leaning into him as they walked into the guesthouse.
It was six hours since the first emergency call, but it felt like twelve. It also felt like it should be dark, but this was Montana in the summer, and it was light past ten. They’d flown five flights, but finally they were back in Bear Paw, and exhaustion clawed at her. She didn’t want to think about what she looked like, although she had a fair idea, if Will was anything to go by. His hair stood up in jagged spikes, hauled up by frantic fingers seeking inspiration, and deep lines of concentration underscored his eyes, half b
uried in black smudges.
Will closed the door behind them and then stroked her hair. “We’ve been signed off until eight o’clock tomorrow morning. Any other emergencies tonight will be handled by another team.”
She rested her head on his shoulder. “Thank God for that. I don’t think I had another run in me. It was a tough day.”
“I’ve had worse,” he said in a clipped tone so unlike his usual relaxed manner.
She’d caught glimpses of a new Will today—one where the laid-back guy vanished momentarily, like when he’d stood stock-still in the pasture as if he’d been there once before. She guessed he’d seen a lot of awful stuff over the years. “What was your worst day ever?”
“You don’t want to know.”
“I do.”
He shook his head. “Mils, it’s been a shit of a day. Let’s not add to it by revisiting past disasters, okay?”
Only it wasn’t a question—it was a very firm statement, and his clenched jaw left her in no doubt that nothing she said would change his mind. As much as she was interested in hearing and learning from his experiences, she got his point and decided not to push it. “Another time, then.”
“Hmmm.” It came out low, sounding more like I don’t think so rather than Sure thing. She was about to say something when his hand ran up into her hair, his fingers pressing firmly into her scalp in a recognizable prelude to sex.
She found herself pushing her head back against his fingers, loving the massage, and the pressure derailed her thoughts along with the faint reminder that now they’d been having great sex for a week, perhaps they should have the conversation, Is this just a summer thing?
She snuggled into his chest. “I’m so tired I can’t decide what I want more: the hot tub, dinner or bed.”
“I can help you make that taxing decision,” he said, a sexy twinkle sparkling in his eyes, replacing his previous intransigent look.
“Can you, now?”
“Oh yeah.” Gazing down at her, he cupped her cheeks with his large hands and gently moved his thumbs in small circles. The slight roughness of his thumb pad against her soft skin sent shivers of anticipation skating through her. Slowly, he lowered his mouth, his wide and generous lips seeking hers, but that was where slow stopped. His kiss invaded her mouth with urgency and a desperate energy that belied his fatigue.