by Sarah Morgan
Talking about sex had made her think about sex, and thinking about sex had made her—
Oh for crying out loud!
‘Apparently the paramedics reported that the patient has some respiratory problems,’ she said crisply, keeping her head in the cupboard for slightly longer than was necessary to give the colour in her cheeks time to fade, ‘so I thought it might be wise to have a thoracotomy pack ready.’
‘Good.’ But there was a sharp edge to his voice that made her wonder whether she was about to become another casualty of his legendary high standards.
The doors to Resus flew open and the patient arrived along with the rest of the trauma team.
Swiftly and smoothly they transferred the patient onto the trolley and Stefano Lucarelli took charge, demanding silence from the entire team with a single sweeping glance.
He had presence, Liv admitted to herself, as each person around the trolley quietly busied themselves with their allotted tasks, while listening to the paramedic’s handover. He was confident, but he didn’t swagger like Greg Hampton, one of the more junior doctors. But neither was he as approachable like Phil, the other casualty officer who was currently looking for a vein in the patient’s arm.
Working on automatic, Liv attached BP, cardiac and oximetry monitors to the patient and the paramedic collected his own equipment and left the room.
Stefano glanced at the monitor, a frown on his handsome face as he swiftly assessed the readings. ‘Phil, put in two lines and send blood for immediate cross-matching. I want all clothes covering the front and sides of the chest removed.’ He had an unmistakable air of authority that communicated itself to all the staff in the room and Liv cut through the man’s clothing and reached for warm blankets to prevent him developing hypothermia.
‘His respiratory rate is thirty-eight and it’s very shallow.’
‘He’s in respiratory distress.’ Stefano examined the man’s chest and Liv noticed that Phil was watching out of the corner of his eye. Although he’d only been working in the emergency department for a few months, Phil soaked up information and never missed an opportunity to learn.
And there would be plenty to learn from Stefano, Liv thought, watching the way he examined the patient.
‘There’s a great deal of bruising,’ she murmured, looking at the purplish marks on the man’s ribs and Stefano looped the stethoscope round his neck.
‘He has diminished breath sounds and decreased chest expansion.’ Working with a cool, calm sense of purpose, he finished examining the man’s chest. ‘He has a clinically significant haemothorax. Call the trauma surgeon and ring the operating theatre co-ordinator and warn them. He might need a thoracotomy to drain it. Let’s do a chest X-ray.’
The radiographer responded immediately. Like a carefully choreographed ballet, everyone worked simultaneously, carrying out his or her own clearly delineated roles.
‘I need a hand here, Liv.’ Phil was struggling to find a vein and Liv stepped forward to help. The more junior doctor slid the cannula into the vein and breathed an audible sigh of relief. ‘OK, I’m in. Let’s tape this, before we lose it.’ Beads of sweat had formed on his forehead and his gaze flickered to Stefano. ‘Wouldn’t he have distension of the neck veins or raised jugular venous pressure if he had a haemothorax?’
‘He’s hypovolaemic.’ Stefano’s eyes stayed on the monitor. ‘If you look closely at the patient, you’ll see that there is a degree of tracheal deviation. Do we have two lines in, yet?’
‘One. I’m just sending blood for cross-matching.’
‘Get that second line in now. I need two lines before I put in a chest drain.’
Phil handed the bottle to Liv and then turned back to the patient to deal with the second IV.
‘His veins are terrible,’ he muttered after a few minutes. ‘The first one was fine, but I’ve failed twice so far on this side. Do you want to have a go?’
Stefano stepped towards him. ‘Turn his arm over. Bene. Cannula.’ He held out a lean, strong hand and Liv passed him the equipment he needed, watching in silent admiration as the consultant slid the needle into the vein with no apparent effort.
He made the seemingly impossible look easy, she thought wistfully and clearly Phil thought the same thing because he shot her a rueful glance.
‘The X-ray is up,’ the radiographer said and they all turned to study the screen.
‘There’s no visible fluid level,’ Phil murmured and Stefano’s eyes narrowed, his gaze fixed intently on the screen.
‘Because with the patient in the supine position the blood collects under the affected lung. If you look, you can see blurring of the hemidiaphragm contour. I’m ready to put in the chest drain.’ He turned towards her. ‘Liv?’
He knew her name?
Liv taped the cannula to make sure they didn’t lose the second line. Did he also know that she hadn’t had sex for four years? ‘Sue will assist you with the drain.’ Her hands occupied, she glanced towards her colleague. ‘There’s a sterile pack behind you. I got it out earlier.’ Then she turned back to Phil. ‘That blood needs to be given through the rapid infuser,’ she reminded him. ‘It needs to be warmed.’
‘Sue can help Phil. I want you to assist me.’ The sudden bite in his tone left no room for argument so Liv simply stepped aside so that Sue could take her place, quietly instructed her to call the operating theatre and the trauma consultant and then opened the sterile pack herself.
Suddenly she found that her hands were shaking and she shook her head, exasperated with herself. All right, so he’d already demolished Rachel—he obviously had high standards, but so did she! She had no reason to be nervous.
Working quickly, Liv opened the cannula that she knew he’d need, but he was already one step ahead, his movements so swift that it required all her concentration to keep up.
For a terrifying moment she almost lost her nerve. She’d never worked with anyone quite as talented as him before and the sheer speed and skill of his fingers left her dragging behind. Fortunately her own natural ability asserted itself.
Don’t think about him, she told herself firmly. Think about the job.
She kept her gaze fixed on those long, bronzed fingers, every nerve and muscle in her body tense as she focused on what he was doing.
Not once did he hesitate or pause. His fingers were precise and steady as he cleaned the skin, injected local anaesthetic and then aspirated the syringe to confirm the presence of blood.
It was no wonder he demanded the best from those around him, Liv thought as she handed him the scalpel and watched him incise the skin down to the rib with astonishing speed and precision. He was a master, and it was obvious that he wasn’t satisfied with anything less than accuracy.
His handsome face blank of expression, he slid a gloved finger into the pleural cavity, checking the position of the incision. ‘I’ll want a 36F tube. Have it ready.’
‘Roberts forceps.’ Without being asked, Liv handed him the instrument she knew he’d need next and watched as he slid the drain into position through the track he’d made. Then he attached the tube to an underwater seal drainage system.
‘That’s a large tube he’s used,’ Phil muttered and Liv glanced at him briefly.
‘It has to be of sufficient calibre to drain the haemothorax without clotting. And if the haemothorax doesn’t drain, there’s a risk of infection.’ Her attention back on Stefano, she reached for the suture. ‘Zero gauge suture.’ She held it out to him and he took it immediately, their movements smooth and synchronised even though they’d never worked together in Resus before.
He inserted a purse-string suture to secure the drain and then glanced at the monitors again.
‘I want another chest X-ray so that I can check the position of the drain.’
The radiographer hurried over and as they shifted the patient and took the X-ray, Phil glanced at the drain.
‘He’s losing a lot of blood. Should we clamp the tube?’
Stefano shoo
k his head. ‘Clamping the tube has no effect on the amount of haemorrhage—the blood just collects in the chest and further compromises respiratory function.’
‘Mr Lucarelli? The X-ray is up on the screen,’ the radiographer said and Liv glanced up as the door suddenly opened and Anna walked into the room.
‘His wife’s arrived. I’ve put her in the relatives’ room,’ she said. ‘Can someone find a moment to talk to her?’
Liv glanced towards Stefano Lucarelli but the consultant was staring at the X-ray, his handsome face unsmiling and his concentration absolute. He’s young, she thought, looking at his masculine profile and dark glossy hair. Young to be in such a responsible position. His strong legs were planted firmly apart, the thin cotton of the scrub suit skimming wide, muscular shoulders, his dark head tilted slightly as he studied the screen. He was staggeringly good-looking, confident and very much in control.
Realising that she was staring, Liv looked away quickly and caught Anna’s speculative glance.
Her friend gave her a wide smile. ‘I can see everything is going well in here.’
Liv glared at her. ‘We’ll talk to his wife in a minute, Anna.’
Stefano turned. ‘We’re waiting for the trauma surgeon. When the patient is stable and they’ve decided on the next step, I’ll talk to his wife.’
Phil studied the drain again. ‘He’s drained 1000 mils.’
‘The initial volume of blood drained is not as important as ongoing bleeding.’ Stefano looked up as the trauma surgeon strode into the room.
The two men conferred although Liv could see that the entire conversation was driven by Stefano Lucarelli.
Clearly his reputation was as formidable as his clinical skills because the senior trauma surgeon seemed only too happy to listen to his advice.
‘I don’t want to perform a thoracotomy unnecessarily.’
‘I’ve used a large enough tube and it’s positioned well.’ Stefano glanced at the drain as if daring it to misbehave. ‘It will drain the haemothorax. Admit him for observation, monitor the drainage output over the next four to five hours. If he loses more than 200 to 250 mils of blood per hour, take him to Theatre. I’m going to talk to his wife. Liv, come with me.’
Liv blinked. ‘I—Yes, of course.’
She was about to make a mild comment about his dictatorial style when he looked at her, his gaze frank and direct. ‘You’re an excellent nurse. When I’m in Resus, I want you with me.’
‘Oh…’ The compliment was so unexpected that hot colour flooded her cheeks but she was saved the bother of replying because they’d reached the door of the relatives’ room.
Without pausing, Stefano opened the door and strode into the room, leaving Liv to follow. She closed the door behind her, braced for him to open his mouth, put his foot in it and then walk out leaving the patient’s relative distraught, a scenario she’d witnessed on all too many occasions with other doctors.
But instead of fumbling for words and making the quickest possible exit, he walked across to the patient’s wife and sat down next to her. ‘I am Stefano Lucarelli, the consultant. I’ve been looking after your husband.’ He held out his hand and the woman shook it and gave a wobbly smile.
‘I’m Helen Myers.’
‘This has been a shock for you, I know.’ He spoke in a deep, velvety voice that held equal amounts of confidence and sympathy. ‘I am sorry I couldn’t speak to you earlier, but your husband was my priority.’
‘Of course—I understand.’ The woman was white with shock, her eyes pink from crying. ‘Is he—is he going to be all right?’
‘He was kicked in the ribs and that kick has damaged his lung.’ In simple, easy-to-understand terms, Stefano gave her the facts, explaining what had happened and the treatment he’d given so far. He kept it short and non-technical. ‘Tim has been transferred to Intensive Care. They are going to monitor him and, if necessary, they will take him to Theatre and drain the blood clot.’
Tim? Liv blinked. She hadn’t realised that he even knew the patient’s name.
‘Oh God, I can’t believe this is happening. I saw him at lunchtime and we were making plans for Christmas. We were going to take our two girls to Lapland to see Santa Claus.’ The woman sat still for a moment and then her face crumpled and she started to cry. ‘I’m sorry, I’m really sorry, it’s just that it’s such a shock.’
Reaching for a box of tissues, Liv sat down on the other side of the woman and waited for Stefano to leave so that she could offer whatever comfort she could. But instead of leaving the room as fast as possible as most of his colleagues would have done, Stefano leaned across and took a tissue from the box.
‘Don’t apologise. It is hard for you, I know. Here.’ He handed the woman the tissue. ‘You mentioned that you have daughters? So who is looking after them now?’
‘My mother.’ Helen blew her nose hard. ‘I called her as soon as I got the news. I didn’t want to bring the children here. I’m sorry. You don’t want to listen to this. I know how busy you must be. You have much more important things to do than talk to me.’
‘At the moment, talking to you is the most important thing,’ Stefano said calmly, his gaze not shifting from her face. ‘Is there anything else you want to ask me?’
Helen gave a choked laugh. ‘I want to ask you if he’s going to be all right, but you can’t tell me that, can you?’
‘Not at this stage,’ Stefano said honestly. ‘The consultant in Intensive Care will be able to give you a better idea in a few hours.’
He was good, Liv thought to herself. Really, really good. He was honest, didn’t give false hope and didn’t try and escape from the emotions in front of him. And despite the workload pressing down on him, he seemed to really care.
‘Liv will stay with you for a few minutes,’ Stefano said, ‘and then she will ring ICU.’
Liv gave an inward smile. He was also controlling. ‘Once they have him settled, I’ll take you up there,’ she assured Helen and the woman blew her nose again.
‘Thanks. You’ve been incredibly kind, both of you.’ Tucking her handkerchief up her sleeve, she tried to smile. ‘Men. Why must they play these dangerous sports?’
Stefano rose to his feet, a sardonic smile touching his mouth. ‘We are incomprehensible, no? Blame it on testosterone.’ Suddenly he sounded very Italian and Liv felt her insides tingle.
She found herself wondering if some glamorous, skinny woman was at that moment lying naked in his enormous bed, waiting for his return.
Horrified by the direction of her thoughts, she rose to her feet. ‘I’ll make you a cup of tea, Helen,’ she said quickly. ‘And then I’ll find out what’s happening in ICU.’ And while she was at it, she was going to bang her head against the wall a few times to try and reprogramme her thoughts back to the place they’d been before the conversation with Anna.
Why on earth was she envying a woman she hadn’t even met for having something that she didn’t even want?
She was definitely losing her grip.
CHAPTER TWO
‘MUMMY, can we have a really big Christmas tree this year? Up to the roof?’
‘Absolutely.’ Liv tried not to dwell on just how much ‘really big’ was going to cost. Maybe if she waited until Christmas Eve she could negotiate a bargain. ‘How was school today?’
‘Fine. I want to get our tree at the weekend.’ Max scrambled onto a chair and spread his toy dinosaurs over the kitchen table. ‘Then we can enjoy it for ages and ages.’
‘It’s only December the first. ‘If we buy it on Saturday it will have no needles by Christmas.’
‘If we don’t buy our tree till Christmas Eve we won’t have time to have fun with it. Sam is getting his tree next weekend. Can we? Please?’ Max looked up at her hopefully and Liv felt something shift inside her.
‘We’ll see,’ she said gruffly, promising herself that she’d sit down with a pen and paper once he was asleep and take a serious look at her budget. ‘I love you. Have I told
you that, lately?’
‘Every day. You’re always telling me that.’
‘Are you complaining?’
‘Nope.’ Max picked up a plastic tyrannosaurus. ‘I love you, too. It snowed again today, but not much. I want there to be piles and piles. Wouldn’t that be great?’
Seeing the sparkle in her son’s eyes, Liv forgot about the havoc that snow always caused. ‘Fantastic.’
‘Ben broke his leg yesterday.’ Lower lip between his teeth, Max crashed the tyrannosaurus into a less superior species and sent it flying. ‘He went to the hospital and they gave him crotches.’
Liv hid a smile. ‘Crutches,’ she said, spreading creamy butter onto crusty bread, ‘it’s crutches.’
‘That’s what I said. I told him my mum works in the hospital, but he said he didn’t see you there. You won’t work on Christmas Day, will you?’
Liv felt her heart flip. Every year she faced this dilemma. The money was good and in her situation that was incredibly tempting, but working Christmas meant not being with Max.
‘I’m not working,’ she said firmly, putting the plate on the table next to Max. It didn’t matter how tight her finances were, nothing would make up for not spending Christmas Day with her son. ‘I’ve saved up my holiday. I have a whole week off. I might work on New Year’s Eve, but not until you’re in bed.’
‘So I’ll do a sleepover with Sam?’
‘Maybe. I’ll have to speak to Anna.’ Liv filled the kettle, wondering what she’d do if her friend and colleague hadn’t had a child the same age as hers.
‘Cool. I love sleeping over with Sam.’ He looked at her, his eyes sparkling. ‘Do you know what the best thing is about his house?’
No, but she could guess. Liv’s heart plummeted as she thought of Sam’s house, with its five large bedrooms, three bathrooms and huge garden. Then her eyes scanned the tiny living room of her cramped flat. If she stood in the middle, she could almost touch all four walls. And although she had two bedrooms, one of them was so small it would barely accommodate a single bed. And when the train went past the entire flat shook…