by Sarah Morgan
Instead of falling into his arms and treating his announcement with the misty-eyed delight that he’d expected, she merely looked at him, visibly unenthusiastic at the prospect of resuming their relationship.
Uncomfortably aware that nothing was going according to plan, Jago suddenly found himself in the novel position of not knowing how to handle a woman. After that kiss he’d assumed that they’d be resuming their relationship as soon as she’d ended her engagement to Freddie. But there was something disturbingly discouraging about the expression in her blue gaze.
‘Up until twenty-four hours ago you believed me capable of sleeping with another man, even though I’d told you that I was in love with you.’ Her tone was cool and controlled. ‘You told me yesterday that your barest minimum requirement in a relationship is fidelity. Well, mine is trust, Jago. I absolutely cannot be with a man who doesn’t trust me.’
Jago sucked in a breath. ‘I already explained what happened.’
‘And that’s supposed to make it OK?’ Her voice shook slightly and he realised that she wasn’t quite as cool as she was making out. ‘You didn’t trust me, Jago. I doubt that you’ve ever trusted anyone. You move on before you can get close to a woman.’
Thoroughly discomfited by her blunt appraisal, he took refuge in attack. ‘You still want me, Katy. Do you think I didn’t feel it when we kissed last night?’
‘A relationship has to be based on more than kissing. I’m not interested, Jago.’ Her grip on the flowers tightened. ‘We might have to work together, but I don’t want anything else.’
And with that parting shot she walked off, leaving him to come to terms with the fact that for the first time in his thirty-five years, a woman had chosen to walk away from him.
He wanted her back.
Katy stuffed the flowers in water so that they didn’t die before the end of her shift and slipped the card into her pocket with shaking fingers.
She wondered what Jago would have said had he known that they weren’t from Freddie at all but from Alex, whom she’d spoken to on the phone the night before. And it was Alex she was having dinner with. Alex and Libby.
In fact, his hasty assumption that she hadn’t broken up with Freddie was yet another indication of Jago’s jaundiced view of her sex. He was assuming that, despite the kiss they’d shared, she was still going ahead and marrying another man.
She wondered what had happened in his life that made him so cynical about women.
It showed that he still knew very little about her. She would never do a thing like that.
She would never kiss one man and then marry another.
And that was the reason she’d ended her engagement to Freddie the evening before.
She felt slightly guilty about not telling Jago but she hadn’t actually lied, she reassured herself. She just hadn’t told the whole truth.
And why should she?
Jago didn’t love her. All he wanted was a physical affair and she knew that pursuing a relationship with Jago would be a quick route to another broken heart. They just didn’t want the same things in life. So surely she was right to protect herself?
She walked out of the staffroom, reflecting that breaking up with Freddie had been surprisingly painless. Even though initially he’d seemed a little startled by her announcement that she couldn’t marry him, he’d accepted it with a readiness that suggested that he’d been having second thoughts about the wedding himself. She just wished that telling her parents would prove as easy.
She needed to pick the right time to do it but it had to be soon, otherwise they’d hear from other sources.
The morning was incredibly busy but she successfully avoided Jago until lunchtime when the doors to the ambulance bay crashed open and the paramedics rushed in with a small girl on the stretcher.
‘This is Molly Churchman. She’s two years old and she fell out of the bedroom window,’ the paramedic told them, his expression tense and anxious. ‘Bedroom on the first floor—the mother is hysterical.’
Jago reached for the oxygen mask and positioned it carefully over the child’s mouth and nose. He watched carefully, nodding with satisfaction as he saw the mask fog.
‘Her airway is patent and she’s breathing by herself,’ he growled. ‘I want two lines in and I need an estimation of her weight.’
Katy wondered whether it was the sick child or their earlier confrontation that was responsible for the grim expression on his handsome face and the tension in his broad shoulders.
It was probably the child, she decided. Their relationship couldn’t possibly be that important to him.
Charlotte looked up. ‘I asked the mother about her weight but she was too upset to give me a lucid answer.’
‘In that case, use the Oakley Paediatric Resuscitation chart on the wall,’ Jago instructed, and one of the other nurses hurried to do that while he carried on assessing the child. ‘Cervical spine injury is rare in a child of this age but we’ll keep the spine immobilised until we’ve ruled it out.’
There was a flurry of action and Annie came back from examining the chart on the wall. ‘Estimated weight is about 12 kilograms.’
‘Right. Charlotte, make a note of that. Annie, go back to the mother,’ Jago ordered, ‘find out if the child cried immediately—I need to know whether she was unconscious for any time. And get me details of allergies, medications, past medical history and when she last ate or drank. And try and get a more precise account of the accident. What surface she landed on, how she was lying—that sort of thing.’
Annie hurried off to do as he’d instructed and Jago spoke quietly to the little girl, reassuring her in a gentle voice as he worked.
Charlotte was visibly upset as she undressed the child so that they could make a more accurate assessment of her injuries.
‘She’s so tiny. That poor mother.’
‘Lose the emotion,’ Jago said harshly. ‘We’ve got a job to do. Finish undressing her and get some overhead heaters and warming blankets—a fall in body temperature causes a rise in oxygen consumption.’
Charlotte swallowed and looked at him, startled by the sharp reprimand.
Katy felt a flash of empathy for her colleague but she knew that Jago was right.
It wouldn’t help the child if they let emotions get in the way of their work. The child needed them to be professional.
But there was no doubt that Jago was unusually tense.
They removed all her clothes and then covered her in warm blankets and adjusted the heaters so that she wouldn’t become cold.
With the minimum of fuss, Katy found a vein and slipped in the cannula.
‘Her blood pressure is slightly down,’ one of the nurses said, ‘but not dramatically.’
‘Check her capillary refill time,’ Jago ordered, and Katy finished taping the first IV in place and glanced up at him.
‘Is that significant?’
He gave a brief nod. ‘A child can suffer considerable blood loss without a significant change to the vital signs,’ he told her, his eyes fixed on her fingers as she searched for another vein. ‘When we diagnose shock in children we rely on other signs, like capillary refill time, the appearance of the skin, the temperature of the extremities.’
‘Based on those criteria, this child is in shock,’ Katy murmured, pausing as she located what felt like a vein.
Without hesitating, she inserted the cannula smoothly and watched as the blood flowed backwards.
‘Both lines are in,’ she said quickly, relieved that she’d managed what had proved to be a difficult task. Finding veins in a child that small was difficult at the best of times and sometimes they had to give an infusion directly into the bone.
The child had barely protested, which was another indication of how ill she was.
‘That was a tricky job.’ Jago’s voice was gruff. ‘Well done.’
For a brief moment their eyes met and he gave a slight smile. The tension in the room seemed to ease slightly but there was a hint of ch
allenge in that smile that made Katy breathless.
The subject of their relationship was obviously far from closed.
She picked up a selection of blood bottles. ‘I’ll take bloods for group and cross-matching, blood-glucose estimation and request a full blood count and biochemistry. Anything else?’
Jago shook his head. ‘No, but we need to get her some pain control.’
‘Her skin is very cold and clammy and her capillary refill time is prolonged,’ Charlotte said quietly, and Katy bit her lip as she took the bloods and administered the pain relief that Jago had ordered.
‘She’s very lethargic,’ Jago murmured, his eyes never leaving the child as he worked. ‘She’s showing all the features of class III shock. I want to give her 20 milligrams of crystalloid per kilogram. Do the calculation, Katy.’
Katy did as he ordered and warmed the fluid before injecting it into the child’s vein.
Jago carried on examining the limp, unresponsive body of the toddler. ‘She’s bleeding from somewhere and we need to find out where. Check her pulse and blood pressure again,’ he ordered, glancing at Charlotte as he spoke. ‘I’ve got a bad feeling about this. Bleep the surgeons and get me some blood up here fast. If her vital signs don’t improve in the next few minutes I’m going to transfuse her. Can we get a nasogastric tube down, please? And I want X-rays of her chest and pelvis.’
Katy looked at the tiny body on the trolley and, despite Jago’s warnings about becoming emotional, she felt a lump in her throat.
The little girl was so tiny and helpless. No wonder the mother was hysterical. She would have been hysterical if it had been her child who was lying there injured.
They had to save the child. They just couldn’t let her die.
A niggling suspicion entered her head and she opened her mouth to speak and then closed it again.
‘What?’ Jago’s tone was sharp. ‘You were going to say something.’
Katy hesitated. ‘I was wondering whether it could be her spleen,’ she said quietly, ‘but there’s no clinical reason to imagine that it could be. Just a gut feeling.’
‘Never dismiss gut feelings.’ Jago looked at her and then returned his attention to the child, his expression thoughtful. ‘It would explain the degree of shock in the absence of visible injury.’
Annie returned, having interviewed the mother in more depth, and she gave a full report to Jago who had examined the X-rays and now had his eyes fixed on the abdominal ultrasound.
‘She’s bleeding into her abdomen,’ he muttered, and Carl, one of the other junior doctors, looked at him questioningly.
‘But her abdominal wall is barely bruised.’
‘That isn’t a reliable sign in children.’ Jago didn’t look up. ‘She’s showing signs of abdominal injury. I think Katy is probably right. It’s her spleen.’
Carl rubbed a hand over the back of his neck. ‘So we need to get her to Theatre urgently?’
‘Not necessarily.’ Jago shook his head. ‘We tend to avoid surgery and adopt a conservative approach where possible. The spleen is the most commonly injured organ following blunt trauma to the abdomen, then the liver and kidneys.’
‘If it is her spleen, will they try leaving it to heal by itself?’ Katy frowned, racking her brains to recall the detail of something she’d seen in a medical journal. ‘Didn’t I read something recently that suggested that removing the spleen can result in significant long-term health problems?’
‘That’s right.’ Jago nodded. ‘It’s very unusual to remove the spleen these days.’
Charlotte checked the child’s vital signs again. ‘I think she’s improving. That fluid is helping.’
At that moment the doors opened and the surgical team swarmed into Resus.
They conferred with Jago, checked the abdominal ultrasound and examined the child carefully.
‘I think you’re right,’ the consultant said finally, glancing at Jago with a slight smile. ‘I’d say she has a small tear in her spleen.’
Jago glanced at Katy and a slight smile touched his firm mouth. ‘It was Dr Westerling’s diagnosis,’ he said softly, and the consultant gave her an approving nod.
‘In that case, well done to you, Dr Westerling. We’ll get a CT scan and take it from there. If her signs continue to improve, we’ll manage it conservatively. Are the parents with her?’
‘The mother’s in the relatives’ room,’ Jago said, ripping off his gloves and dropping them in the bin. ‘I’m going to speak to her now. Katy, you can come with me as this seems to have turned into your case.’
Warmed by his approval, Katy blushed slightly. Despite his encouraging comments, she was well aware that it was he who had saved the child.
‘Do you think she’s going to live?’ Katy quickened her stride to keep pace with him as he strode out of Resus and made for the relatives’ room. She’d never been assigned the task of talking to relatives before, and was relieved that he was there to do it with her.
Jago pulled a face. ‘Because children are so small, a fall like that can cause multisystem injury. You have to assume that they have multiple injuries until proved otherwise. If it’s just a small tear to her spleen, she should recover fully.’
‘You were so calm.’
He cast her a wry smile that was thoroughly unexpected. ‘Not that calm.’ He paused for a moment, his dark eyes resting on her face. ‘I have feelings, too, you know.’
She looked at him, breathless, wondering whether he was just referring to Molly.
‘But you don’t show them.’
He lifted a broad shoulder in a shrug. ‘How would that help the child? The patient needs me to be detached and efficient. Emotion clouds judgement, Katy. Remember that.’
He gave a twisted smile and suddenly she knew what he was thinking.
That emotion had clouded his judgement eleven years ago when he’d seen those photographs.
And in a way, wasn’t it the same for her?
She knew that loving Jago was a quick road to heartache but she just couldn’t help herself. He was drop-dead gorgeous and seeing him save a child’s life with such impressive skill and supreme coolness made her want to surrender to him on the spot.
She studied him helplessly.
Everything about him was just so masculine. From his straight, aristocratic nose and perfect bone structure to the blue-black stubble beginning to show on his hard jaw, he was one hundred per cent red-blooded male and she realised with a sinking heart that she’d never stopped loving him.
Realising that they’d reached the relatives’ room, she jerked her eyes away from his sinfully sexy mouth and tried to concentrate.
‘Don’t you usually take a nurse with you to do the gentle, caring bit?’
He dealt her a sizzling smile that cranked her pulse rate up still higher. ‘Why do you think I’ve brought you along?’
Without waiting for her reply, he pushed open the door with his shoulder and extended a hand to the woman sitting slumped in one of the armchairs.
‘Mrs Churchman? I’m Mr Rodriguez, one of the A and E consultants. This is Dr Westerling. We looked after Molly in the resuscitation room.’
Katy closed the door behind them and went to sit beside the mother, concerned that she looked so distraught. Annie had told them that she hadn’t even wanted to see her daughter in the resuscitation room.
‘I’ve killed her. I know I’ve killed her.’
She started to sob hysterically and Katy glanced at Jago, expecting to see him tense and uncomfortable in the face of such hysterics. Instead, he frowned in concern and hunkered down next to the sobbing woman, taking her hand in his.
‘You haven’t killed her, Mrs Churchman.’ His voice was warm and firm. ‘She had a bad fall and she is suffering from some internal injuries but she is doing very well at the moment. We’ve transferred her to the children’s surgical ward for some more tests and observation.’
The young mother looked at him, her chest jerking as she tried to hold ba
ck the sobs. ‘She climbed out of the window.’
Jago nodded. ‘So I understand.’
‘I didn’t even know she could reach the window,’ Mrs Churchman whispered, horror in her voice as she related the tale. ‘She pulled up a chair and climbed onto the window-sill. I was changing her bed at the time and I’d only nipped out for a moment to fetch a clean sheet. I must have been out of the room for less than thirty seconds, no more.’
She gave another sob and Katy reached for a box of tissues. ‘Being a parent is the most difficult, responsible job in the world,’ she said quietly. ‘What Molly needs now is not for you to feel guilty but for you to be there for her. She needs her mother.’
Mrs Churchman blew her nose and nodded. ‘You’re right, I know you’re right. But seeing her lying there as if she was dead just upset me so much.’
Jago frowned. ‘She isn’t dead, Mrs Churchman.’ He went on to outline Molly’s injuries and treatment in a cool, factual way and eventually the young mother seemed to gain some measure of control.
‘Can I see her now?’
Katy nodded. ‘When you’re ready, one of the nurses will take you to the children’s ward and you’ll be able to stay with her. Is there anyone you’d like us to call to be with you?’
Mrs Churchman shook her head and reached for her bag. ‘No. Her father is away on business and I don’t want to worry my parents with it. I’ll be fine now.’
Looking at her pale face, Katy wasn’t so sure and she made a mental note to check on her later.
Leaving Mrs Churchman to gather her belongings together, they left the room and Katy arranged for a nurse to escort her to the ward.
‘I’m glad you were there,’ Jago said dryly as they walked back towards the main area of the A and E department. ‘Dealing with hysterical females is not my strong point.’
She smiled at him. ‘I thought you were brilliant.’
‘Well, thank you,’ Jago drawled softly, pausing as one of the other casualty officers waylaid him to ask his opinion on an X-ray.