The Surgeon's Engagement Wish

by Alison Roberts

  She’d seen so many and varied emergencies coming through those automatic doors into Ocean View’s A and E department she could cope with anything.

  Mind you, the car that had come through those very doors recently had been one out of the box, but it hadn’t been nearly as alarming as what she was now seeing.

  ‘Luke!’ Maureen dropped the file she was holding and ran towards the surgeon. It wasn’t until she met him halfway across the tiled reception area that she recognised the face on the limp figure he held in his arms. ‘It’s Beth,’ she cried in horror. ‘What’s happened?’

  Luke kept moving towards the resuscitation rooms. ‘I found her standing in the middle of the road just outside the car park. She looked totally out of it and then collapsed. Completely unresponsive, and I can’t find a radial pulse.’

  He laid his burden down on the bed with extraordinary care. It was good clinical practice to tilt Beth’s head back and maintain an open airway, but Maureen had never seen a doctor brush loose strands of hair from a patient’s face quite like that. Not that this was the time to process such information.

  ‘She’s tachypnoeic.’ Maureen estimated the rate of Beth’s shallow breathing to be well above normal. Close to forty breaths a minute probably. ‘I’ll get some oxygen on.’

  Luke had pushed up the loose sleeve of the old pullover to wrap a blood-pressure cuff around Beth’s upper arm. ‘Where’s Mike?’

  ‘In the small theatre, cleaning out a dog-bite wound.’ Maureen slipped an oxygen mask over Beth’s face, turned the flow up to ten litres and clipped an oxygen saturation probed over a finger. She could feel the clamminess of Beth’s skin and her anxiety level increased sharply as she noticed what looked like a touch of cyanosis darkening the younger nurse’s lips. ‘I’ll get him,’ she said tersely.

  Luke simply nodded, his gaze fixed on the mercury slipping down inside the sphygmomanometer. ‘Unrecordable,’ she heard him mutter as she left the area swiftly. ‘My God, Beth…what’s going on here?’

  Maureen returned with Mike seconds later, a house surgeon right behind them, having left Chelsea to complete the dressing and bandaging of the dog-bite wound.

  ‘She’s in shock,’ Luke informed the emergency department consultant. ‘Tachycardic at 130, BP is unrecordable and her oxygen saturation is down to ninety-four per cent.’

  ‘What happened?’

  ‘We don’t know.’

  ‘She was out with that whale rescue last night, wasn’t she?’

  It was Maureen who answered. ‘I took her home about seven o’clock this morning. She said she was just very tired but she didn’t look well.’ She picked up a pair of shears. “She was very pale and she had refused anything to eat or drink before we left.’ Maureen was cutting away the pullover. ‘She hasn’t even changed her clothes. These are the dry ones I gave her at the beach.’

  ‘Was she injured in any way?’ Mike had his stethoscope on Beth’s chest.

  ‘She didn’t appear to be when I spoke to her last.’ Luke caught Maureen’s glance and looked away hurriedly. Did he know she had seen him kissing Beth? That the way they had been clinging to each other had suggested the embrace had been far more significant than the celebratory gesture Beth had made it out to be? ‘She was very cold,’ Luke said quickly, ‘but we all were by then.’

  ‘Equal air entry and no sign of trauma, but she sounds congested.’ Mike slung the stethoscope around his neck and reached for a tourniquet. ‘Let’s get Kelly through for a chest X-ray. This could be a pulmonary embolism.’

  It took several seconds for Mike to successfully locate a vein on Beth’s arm and he shook his head. ‘She’s completely shut down. Start another IV on the other side,’ he instructed the house surgeon, Seth, ‘and get some fluids running. Maureen, I need some blood tubes. A full biochemistry screen to start with and…’ Mike frowned. ‘Let’s do a coagulation profile and cultures as well. She could well be septic. What’s her temperature?’

  Maureen put the kidney dish full of blood-test tubes on the bed beside Mike. ‘I’ll find a thermometer.’

  ‘Is she wearing a medical alert bracelet?’

  ‘No.’

  The radiographer arrived to take the chest X-ray and the other staff members moved briefly behind the lead-lined screen.

  ‘Does anyone know anything of her medical history?’ Mike asked. ‘Luke?’

  Maureen was holding the tympanic thermometer she hadn’t had a chance to use yet. ‘She’s never said anything but, then, she’s only been here for a short time, hasn’t she?’

  ‘I knew her years ago, Maureen,’ Luke said. ‘We worked together in south Auckland. But, no, she didn’t appear to have any major health issues then.’

  Was he avoiding any eye contact with her, Maureen wondered, or was there another reason why Luke’s gaze was fixed so firmly on Beth’s still figure on the other side of the heavy glass?

  Definitely another reason, she decided on hearing him sigh almost inaudibly and watching the way he raked his hair back from his forehead with stiff fingers. She had never seen Luke look this perturbed before.

  His colleague’s distress hadn’t escaped Mike. ‘You shouldn’t be here, mate,’ he said quietly. ‘Go home.’

  Luke’s head shake was terse. ‘Not yet. Not until we know what’s going on here.’

  ‘It could take a while.’

  ‘I know that.’

  Mike cleared his throat. ‘I was sorry to hear about your brother-in-law, Luke. Early this morning, wasn’t it?’

  ‘Yeah.’ Luke’s face settled into even grimmer lines. ‘Apparently he was watching for the whales from his window. His mum said that as soon as he saw them heading out to sea, he closed his eyes and just stopped breathing.’

  Maureen’s heart squeezed. No wonder Luke was looking so perturbed. Even if his connection with Beth was not as significant as she suspected, it would still be too much of a blow to lose another young life right now. She touched Luke’s arm with a comforting gesture.

  ‘I saw Maree leaving before the refloating started. Was she there with Kevin at the end?’ She could see how hard it was for Luke to swallow.

  He nodded grimly. ‘I should have been there, too.’

  ‘Maybe you were needed just as much where you were.’ Maureen’s suggestion was soft and this time Luke’s eyes acknowledged what she had seen on the beach, but was the pain she was seeing because of his feelings for Beth? Maybe involving himself to this degree here was simply a distraction from the agony of losing his best friend and feeling that he had let Kevin down by not being there at the end.

  Mike must have sensed something of what Maureen was wondering. ‘How well did you know Beth, Luke?’

  His words gave nothing away. ‘Well enough, I guess.’

  Mike was moving in response to a signal from the X-ray technician. ‘Then do stay,’ he urged. ‘A familiar face could be just what she needs.’

  Luke was still there an hour later when the anaesthetist was called down to intubate Beth and put her onto a ventilator after the oxygen levels in her blood dropped to dangerously low levels.

  Luke’s counterpart, Ocean View’s other general surgeon, Len Armstrong, was there as well. ‘She’s not in the best shape for surgery yet, Mike.’

  ‘We can’t afford to wait,’ Mike decided grimly. ‘The dopamine infusion has at least brought her blood pressure up a bit and we’re getting some urine output, thanks to the diuretics.’ He glanced towards the ultrasound machine he had been using a short time ago to examine Beth’s now rigid abdomen. ‘We’ve started aggressive antibiotic cover but the longer that perforated appendix is in there, the harder this is going to get.’

  ‘Right.’ Len turned away. ‘I’ll head upstairs and get scrubbed, then.’

  ‘Has someone got in touch with her family yet?’

  ‘I can do that,’ Maureen offered.

  ‘No. I will.’ Luke looked grey with fatigue now. ‘And then I’ll come upstairs.’

  ‘Only as a spect
ator, mate.’ Len’s smile was clearly intended to cover a concern for Luke’s state of mind. ‘I’m the one who’s on call here, remember.’

  ‘I just need to be there.’ Luke pushed himself away from his position and paused for a second beside Beth. Reaching out, he laid the back of his fingers, very gently and very briefly, on Beth’s cheek.

  Maureen saw the glance that passed between Mike and Len. Puzzled and questioning initially and then accepting. They had even less of an idea of what might be happening here than she did but they knew that some connection existed between Luke and this very unexpected and now critically ill patient. And that connection had just markedly increased the urgency and tension of this case.

  Seven p.m. on a Friday night.

  The address was still the same but what was the chance of finding Beth’s parents at home? Luke punched new numbers into the phone, having just hung up from talking to Directory Service.

  Nigel and Celia Dawson were highly likely to be out at a social gathering of some description—if they were even in the country. They were just as likely to be somewhere else, attending one of the numerous international conferences that needed a star line-up of speakers.

  Then again, the Dawsons had to be well into their sixties by now. Maybe they had retired and were embracing a quieter lifestyle. Sure enough, the phone call was answered on its third ring by a gruff but familiar voice.

  ‘Yes?’

  ‘Mr Dawson?’

  ‘Who wants to know?’

  ‘This is Luke Savage, Mr Dawson. I’m calling from Ocean View hospital in Hereford.’

  ‘Savage? That name rings a bell. Do I know you?’

  ‘I’m a surgeon, sir.’ Old habits died hard, Luke thought wryly. Like respect for an eminent specialist. ‘I met you several years ago when I was going out with your daughter.’

  ‘Ah…’ Nigel sounded thoughtful. Or possibly disinterested.

  ‘It’s Beth I’m calling about.’

  ‘Who?’

  ‘Beth.’ Being so tired made it easier to keep his tone even. ‘Your daughter,’ he added wryly. ‘I thought you should know that she’s—’

  ‘Savage,’ the older man interrupted. ‘Weren’t you the young chap thinking of a career in cardiothoracic?’

  ‘Yes. I wanted to tell you that—’

  ‘And where did you say you were calling from again?’

  ‘Hereford.’

  ‘Where the hell is Hereford? England?’

  ‘No. Marlborough. South Island, New Zealand.’

  ‘Never heard of a cardiothoracic unit down that way.’

  ‘There isn’t one. I’m a general surgeon.’

  ‘Oh?’ The monosyllable carried a distinct edge of contempt. ‘I seem to remember you as a lad who was going somewhere, Savage. You reminded me of myself, in fact.’

  ‘I’ve got to exactly where I wanted to go, sir.’ So Beth hadn’t been the only one to pick the unsettling similarity. Luke tried to push away the weariness threatening to allow any further distraction. He didn’t care what Nigel Dawson thought of him any more and he certainly wasn’t about to start defending his career choices. ‘Right now I’m heading up to Theatre where your daughter is about to undergo surgery.’

  ‘What the hell is she doing in…Hereford, did you say?’

  ‘She’s been working in the emergency department here for a couple of weeks now.’

  ‘First I’ve heard of it. What’s she having surgery for?’

  ‘A perforated appendix. Beth is critically ill right now, Mr Dawson. She’s in septic shock and is on life support.’

  ‘Well, she shouldn’t be in a tin-pot hospital in the middle of nowhere, then, should she? Get a damned helicopter and ship her out, son. What’s the closest tertiary centre? Dunedin? Wellington?’

  ‘Beth couldn’t possibly be moved right now. She’s far too ill.’

  ‘It should have been done earlier, then, shouldn’t it? Who’s in charge down there?’

  Luke ignored the bluster. ‘We’re doing everything that can be done,’ he said firmly. ‘And we have excellent intensive care facilities available.’

  He could hear another voice in the background. A female voice, calling for Nigel. Maybe Beth’s mother would be more appropriately concerned with her child’s state of health rather than her whereabouts or finding someone to blame for her condition.

  ‘You should be able to get a commercial flight to Nelson,’ Luke said into the silent line. ‘It’ll take about ninety minutes by road from there. Otherwise there are small airlines operating out of Hereford airport.’

  ‘I can’t go to Hereford.’ Nigel sounded astonished at the suggestion. ‘I’m about to take a flight to Rome. I’m the keynote speaker at a conference that’s due to kick off in less than twenty-four hours. The taxi’s here now, as a matter of fact.’ The voice became fainter, as though the phone was being held at arm’s length. ‘I’ll be there in a second, darling.’

  ‘Perhaps I could speak to Beth’s mother?’

  ‘There’s no time for that. We’re going to miss our flight at this rate.’

  A wash of something like desperation hit Luke and he closed his eyes for a moment. Her parents were strangers, Beth had said. She had never known the kind of love Luke had been blessed with from family and friends. Could Luke ever hope to make up for that? Would she trust him enough to let him try?

  ‘Look. I’ll pass the message on.’ Nigel’s tone was dismissive. ‘I suppose I’d better try and let that young man know what’s going on as well. Or is he down there already?’

  Luke’s eyes opened smartly. ‘Who?’

  ‘Her fiancé, of course. Brent what’s-his-name. Ranger or Granger, maybe.’

  The heaviness engulfing Luke became unbearable. It was an effort to draw in a deep breath. ‘I was under the impression that Beth’s engagement had ended before she came to Hereford.’

  ‘News to me. Mind you, I haven’t actually spoken to the girl since she stormed out of here that day. When was it, two years ago? I hear any news secondhand, through her brother or that Brent chap. She’s the worst of the lot as far as keeping in touch.’

  ‘I wonder why?’ Luke muttered.

  ‘Pardon?’

  Luke cleared his throat, suddenly more than ready to end this conversation. ‘Please, do pass the message on to anyone who may be concerned about Beth’s welfare.’ He wasn’t worried that his criticism might not be veiled well enough to avoid causing Nigel offence. He might find out whether the man actually cared a fig for his daughter. ‘Rest assured that we will be taking the best possible care of her in the meantime.’

  ‘Good lad.’ Beth’s father sounded relieved at the opportunity to abdicate any responsibility. ‘You do that.’

  Not that there was much that Luke could do except to be there for Beth. The effort that took, however, made it possibly the hardest thing he’d ever done in his life.

  Never before had he felt like this in any operating room. Every unusual blip on the cardiac monitor—and there were plenty as the anaesthetist struggled to keep Beth’s blood pressure at a level that could sustain life—made his own heart skip a beat and then start racing in alarm. He had to look away from the initial incision because it made him feel physically sick. This was Beth’s flesh being cut.

  Luke’s professional side noted how well Len was dealing with the surgery. The caecum was identified. The appendicular artery was secured, clamped, divided and ligated. The appendix mesentery was divided. The nasty, swollen and infected appendix was clamped with artery forceps and removed with care to avoid it spilling any more of its poison into the surrounding tissues and blood vessels.

  But that damage had already occurred and it was no less nerve-racking for Luke to be beside Beth’s bed after she was transferred to the intensive care unit. Her blood pressure was still marginal and the function of vital organs like her kidneys and lungs was severely compromised. Central venous pressures were being monitored by a Swan-Ganz catheter, which had been threaded righ
t through her heart to rest in a section of her pulmonary artery and Beth was kept intubated and ventilated.

  The consultant now in charge of her care was more than a little concerned about her renal function, but Luke was only half listening to the professional interchanges as he sat there holding Beth’s hand and talking quietly to her whenever her medical attendants were occupied with the machinery rather than with Beth’s body.

  ‘I’m here, Beth,’ he whispered, time after time. ‘You’re going to be all right.’

  Barbara came up to the unit just after midnight, and Luke left Beth’s side to meet his mother on the other side of the double swing doors.

  ‘What are doing here, Mum? Is everything all right?’

  ‘I was worried about you, love,’ Barbara told her son. ‘Nobody would tell my anything except that you were keeping a sick friend company.’

  ‘I’m sorry,’ Luke said sincerely. ‘I should have called. I should be with you at the Winsomes’ but I lost track of time.’

  ‘It’s all right.’

  ‘I can’t leave Beth just yet. It’s still touch and go.’

  ‘Of course you can’t, darling.’ Barbara squeezed his hand.

  How could she know? Luke wondered. How he really felt about Beth when he hadn’t known himself until faced with the prospect of losing her like this? He’d lost track of time all right, because minute by minute his feelings for this woman were growing stronger. He wasn’t going to lose her.

  He couldn’t.

  ‘How is she?’

  ‘Not good. She waited too long to get help. The infection has really taken hold. We’ll just have to hope the antibiotics kick in soon.’

  ‘But she is going to make it, isn’t she?’

  ‘I hope so, Mum.’ For just a split second Luke lost control and fear tangled its icy fingers around his heart just a shade more tightly. Had he found Beth again and been given the possibility of making things right just in time to lose her for ever?

  Was it somehow his fault that he lost the people he loved the most?

  ‘This is not your fault, Luke,’ Barbara said softly. ‘None of it. Not Jodie or Kevin. Or Beth. And Beth’s going to be fine, I’m sure of it.’