by Anne Fraser
“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 relieved 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.
“But I’m not qualified to perform the procedure,” she admitted. “He needs a surgeon. We belong upstairs, now!”
Dr Horton suddenly nudged her aside. “He won’t make it as far as the elevator. Move over.”
“Nice of you to join us, Frank,” she replied caustically as she traded places with the tardy surgeon.
“Hey, I’m here now.” He turned to Candy. “It’ll ruin his tattoos, but get ready for a thoracotomy.”
“At least he’ll be alive to complain,” Gina muttered.
“Only if we stop the bleeding before he goes into cardiac arrest. Scalpel.”
While Frank began to work, Gina glanced at the paramedics hovering nearby. “Do we have names for these two yet?”
“I’ll check.” Andy slipped from the room.
Intent on assisting Frank and urging her patient to hang on, Gina didn’t notice Ruark until he stood at the foot of the bed. “How’s your fellow?” she asked.
“Better than yours,” he answered. “He’s on his way to an operating room as we speak. They’re also holding a suite open for your patient.”
“And here we have it,” Frank announced with distinct arrogance at discovering the problem. “His coronary artery is nicked. I’m cross-clamping the aorta and then we’re out of here.”
A few minutes later, Frank and the John Doe were gone. Lucy and Candy immediately began the unenviable task of dealing with the mess and, oh, what a mess it was. Instruments littered every available surface, paper wrappers and used gloves covered the blood-slickened floor.
Gina tiredly stripped off her face shield and blood-stained gown before removing her gloves, conscious of Ruark doing the same. She started to slip out of the room with the other extraneous personnel, but the sound of his voice stopped her, and everyone else, in their tracks.
“Nobody move,” he commanded.
CHAPTER THREE
EVERYONE froze. Most appeared resigned, as if they were already bracing themselves for a coming storm. Determined to protect her staff, Gina immediately began her defense. “Don’t blame them for not instantly following your orders. You could have been a medical student for all they knew.”
Anyone with two eyes and an ounce of common sense would never believe he was a mere med student—he was far too confident and authoritative, not to mention distinguished. From the wry expression on his face, he recognized the feeble excuse for what it was.
“I’m well aware we didn’t get a chance to observe the formalities, Dr Sutton,” he stated as he met her gaze. “So we’ll put this incident behind us. However, I am the new emergency director and I can assure every one of you I am fully qualified to handle the position.”
Gina’s face warmed at his rebuke. Clearly, he’d known she had sent Lucy to monitor him. Her embarrassment grew as he shared his experiences in other emergency departments and during the course of his medical relief efforts. At first, she felt guilty for having thought he was only a figurehead—a royal prince who didn’t do more than lend his name in support of a cause—but how was she to have known otherwise? She hadn’t even known his name before he’d waltzed in and took over. No, if anything, he should feel remorse for sneaking into Belmont like a burglar.
“I don’t plan to change your routine overnight,” he continued, “but I will be looking at your operations closely and fine-tuning those processes that need it. No matter how well a department functions, there’s always room for improvement. Rest assured, I will not tolerate slipshod performances. I expect one hundred and ten percent from each of you, and intend to put forth the same effort.”
Gazes met and shoulders squared as everyone seemed willing to meet his demands. It was almost surprising to see the staff cooperateso wholeheartedly this soon, but h
e had proved himself with his first case. Clearly, they were eager to impress him as well.
“What’s the possibility of budgeting for more staff?” someone asked.
“If the numbers justify it, I’ll do what I can to get them,” he promised.
Those who had still appeared suspicious now nodded as if satisfied with Ruark’s response. Slowly, skepticism and stoicism faded as he shared his vision for the department as well as a few personal facts. By the end of his impromptu meeting, not only was everyone smiling and joking with him, but they’d also learned he liked all flavors of coffee as long as they were strong, loved fresh pastries and any dessert containing apples. No doubt there would be donuts and apple pie tomorrow.
“I’m certain you’ll have more questions as time goes on, but if you have a problem, my door is always open,” he added in conclusion.“Meanwhile, you can return to work.”
Gina accompanied him from the room while the rest of the staff headed off to deal with their respective tasks. “You had them eating out of your hand,” she remarked.
His wide grin only enhanced his handsome features. “People usually produce in accordance with the level of expectation. If they know I expect a lot, they’ll deliver. If not…” He shrugged.
Determined to clear the air, she squared her shoulders and met his gaze. “For the record, I’m not sorry I’d asked Lucy to report any problems you had to me. Having never seen you in action, I’d do it again in a heartbeat.”
“Under similar circumstances, I would have done the same, as would any physician who cares about his patients. I trust I’ve satisfied your curiosity and relieved your doubts?”
“Yes.”
“Then we’ll put this behind us, too.”
“Why didn’t you tell them you were a prince?”
“They need to see I’m a physician first and a prince second,” he said simply, “otherwise they won’t look past the issues of royalty and we can’t form the cohesive unit we need to be.”
He was obviously speaking from experience. “You told me who you are.”
“Given our backgrounds, I made an exception for you.”
Lucky her, she thought glumly. “I thought you prided yourself on honesty.”
“I do, but do you want reporters swarming all over the place, digging into your past? Believe me, it only takes one curious reporter for all of your secrets to become tomorrow’s headlines. Are you ready for that, Countess?”
She gritted her teeth. “I told you before, I consider that title purely academic. I prefer to use the one I earned, and I’d appreciate it you did, too.”
“I stand corrected. In any case, my personal background is irrelevant.”
She scoffed. “Do you really believe that? The staff aren’t blind. People will notice your bodyguards and ask questions.”
“After what happened today with Bill Nevins, no one will give two extra guards a second thought. Besides, my men are professionals. They’re experts at blending in. But if someone does ask questions, I’ll tell them the truth. They’ll find out soon enough, anyway.”
His ready reply caught her off guard. “You have all the answers, don’t you?” she asked waspishly, lumping in their earlier, more private discussion with this one.
“What sort of leader would I be if I didn’t?” he countered. “You see, Gina, I don’t like surprises.”
After today, neither did she.
Ruark spent what remained of the morning observing the work flow of the department. Fortunately, no other traumas arrived, which left him free to talk individually with the staff regarding everything from scheduling to ordering supplies. He would have preferred Gina acting as his guide, but she often disappeared in other directions—“to take care of patients,” she’d said.
It was only an excuse. The whiteboard indicating room assignments and diagnoses plainly showed nothing that the physician’s assistant couldn’t handle. However, he was willing to cut her some slack today. She clearly wanted space to digest the information he’d given her, although little did she know he’d barely scratched the surface. The rest would come this evening, when he outlined their families’ proposed plan in complete detail.
When his father had first approached him and he’d read the dossier on Gina that had been compiled by the palace security team, he’d been resigned to fulfilling his obligations. After meeting her, talking to her, watching the way she handled a difficult situation, he’d become more…hopeful? about the long-term success of the scheme they had devised. Doing his duty to restore his family’s honor wouldn’t pose a hardship at all.
In fact, if he’d come to Belmont without any ulterior motive or agenda, if he’d only arrived as a physician who merely intended to use his medical skills until the next career move presented itself, Gina still would have captured his attention. Her elfin features, willowy frame, tawny-colored hair and special smile charmed him more than he’d imagined possible. After he’d touched her soft skin, seen the damage done by the shard of china and her blood staining his white handkerchief, he’d wanted Bill Nevins’s head. For a man who prided himself on his control, his reaction amazed him.
He was almost tempted to pull rank and follow as she went about her business, to compare what he learned about her firsthand with what he’d gathered from her file, but he had to be patient. If she felt threatened and he couldn’t win her over tonight, then the next few weeks wouldn’t pass by pleasantly.
To his surprise and delight, he’d learned more interesting things about Gina and Belmont’s emergency department from Gina’s colleagues than he would have learned from her. More often than not, he heard what had fast become a familiar refrain.
“Dr Sutton takes care of that.”
“Dr Sutton completes those reports.”
“Dr Sutton always talks the supply department into giving us what we need.”
“Dr Sutton is a stickler for continuing education,” one nurse said proudly. “We’re the only department in the hospital where all staff certifications are current.”
At first, he’d wondered how it could be possible for one woman to accomplish so much in a given day, until he stood at the nurses’ station and merely watched her go from one task to another. She might deny her heritage, but she still possessed the innate grace and regal bearing of her ancestors.
“If you’re waiting until she has a free minute to talk to her, you’ll be waiting a long time,” Lucy warned.
He pulled his attention away from Gina and his thoughts at the sound of the nurse’s voice. “Excuse me?”
“If you ever want to catch Dr Sutton, you have to do like the rest of us and just interrupt,” Lucy commented. “She’s in constant motion. The only time she sits down is when she’s at her desk or at lunch, which she takes on a hit-and-miss basis. Sometimes just thinking about everything she does makes me tired. I don’t know how she has the energy to run at full speed all day, but she does.”
“I assume she stays past her shift,” he said before he caught a glimpse of Gina slipping out of one exam room and into another.
“All the time,” Lucy told him bluntly. “The woman doesn’t have a life. She’s here at 6:00 a.m. and stays until eight or nine at night, five days a week. I keep telling her she’s going to burn out, but she only laughs. If you ask me, Bill Nevins took advantage of her good nature.”
Ruark suspected as much.
“To be honest…” Lucy cast a sidelong glance at him “…we’d hoped that when Bill decided to retire, Gina, er, Dr Sutton would take over.”
“Did you?” he replied mildly.
Lucy raised her chin. “She’s done a lot for us. The staff are intensely loyal to her.”
Ruark locked his gaze on hers, but she held her ground. “Is this a warning?”
“Not unless it needs to be.”
He grinned at her tart tone. “Dr Sutton’s place remains secure,” he assured her. “Although I would appreciate it if, when Dr Sutton is relieved of some of her duties, the staff will understan
d it isn’t because she hasn’t done an excellent job. As head of Belmont’s emergency department, I don’t intend to follow in Bill Nevins’s footsteps and shirk my own responsibilities.”
“They’ll understand,” she promised, a smile returning to her face. “I’ll see to it myself.”
Certain he’d gained the head nurse’s co-operation, which meant everyone else’s would follow, he pointed to the schedule taped to the counter’s backsplash. “Other than Gina, I rarely see the same doctor’s name twice in a week.”
“Because it doesn’t take long for most doctors to get fed up with being overworked and underpaid, so they leave. When Gina assigns the shifts, she relies heavily on locums, friends, or previous on-staff physicians who just can’t say no.”
She sighed. “Then again, none of us seem to be able to say no to her. It’s impossible to refuse someone who works harder and more hours than you do. She takes up a lot of the slack herself.”
He thought about Frank Horton. “What about residents? Shouldn’t a surgeon be available all the time?”
“Belmont only has a few residents,” Lucy mentioned. “An OB-GYN who spends most of her time on the maternity floor and a neurology fellow who’s usually in ICU or Rehab.”
“And Frank?”
“Oh, don’t let him hear you call him anything but a board-certified physician,” she warned. “He’s hired as a hospitalist and is assigned to our department, but he only drops by when we call him.”
“He’s allowed to do that?”
She shrugged. “Who’s going to stop him? Gina’s tried, but without having the authority she didn’t get very far.”
“Why didn’t Nevins stand behind her?”
“As long as Frank responded in a ‘timely’manner…” she emphasized the word with quotes in the air “…Bill wasn’t going to force the issue.” She glanced at him slyly. “If you’re looking for quality improvement ideas, you should start with that one.”
After dealing with cases she could have handled blindfolded, Gina had silently begged the fates to send a patient with something more complicated than shingles or an ingrown toenail. After suffering two major personal surprises today, with the arrival of both Prince Ruark and a letter from a grandmother she’d never met, she suspected the upcoming evening would have more surprises in store. Already her imagination was running rampant with possibilities of what a famous radio commentator liked to refer to as “the rest of the story”. Rather than waste her time worrying or second-guessing what Ruark would tell her, she needed a case that required her full attention.