A Doctor's Secret (Lifeline Air Rescue Book 2)

by Scott, Laura

  A DOCTOR’S SECRET

  LAURA SCOTT

  READSCAPE PUBLISHING, LLC

  Copyright © 2019 by Laura Scott

  All rights reserved.

  No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.

  Created with Vellum

  CONTENTS

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Untitled

  15. A Doctor’s Dilemma

  1

  “Two minutes till landing.”

  Dr. Samantha Kearn took a deep breath as Reese Jarvis’s calm, steady voice flowed through her headset. The Lifeline helicopter pilot could have made a living as a radio announcer playing late-night love songs. His voice reminded her of hot sultry nights, in contrast to the harsh, cold winter day she was stuck flying in.

  At least she was flying.

  This was it. Her first solo flight as the physician in charge. Only five more months of her residency to go and she’d graduate to a full-time attending physician. Reese landed the helicopter gently, without so much as a thud. For a moment she hesitated, her hand on the door. What if she messed up?

  With a sudden burst of determination, Samantha pushed the door open and jumped to the ground. She wouldn’t screw up. She was confident in her training. And maybe she was finally putting her past behind her, too.

  With renewed vigor, she followed Andrew, the flight paramedic on board, and helped him slide the gurney from the hatch in the back of the chopper.

  Samantha’s sweeping gaze gauged the distance from the helicopter to the building. The small community hospital didn’t have a rooftop helipad; they would be forced to cross the expansive and mostly empty surface parking lot to find the hospital entrance and then finally the intensive care unit.

  She’d already gotten a brief report from the ICU attending physician. Her patient was Jamie Armon, a thirty-eight-year-old woman who had originally come in with flu-like symptoms which had grown increasingly worse over the next several days. Fearing there was something more complex wrong with her, they’d requested a transfer to a larger tertiary care hospital.

  Samantha impatiently tapped her foot as the elevator rambled to the third floor. Andrew noticed and offered a wan smile.

  “Almost there.”

  She nodded. “I know.” What she didn’t know was how their patient was doing.

  Inside the hospital’s small ICU, her first glance at the monitor over the patient’s bedside made her heart sink. As a rule, patients needed to be stable prior to transport, but right now, Jamie’s heart rate and blood pressure teetered on the edge of a very steep canyon.

  Samantha steeled her resolve. No way was she going to lose her first patient on her first solo flight.

  “How much dopamine to you have her on?” She looked at the nurse as Andrew began switching all the IV connections to their smaller, compact transport models.

  “Not sure, maybe around seven micrograms per kilo per minute, maybe a little more.” The Cedar Ridge Hospital nurse appeared flustered as she thrust a stack of printed paperwork at Andrew.

  Samantha felt a flash of pity. Smaller hospitals didn’t get a lot of experience with very sick and complicated patients. From what she could tell, the nurse wasn’t getting much support from the physician either. No wonder she was frazzled.

  “Let me see.” Samantha looked at the bag, then at the pump for the rate. She quickly did the math, verifying the patient was getting twice as much as the nurse had told her. “She’s over the maximum limit, has her blood pressure always been that low?”

  “Yes. No matter how high I titrate the medication, her blood pressure won’t budge. The doctors here aren’t even sure what’s wrong with her.” The nurse’s bloodshot eyes were wide with anxiety.

  “What are her labs?” Samantha took the paperwork from Andrew and paged through it. “She needs more volume. Double the rate of her maintenance fluids. She’s low on potassium, too. Do you have a supplement we can hang before we go?”

  The nurse nodded. “I’ll get it.”

  Samantha wanted to see the radiology results, but they didn’t actually print them on film anymore. When the nurse returned, Andrew took the supplement and hung it on the IV pole he’d already set up on their equipment.

  “Pull up her most recent X-ray,” Samantha ordered.

  “I’m not sure it’s been read yet.” The nurse fiddled with the controls on the bedside computer until the image bloomed on the screen. “We took it ten minutes ago after placing a new central line.”

  The picture was grainy and not as clear as Samantha would have liked. She filed the information on the new line away and glanced at Andrew. There wasn’t anything more they could do other than get this patient to Trinity Medical Center as soon as possible. “Okay, let’s go.”

  She and Andrew packed Jamie up and quickly wheeled her out to the waiting helicopter. The wind was bitterly cold, and Samantha tugged the blanket more securely around their patient.

  With Andrew’s help, they loaded the patient into the chopper, then climbed in after her. As soon as they were settled with their helmets on, Reese asked, “Are you ready back there?”

  “Good to go,” Samantha confirmed, before placing the extra pair of headphones on Jamie’s head. They were necessary in order to communicate with her, although Jamie appeared to be pretty much out of it. Even as she watched, Jamie’s blood pressure dipped lower.

  Reese was conversing with local air traffic control, giving coordinates for their flight plan, so she waited until he was finished.

  “Reese, what’s the fastest you can get us to Trinity?” As she spoke, she increased the dopamine medication, knowing it wasn’t going to help much since it was maxed out. The knot in her belly tightened. If the blood pressure didn’t respond, she’d have to add another vasopressor.

  “We have the north wind behind us now, so we should be able to make it back to Milwaukee in forty minutes. A light snow is beginning to fall, though, so I may have to fly at a lower altitude to avoid the freezing rain. It will add time to the trip.”

  Normally the idea of flying in freezing rain bothered her. She’d learned in her training how ice coating the blades could down a chopper faster than a clay pigeon. But Reese’s voice was so unflappably steady she didn’t argue. “Do what you can to get us safely to Trinity as soon as possible.”

  “Roger that.” Reese lifted the chopper off the ground and gently banked to the left.

  “Hey, Dr. Kearn, I’m not feeling a pulse.” Andrew was holding his fingers on Jamie’s carotid artery.

  Samantha wanted to tell Reese to go back, but that wasn’t an option. She pulled the blankets aside and noticed the skin along the entire left side of the patient’s chest, the same side with the new central line, was puffy, the tissue clearly filling with air. Just then, the chopper took a hard bump. As she was unbelted and perched on the edge of the bench seat, Samantha almost fell face-first onto the patient.

  “Sorry, are you all right back there?” Reese’s even tone eased her alarm, calming her shaky nerves.

  “Yes, but we have a problem. She’s crashing. Can you hold this thing steady?”

  “If I need to slow down an
d lower my altitude, I will,” was his immediate response.

  “I need to insert a chest tube; she has a tension pneumothorax.” Samantha quickly dug in the flight bag for the necessary equipment. Maybe she should have waited back at the hospital, requesting a better chest X-ray before leaving the ICU with their patient.

  She hoped and prayed her error didn’t cost this patient her life.

  “Now?” Andrew’s voice rose an octave. “I’ve never done an in-flight chest tube.”

  “Watch closely, because we’re doing one now.” Samantha didn’t let on that she’d never performed the procedure at thousands of feet in the air either.

  “Okay, I’m reducing altitude,” Reese informed them.

  The helicopter’s flight smoothed out. Samantha took a large bore needle and catheter and quickly inserted it between the patient’s fourth and fifth ribs. Jamie moaned and flinched beneath her hands. Andrew managed to connect the small portable suction machine to the end of the catheter.

  “I have a pulse.” Samantha couldn’t prevent the wave of relief. Thank goodness the chest tube worked.

  “Blood pressure is up, too.” Andrew sounded content as he sat back in his seat. “You did it.”

  “Yes, we did.” They were a team, and Samantha was grateful for it.

  “Do you need me to divert to a closer facility?” Reese asked a few minutes later.

  To veer off course to request an emergency standby landing was rare. Most pilots would rather push on to their scheduled destination. She wasn’t surprised to discover Reese was the type of pilot who would do whatever was necessary for their patient.

  “No, thanks. We can make it to Trinity.” Samantha busied her hands with double-checking every connection, readjusting the medication rates, all in an effort to hide the fact that her hands were shaking. She wondered if Andrew had any idea how close their patient had come to dying.

  “ETA twenty-five minutes.” Reese’s steady voice filled her helmet. “Just let me know if you need anything. I’m climbing back up another five hundred feet.”

  “Her pressure is dropping again,” Andrew said, concern lacing his tone.

  “I’m going to place a new line. I’m not convinced the one they put in is any good.”

  “What can I do?” This time, Andrew seemed determined to help rather than freak out.

  “Prep the right side of her chest.” She pulled out a new central line kit and sterile gloves.

  “Dr. Kearn, do you need me to reduce altitude again?”

  She was surprised to hear Reese address her so formally, but she was thankful he was paying attention to what was going on with their patient. The situation was still tenuous, but his reassuring voice remained her anchor.

  “If you could.” Somewhere along the way her fingers had stopped shaking and she was able to insert the needle and find the subclavian vein without difficulty. That’s it, she told herself. Just pretend you’re in the ED where you completed months of training. See? No problem.

  Within minutes, she had the new line placed.

  “Move the drips to the new line,” she told Andrew. “I have good blood return. The chest X-ray will have to wait until we land.”

  Moments later, Jamie’s blood pressure returned to normal. Satisfied, Samantha quickly cleaned and dressed the site.

  “Sounds like things are better back there,” Reese said.

  She found herself smiling. “They are.”

  “ETA fifteen minutes. Less if I put more air under our belly. There’s a nice tailwind up there.”

  The image of Reese body surfing, flying like Superman on a wave of wind, made her smile widen. Now that the worst was over, she could afford to relax.

  “Sure, why not? I like a little air under my belly. And things are good back here.”

  Andrew made several notations in the medical record, then reduced the rate of the dopamine drip. With the line working properly, Jamie didn’t need those massive doses she’d been on when they’d picked her up.

  Something the ICU attending at the hospital should have figured out for himself.

  She decided against pulling out the line that wasn’t working, fearing that it would only cause uncontrolled bleeding. They were so focused on their patient that she didn’t realize how much time had passed until she heard Reese’s voice in her ear.

  “Five minutes until landing.”

  “Thanks.” Samantha helped Andrew prepare their patient for transport. She hit the button on her mic, signaling a call to the paramedic base. “Lifeline to paramedic base, please let Trinity’s ICU staff know that we need a chest X-ray completed upon arrival. A new central line was placed in the right subclavian vein.”

  “Roger Lifeline.”

  Reese landed the helicopter with finesse on the rooftop helipad at Trinity Medical Center. Samantha waited until Reese gave them the all clear before jumping out to unload their patient.

  As promised, the portable chest X-ray machine was waiting for them in the ICU. The digital reading proved that the line she’d placed was in the correct place and verified that the original line had gone through the vein. Even better, the air pocket in Jamie’s lungs was already resolving.

  Relieved, Samantha watched the ICU team work on Jamie, a woman only eight years her senior. Now that she’d handed over Jamie’s care, the seriousness of the situation hit hard. This poor young woman had almost died up there. Thank heavens, she’d recognized the problem early enough to fix it.

  “Nice job, Dr. Kearn.” Andrew pulled the gurney out into the hall. “Ready to go?”

  “Yeah.” She wasn’t really, but of course, her work here was finished. She’d survived her first solo flight. Surely they’d get easier from here on out. Now, if only she could find a way to get the rest of her personal life on track.

  One step at a time. You have a new apartment, and you’ve just about finished your training, only five more months to go. You finally have your independence. Be thankful for what you have.

  Once they were back on the rooftop landing pad, she and Andrew headed over to where Reese waited with the chopper.

  She frowned when she noticed that Reese had shut the machine down. He stood outside the helicopter, his expression grim as he stared at the aircraft.

  “What’s wrong?” Samantha asked.

  “Ice on the blades. It’s amazing we made it here in one piece. We’ll have to de-ice before we can return to the Lifeline Air Rescue hangar.”

  REESE’S thigh muscles quivered with the effort of keeping himself upright as the bones in his legs seemingly disintegrated into dust. His face felt frozen, but he couldn’t relax. He refused to let the rest of the crew know how badly this had shaken him.

  They’d almost crashed.

  In fact, he had no idea why they hadn’t.

  Red dots swam before his eyes until he feared he would end up much like the unconscious patient they’d just unloaded minutes earlier. He didn’t want to believe what he’d seen, but the vision of the ice-covered blades was indelibly etched in his brain.

  He’d noticed the slightest change in the stick as they’d landed. He wanted to claim instinct had forced him to double-check the chopper blades, but in truth, he’d been following routine training that was drilled into every pilot.

  Five minutes longer and they certainly would have crashed. Or at the very least been forced into a hard landing.

  Was this how Valerie had felt in those moments before the crash? And Greg? Had his best friend noticed the slight hesitation of the stick mid-flight, or had the blades just stopped spinning?

  Did he really want to know what had gone through his fiancée’s and best friend’s minds before they’d died?

  The frankly curious gazes of Samantha and Andrew, watching as he de-iced the chopper, was all that kept him from sinking to his knees.

  “Reese, do you need help?”

  Samantha’s lyrical sweet voice helped strengthen his resolve not to show his weakness. Dr. Kearn to you, dummy, he chided himself. The la
dy was smart, cool under pressure, and she deserved his respect, not his overly familiar thoughts. He didn’t turn around but sensed rather than heard her come up behind him. A light evergreen scent teased his nostrils, kicking his pulse into high gear. The metallic taste of fear faded, quickly replaced by the slightest stirring of desire.

  “No, thanks. I’ll be finished in a few minutes.” His voice sounded wooden to his ears, but hopefully Samantha wouldn’t notice.

  Dr. Kearn. Get it through your concrete-lined skull, she’s Dr. Kearn!

  “This is a first for me, being grounded to de-ice,” she admitted softly, stepping into the line of his peripheral vision. “I guess it’s better to be safe than sorry.”

  No, it was better to be safe than dead. The living were the only ones who were sorry. Reese mentally drew himself back on track. No sense in scaring the daylights out of the rest of the crew. Better that he kept his dark thoughts to himself.

  “There, I’m finished.” He verified the chemicals had performed their magic and pronounced the helicopter back in flying form. “I’ll put this stuff away, then we can board.”

  “Reese?”

  Bracing himself, he slowly turned to face her. For a moment he couldn’t speak. She was so beautiful, no matter how hard she tried not to be. She’d caught his eye that very first day, her glorious red hair pulled into a no-nonsense braid and her creamy complexion free of makeup. She appeared oblivious to the male attention she drew from the other paramedics and physician crew members. Several pilots had commented about her, wondering about her availability, but Reese noticed that she never made a flirtatious gesture or remark. Almost as if she made it a point to never cross the line of polite friendliness. The “off-limits” signs couldn’t have been any clearer.