A Christmas Knight

‘Hurts,’ Rhiannon mumbled. ‘Where’s Gary?’

‘Your husband’s right here,’ he reassured her. ‘Ronnie’s looking after him, and as soon as she’s checked him over and made him comfortable, he’ll be able to come and see you. And we’re going to give something to help with the pain,’ he said. ‘I’m going to put an oxygen mask on you to help you breathe better, and then we’re going to have a proper look at you, OK?’

On Dominic’s direction, Sally gently cut through Rhiannon’s clothes so he could do a full body assessment, top to toe. Meanwhile, Louisa hooked Rhiannon up to a cardiac monitor, put in a second line and started taking obs.

‘Heart rate 135, respirations twenty-six, blood pressure 82/54,’ she said. Tachycardia and low blood pressure pointed to major loss of blood—probably caused by internal injuries, Louisa thought.

‘We need to get some fluids in. Start with a litre of Hartmann’s, and get six units cross-matched for me,’ Dominic said—and looked approving when he saw that she already had the saline solution in her hand.

Dominic had given Rhiannon painkillers to make her more comfortable; but when her blood pressure didn’t respond to the fluids and her sats started dropping, he glanced at Louisa. ‘Can you do ABGs for me, please, Louisa? And, Sally, I need X-rays.’ He listened to Rhiannon’s chest.

From the bruising on Rhiannon’s skin, it looked as if she had several broken ribs. No doubt Dominic wanted to check for pulmonary contusions. There were a lot of problems that could be caused by blunt trauma at high velocity, Louisa knew; with damage in Rhiannon’s chest area, there could be trauma to the heart as well as the lungs.

‘I think we need to intubate.’ He held Rhiannon’s hand as he explained to her what they were doing. ‘You’re struggling to breathe, sweetheart, so we need to help you with that and make sure you get enough oxygen. I’m going to put a tube down your throat so you won’t be able to speak, but I’m going to give you some medication first so you won’t feel it and it won’t hurt—it’ll make you more comfortable. I know you’re feeling tired and it’s hard to talk, so just squeeze my hand if you’re OK with that—once for yes and twice for no.’ He paused. ‘That’s a yes—that’s my girl. We’ll get you comfortable as soon as we can.’

Louisa was just drawing up the ampoules of anaesthetic when one of the drivers who’d been brought in came over to them, his face ashen. ‘Oh, my God, Rhi! I’m so sorry. I couldn’t avoid him—he just pulled out on me and there was nothing I could do.’ He looked distraught as he stared wildly at Dominic and Louisa. ‘I can’t believe I’ve come out with just bruises, and Rhi’s so…so…’ His voice caught.

‘Gary, isn’t it?’ Dominic said, somehow managing to divide his attention and eye contact between his patient and her husband.

‘Yes.’

‘She was asking for you.’

‘Can I hold her hand?’ At Dominic’s brief nod, Gary curled his fingers round his wife. ‘Honey, I’m here, and I love you, and I’m so sorry.’ He dragged in a breath and looked pleadingly at Dominic. ‘Is she going to die?’

‘Not on my shift,’ Dominic said, ‘though it might be easier on you if you wait outside. There’s a vending machine just round the corner. I promise we’ll come and find you as soon as we’ve got her stable and let you know what’s going on, but for now we need to concentrate on Rhiannon here and treat her.’

Gary shook his head. ‘No. I need to stay with her.’

‘Unless you’re a trained medic, it can look very worrying in here,’ Dominic said gently. ‘Especially as we’re just about to intubate her to help her breathe. Trust me, we’re going to do everything we can for your wife, but it will be much better on your nerves if you go and get yourself a hot drink and leave us to it for the next few minutes.’

‘I’ll come and get you as soon as there’s any news,’ Louisa promised. But she noticed that Gary was staring at his wife, looking stunned. In shock, she thought—not the medical kind, but the emotional kind. They needed to get him out of here. ‘Do I have two minutes, Dominic, to show Gary where everything is?’

‘Two minutes,’ Dominic confirmed; the expression in his eyes told Louisa that he knew exactly what she was doing and approved. Which was a huge relief: he was much easier to work with than she’d expected. And he was sensitive with patients and relatives. Maybe she’d just caught him on a bad day on Monday.

‘Come on, I’ll show you where the drinks machine is,’ Louisa said, slipping her arm through Gary’s and guiding him out of Resus.

‘I was coming down the hill. I wasn’t speeding. I could see the other car approaching the junction, but he wasn’t even indicating! And then he just pulled out in front of me. It was as if it all happened in slow motion. I could see we were going to crash, and I couldn’t do anything to stop it. I slammed on the brakes, but it wasn’t enough.’ Gary shivered. ‘We hit him and the car spun round. Rhi’s side of the car was squashed against another one. And…’ He covered his face with his hands. ‘She can’t die. We celebrated our twenty-fifth wedding anniversary last week. I can’t…Not without her…’

Louisa got him a cup of hot, sweet tea from the vending machine—even if he didn’t normally take sugar or drink tea, she knew it would help—and settled him in a chair. ‘Gary, it wasn’t your fault, and the staff here are really good,’ she told him gently. ‘We’re going to do our very, very best. Now I have to go back and help Dominic treat Rhiannon, but I’ll be back as soon as I can with any news.’ She squeezed his shoulder. ‘I know waiting’s hard but hang on in there, love.’

‘You’re so kind. Thank you. And please—’ Gary’s face was stricken ‘—please, don’t let my wife die.’

By the time Louisa got back into Resus, the medication had taken effect, and Dominic started to intubate their patient. She’d seen it done before, but never with this calm, confident efficiency—and he was amazingly quick.

Dominic Hurst was a superb doctor, she thought. And she liked the way he’d made time to talk to his patient and her husband, clearly aware of how important communication was as a way of bringing down stress levels.

He blew up the cuff on the tube and turned to the other nurse. ‘Sally, are they ready for us in Radiology?’

‘Yes.’

‘Great. Thanks for that. Can you bleep the orthopods, please, and let them know we have a patient with suspected flail chest? I want to have a look at the X-rays, so I’m going down to Radiology with Rhiannon.’

‘Do you want me to give ITU a call, to put them on standby?’ Louisa asked quietly, so Rhiannon couldn’t hear her and start to worry. In her experience, it was best to involve the intensive care unit as early as possible, because cases of pulmonary contusions often led to ARDS—adult respiratory distress syndrome. And if there were multiple broken ribs, she’d need careful monitoring.

‘Yes, please. And could you tell Gary I’m taking her to X-Ray? Not because he should worry himself sick, but because it means I can see the X-rays straight off and it’ll save us some time. Tell him I’ll come and talk to him as soon as we know more.’ He smiled at her. ‘Thank you, Sally. You’ve done a really good job. You, too, Louisa. Even though this is the first time we’ve worked together, it’s felt as if we’ve been on the same team for years. Your old department must really be missing you.’

The compliment made her feel warm all over—especially as she hadn’t expected it from him. And it was good to work with a doctor who appreciated the nursing staff rather than taking them for granted, especially one who bothered to give a student praise where it was due. She smiled back at him. ‘Thanks.’

While Dominic went off to X-Ray with Rhiannon, Louisa contacted the intensive care unit to put them in the picture, then went in search of Gary to let him know what was happening.

‘Is she going to be all right?’ he asked. ‘I’ll never forgive myself if anything happens to her. And that stupid guy who tried to get into a gap that wasn’t there, just to save a few seconds…’ He was shaking, clearly near tears.

Louisa put her arm round him. ‘I know, love. You said yourself there was nothing you could do, so don’t blame yourself. The police will deal with the other driver.’ Who’d also walked away without a scratch, according to Ronnie, but that wasn’t something Louisa intended to share. ‘We’ll know a lot more when the X-rays are back, and Dominic will talk you through what Rhiannon’s injuries are and how we’re going to treat her. But for now we’re keeping her comfortable. Try not to worry—and, yes, I know that’s a lot easier said than done.’ She gave him a sympathetic smile. ‘Is there anyone we can call for you?’

‘I…No.’ He shook his head. ‘I’d better call our daughter myself. She’ll be devastated.’ He dragged in a breath. ‘I can’t use a mobile phone here, can I?’

‘In the corridors, you can,’ she reassured him. ‘The phone won’t interfere with equipment there.’ It wasn’t the only reason the hospital preferred not to have people chatting on mobile phones—loud conversations disturbed other patients, and some ringtones sounded eerily like alarms on equipment. The blanket ban on mobile phones throughout the hospital had been relaxed, except for critical-care areas such as the emergency department, the coronary care unit and the special care baby unit, where equipment could be affected by electromagnetic interference.

‘Thank you.’

When Dominic came back from Resus, he looked serious but calm. ‘Gary, I’ve seen the scans and I’m sending Rhiannon up to Theatre where the surgeons can help her. She’s got four ribs broken in two places, pulmonary contusions—that’s a bruise on the lung and you often get that with broken ribs—and what looks to me like a cut to her liver.’

‘So the surgeons can fix her ribs?’

‘They might decide to let them heal without fixing them,’ Dominic said. ‘But the contusions are going to make it a bit hard for Rhiannon to breathe, so she’ll be in Intensive Care afterwards until they heal—they can keep a close eye on her and make sure she’s comfortable.’

‘You mean she’s going to be ventilated?’ Gary’s eyes widened. ‘Oh, my God.’

‘It looks and sounds a lot scarier than it is. It’s going to be the best treatment for her,’ Dominic reassured him. ‘We’re taking her up to Theatre now, and if you’d like to you can come with us, as far as the doors. There’s a waiting area there, and one of the surgeons will come out and talk you through what’s happening. The staff at the ICU—the intensive care unit—are lovely, and they’ll be happy to answer any questions you have.’

They headed up to Theatre, Gary holding his wife’s hand all the way.

‘I’m so sorry, Rhi. I love you,’ he said, clearly trying to hold back tears.

‘They’ll take care of her,’ Louisa said gently, putting her arm round his shoulders as Rhiannon was wheeled through the doors to Theatre. ‘Is your daughter coming?’

‘She’s on her way.’ He bit his lip. ‘And I’m keeping you from your work.’

‘That’s OK.’ If necessary, she’d work through her lunch hour to make sure that the targets were hit. People came before admin, in her book, and always would; and if she had to explain herself to the bean-counters, so be it. Nursing was about people, not numbers. ‘I’ll wait until she gets here.’

When Gary and Rhiannon’s daughter arrived, Louisa explained what had happened and what would happen next, made sure they both had a hot drink, then headed back down to the emergency department. She was back in Minors as nurse practitioner for the rest of her shift, and her lunch break consisted of two minutes to bolt a sandwich so that she could catch up with the delay in treating her patients. When it was clear that she was still running late, she made a quick call to her mother to ask if she could pick up Ty from after-school club, and continued working steadily through her list. After she’d seen her last patient, she headed for Resus, hoping that Dominic would be there and that he knew how Rhiannon was.

‘Shouldn’t you have been off duty half an hour ago?’ he asked.

She shrugged. ‘It happens. I just wondered if you’d heard anything from the ICU about Rhiannon?’

‘Yes, I have.’ He smiled at her.

Without that reserve, he was truly stunning; her heart felt as if it had just done a somersault. Which was crazy, because she wasn’t looking to feel this way about anyone. She didn’t need a relationship to complicate her life.

‘Do you have time for a quick coffee while I fill you in?’ he asked. ‘I could do with a Danish pastry.’

That sounded dangerously close to a date. Even though Essie had said he was wrapped up in his work rather than relationships, she didn’t want Dominic to get the wrong idea. Especially as she was aware of how attractive she found him. ‘Sorry, I can’t. I need to pick up my son. Mum met him for me, but he hates it when I’m late.’

‘Can I give you a lift home and tell you on the way?’ he asked.

‘Thanks for the offer, but my car’s in the staff car park.’

‘Then how about I walk you to your car while I tell you about Rhiannon?’

She nodded. ‘That’d be good. Thanks. I’ll just get my bag from my locker.’ She hurried off to collect her things. ‘So what did they say?’ she asked when she returned and Dominic walked with her to the car park.

‘Rhiannon’s pulled through—the surgeons fixed the liver damage and stopped the bleeding. She’s got an epidural in for pain relief, and she’s going to be observed in ICU for a while to make sure she doesn’t develop pneumonia.’

‘Did they wire her ribs?’

‘They decided against surgical correction of her flail chest, because the ventilator will make sure her lungs are working properly and aren’t compromised by her ribs,’ he said. ‘As soon as the contusions are resolved, provided there aren’t any secondary complications, she can come off ventilation. I popped in to see how she was doing and have a chat with Gary. They’ve warned him that her breathing is going to get slightly worse before it gets better—on the same principle that a bruise always hurts more the day after—but now he knows she’s got a good chance, he’s relaxed a bit.’

‘His daughter’s nice,’ Louisa said. ‘She’ll support them both through it.’

He looked at her and raised an eyebrow. ‘You didn’t have a lunch break either, did you?’

‘Yes, I did,’ she protested.

He gave her a wry smile. ‘Long enough to scoff a chocolate bar, hmm?’

‘A chicken wrap, actually. I don’t like chocolate.’

He looked surprised. ‘You must be the first medic I’ve ever met who doesn’t think it’s a food group. And didn’t you bring in a tin of chocolate biscuits the other day?’

‘Yes—because most people like them.’

‘So you’re more of a savoury person?’ he asked.

‘I love cheese scones,’ she said. ‘And hot buttered toast with Marmite.’

‘That’s utterly revolting,’ he said, pulling a face. ‘So where did you work before here?’

‘The London Victoria. It’s where I did my training.’

‘It’s got a good reputation. What made you come to the George IV?’ he asked.

‘The nurse practitioner post was vacant—plus my parents wanted to retire to the coast. I know London’s only an hour and a half from Brighton, but Ty adores his grandparents and I wanted to be able to stay close to them.’

‘So your husband was able to move his job, too, or is he commuting to London?’

‘Ex.’ She took a deep breath. ‘And Ty’s father isn’t part of our lives. At all.’

He grimaced. ‘Sorry. That was nosey of me, and I didn’t mean to stomp on a sore spot.’

She shrugged. ‘It’s OK. I guess the only way you get to know a new colleague is to ask questions.’

‘True.’ Dominic looked wary. ‘And I owe you an apology from the other day. I’m not normally that rude.’

‘I didn’t think anything of it.’

‘Yes, you did—otherwise you wouldn’t have been so sharp with me in Resus this morning.’

She bit her lip. She had been a bit sharp with him. ‘I’m sorry I was—well, snotty with you.’

‘I understand why. Anyway, there isn’t room for egos in our business. The patients should always come first.’

Her sentiments exactly. ‘I think we started off on the wrong foot.’

‘Agreed, and I’m sorry, too. For the sake of a decent working relationship, can we start again?’

She was all in favour of decent working relationships. ‘Louisa Austin, nurse practitioner. Pleased to meet you.’ She stretched out her hand.

He shook it; again, it felt as if electricity bubbled through her veins, but she ignored the sensation. This was work.

‘Dominic Hurst, senior ED reg. Pleased to meet you, too, Louisa.’ He paused. ‘You said you were looking for riding lessons for your son. I assume Essie told you I have a horse? My best friend owns the stables where I keep him. I could have a word with him and his wife.’

‘Thanks, but there’s no point. He won’t have a space.’

He frowned. ‘How do you mean?’

‘I’ve already tried ringing round some of the local riding schools and…well, their lists are all full.’

He looked surprised. ‘We’re in a recession and riding lessons are one of the first things that tend to get cut, because they’re not cheap—instead of going twice a week, people go riding maybe once a fortnight instead.’

Just as she’d thought. Especially when the waiting lists had suddenly become two years long. Might as well get it over with now. ‘The thing is, my son has Asperger’s.’

He shrugged. ‘And?’

‘The riding schools I rang changed their minds about having places when I explained.’

‘More fool them. Riding’s really good for Asperger’s kids. Being with horses helps them learn to understand non-verbal body language.’

Now that she really hadn’t expected. She was more used to people being uncomfortable around Ty. Understanding like this was rare. ‘Did you used to work in paediatrics, or do you know someone with Asperger’s?’

‘I know someone,’ he said, ‘and horses have made a huge difference to him. But I can remember his parents used to worry themselves sick about him, because he never seemed to make friends at school. I guess you probably do the same with your son.’

‘All the time,’ she admitted, caught off guard.

‘Don’t,’ he said softly. ‘He’ll be fine. He might only have one or two really close friends, but they’ll be good ones—and that’s better than having hundreds of acquaintances you can’t really rely on when life gets tough. And if he finds a job that matches the things he’s interested in and doesn’t involve having to deal with people whose minds aren’t quite as quick as his, he’ll shine.’

She blinked back the sudden rush of tears. How ridiculous. Just because someone understood, instead of making unfair judgements.

‘Look, I’m going straight to the stables from here. I’ll talk to Ric and Bea tonight, and then maybe you can come and have a look round at the weekend, meet the team, and see if Tyler likes the place.’

‘That’s very kind of you. Are you sure?’

‘They do a lot of work with the RDA—Riding for the Disabled Association,’ Dominic said.

Louisa’s chin came up. ‘Tyler isn’t disabled. He just happens to have a diagnosis of Asperger’s Syndrome.’

Dominic sucked in a breath. ‘Sorry, I didn’t mean it to sound like that. What I mean is, Ric and Bea believe in inclusion and it doesn’t matter who you are or what your particular challenges are—if you love horses and want to ride, then you should have the chance to do it. Ric’s parents owned the riding school before they retired and Ric took over, and they were the ones who started the RDA work at the stables. So Tyler won’t be made to feel that he’s a special case or anything—he’ll be treated just like everyone else.’

Again, the tears threatened. How long had it been since people outside her own family and her best friend had treated her precious son just like anybody else? ‘Thank you.’

‘You’re welcome.’

‘He’s eight,’ she warned, ‘and he’s only ever ridden a horse at one of the farm park type places. He’s a complete novice.’

‘Bea’s a brilliant teacher. She’s great with kids and she’s really patient with novices. I’ll talk it over with her tonight. See you tomorrow,’ he said as they reached her car.

‘See you tomorrow. And, Dominic?’ She gave him a heartfelt smile. ‘Thank you.’

Chapter Three

‘WHAT happened?’ Louisa asked.

Mrs Livesey was ashen with worry, cradling her two-year-old son. ‘It’s all my fault. The children were playing nicely and I was chatting to my friend over coffee—I should’ve been watching them more closely. Julian slipped and cut his head open on the piano. I put a cold wet cloth on it to try and stop the bleeding, but it wouldn’t stop, so I brought him here.’

‘That was the best thing to do,’ Louisa reassured her. ‘Scalp wounds always bleed a lot, so they often look worse than they are. Has Julian been sick at all, or had any kind of fit?’

‘No.’

‘Did he black out, or has he been drowsy since?’

Mrs Livesey shook her head.

‘That’s good,’ Louisa said. She assessed the little boy’s limb movements, then shone a light into his eyes; she was relieved to see that his pupils were equal and reactive. She took his pulse and temperature—both of which were in the normal range—and gently examined the cut on his head. ‘It’s clean—you did brilliantly there,’ she told Mrs Livesey, ‘but it’s a little bit too deep just to glue it.’

‘Glue it?’

‘You’d be amazed at what we can do nowadays,’ Louisa said with a smile. ‘I’m going to put a couple of stitches in there, because it will heal better with less scarring.’ She stroked Julian’s hair. ‘I’m going to put some magic cream on your head now to stop it hurting. But to make the magic work even better, we’re going to have to sing a song. Do you know “Twinkle Twinkle Little Star”?’

‘Yes,’ the little boy said. ‘Tinkle tinkle.’

‘And can you waggle your fingers like starlight?’ She demonstrated, and he copied her.

‘Brilliant,’ she said. ‘And we’ll get Mummy to sing, too, shall we?’ From experience, Louisa knew that often parents needed as much distraction as toddlers. And Julian was giving a normal two-year-old’s verbal response, which made Louisa fairly sure that the worst of his injuries was the cut.

Once the cream had numbed his skin, she got Mrs Livesey and Julian to sing with her, and gently but swiftly made sure the wound was perfectly clean, then sutured the cut.

‘That was brilliant singing, sweetheart,’ she told the little boy. She glanced up at Mrs Livesey. ‘They’re dissolvable stitches, so you don’t have to worry about bringing him back to have them taken out. You need to keep an eye on him over the next couple of days; if he starts being sick, has a fit or is drowsy or just a bit unwell and you feel something’s not right, come straight back. A mother’s instinct is usually pretty sound and you know your child best.’ She smiled. ‘It’s a lot to take in, so I’ll give you a leaflet about head injuries.’

‘And I have to keep him awake, right?’

‘No, it’s perfectly safe to let Julian go to sleep—he’s going to be tired from crying and the stress of hurting himself. If you’re worried, try waking him after about an hour. I can tell you now, he’ll be pretty grumpy about it, but that’s normal. If you can’t wake him easily, that’s when you need to bring him back.’

She answered a few more questions and, once Mrs Livesey was reassured, Louisa gave Julian a shiny ‘bravery’ sticker and called in her next patient.

When she walked into the staff kitchen for a swift coffee break, Dominic was there.

‘Good timing. The kettle’s hot.’ He smiled at her. ‘Want a coffee?’

That smile was lethal, Louisa thought. Those dimples…no wonder her heart felt as if it had just done another of those odd little flips. But Dominic was her colleague. There wasn’t room in her life for him to be anything more than that. And, even if there was, she’d got it so badly wrong last time that she was wary of repeating her mistake. Handsome is as handsome does.

She strove to sound normal. ‘Thanks, that’d be wonderful. Milk, no sugar, please.’