The Surgeon's Engagement Wish

‘Open fracture of the femur,’ she advised.

‘Cover it,’ Mike responded. ‘We can’t deal with that just yet.’

Beth reached for a large gauze dressing and tried to concentrate on squeezing a sachet of saline onto the pad to dampen it, but she simply couldn’t help glancing back towards Luke.

Had Luke recognised her voice as easily as she had recognised his?

Apparently not.

‘Oxygen sats aren’t climbing.’ Luke was staring at the monitor above the bed. ‘We’ll have to intubate.’

‘I’ll get another IV line going,’ Mike said. ‘We need to speed up this fluid resus.’

A new face peered in through the curtain. ‘Luke? They just called to say they’re ready for you in Theatre.’

His glance seemed to bypass Beth effortlessly as she used the damp dressing to cover the gaping wound on their patient’s leg. ‘Thanks. I’ll be up as soon as I can.’

Mike took the cannula Beth was holding out for him. ‘Could you help Sid take Jackal upstairs, please?’

‘Sure.’ The prospect of making an exit was appealing.

Was Luke simply being professional, ignoring her—quite properly—due to the emergency treatment of a patient? It was possible that he had not yet recognised or even noticed her.

It was also quite possible that he just didn’t give a damn.

And why, in God’s name, should that bother her so much anyway?

Beth turned her back on Luke but she wasn’t going to escape quite so easily. The sound of breaking glass made everybody pause.

‘What the hell was that?’

‘We locked the doors when we came in.’ The male ambulance officer had abandoned his paperwork to step closer. ‘Sounds like someone really wants to get in.’

A police officer appeared behind him. ‘ETA for the chopper is only two minutes. We’ve got a bit of a skirmish going on in the car park right now, though.’

The sound of a shotgun being fired was unmistakable.

So was the alarm that sounded on the new patient’s monitor in the tiny silence that followed.

‘He’s in VF,’ Luke warned.

Mike was already reaching for the defibrillator paddles. ‘Everyone stand clear.’

‘I don’t want anyone moving from here until we get some back-up,’ the police officer ordered.

‘Stand clear,’ Mike ordered.

Beth stood clear. In fact, she was quickly penned into the corner of the area, along with the paramedic and Chelsea, and couldn’t escape the awareness of how appalling the situation was.

They watched as Maureen squeezed air into the patient’s lungs and Luke readied himself to do compressions when the initial series of shocks was completed. Mike pressed the paddles into position and pressed the buttons to deliver the second shock and then the third.

Beth closed her eyes for a moment. This was all so bizarre it was almost a joke. Some huge, cosmic joke. And whoever decided which way the winds of fate were going to blow was laughing at her right now.

She had come here to get away from the stress of dealing with violence and was now up to her neck in the most major incident she had ever encountered.

And she had also come to get away from the lingering effect Luke Savage had branded on her life. She had just ended her extremely brief engagement to Brent, for heaven’s sake, because she had recognised that the only qualities he had that were attractive had been the ones that reminded her of Luke.

The prospect of actually crossing paths with Luke Savage had haunted Beth for far longer than the fear of finding herself living Neroli’s nightmare, and coming to a small town like Hereford had seemed like the perfect way to escape that particular ghost.

And here she was, only a few feet away from the man. And it felt like the first time she had seen him all over again. He was just as physically attractive, but it hadn’t been simply his looks that had drawn her so convincingly at that first meeting. It had been his presence. The feeling she’d got that this man would be able to handle any situation he found himself in, no matter what it was. And she could feel that again right now. Luke was just…exactly the same.

It was so bizarre. It went way beyond being a disappointing start to a new beginning. This was gutting. Maybe she should have taken up Neroli’s invitation to go to Australia with her. Melbourne would be a nice place to live and Neroli’s sister was always short of waitresses in that coffee-shop.

The static cleared from the monitor screen after the third shock to show a pattern that settled over several seconds into normal sinus rhythm. The quiet was broken by the steadying beeps of the monitor, loud but muffled shouting from somewhere outside and then the crescendo of an approaching helicopter’s rotors.

Relieved glances were exchanged between staff members and it was only then that Beth’s gaze met that of Luke. The, oh, so familiar dark grey eyes beneath that shaggy mop of black hair widened and Beth realised that he hadn’t been ignoring her.

He couldn’t look this shocked if he had known she was so close.

Her presence was a surprise. And it wasn’t a pleasant one.

It shouldn’t have hurt but it did. Any fantasies she’d ever had of looking into those eyes again and seeing the love that had once been there were crushed in an instant, and Beth could hear echoes of that cosmic laughter.

She wanted nothing more than to get away, and Mike’s repeated instruction to help shift Jackal up to Theatre seemed timely.

It wasn’t until Beth pulled the curtain back and stepped outside the resuscitation area that they realised the move had been premature.

Black-clad, helmeted and armed offender squad members were filing rapidly into the emergency department of Ocean View hospital, but the skirmish that had been taking place outside had also moved in. Somehow one of Jackal’s mates had gained access and was now standing outside Resus 1 with a knife in his hand as a member of an obviously rival gang advanced rapidly towards him.

And Beth had inadvertently stepped right between them.

Was this the punchline of the joke?

There was nobody close enough to help but the fear that should have swamped and immobilised Beth simply wasn’t there.

‘Don’t even think about it!’ she snapped.

Beth drew herself up to her full height of a not very impressive five feet four inches. Her lack of height was irrelevant because the misery over the personal disaster she had engineered for herself in coming here had just morphed into pure fury.

‘You!’ She jabbed her finger at the leather-clad chest of the man whose progress towards Resus 1 she had just blocked. He was at least six feet tall and his bearded, tattooed face was bleeding heavily from a jagged laceration. ‘Go and sit down and behave yourself.’

Whirling to confront Jackal’s mate, Beth was dimly aware that the police officers rushing to her assistance had slowed involuntarily, their jaws drooping.

‘Drop the knife,’ she commanded.

‘No!’ she yelled as both men made a move to close her further into the middle of the potentially very dangerous human sandwich. Her voice remained at a furious shout. ‘Do as you’re bloody well told! I am just so not in the mood for this.’

Amazingly, the gang members froze. The hand holding the lethal-looking knife began to drop and suddenly the police were right there. As fast as the incident had occurred, it was defused and the space cleared.

Beth was aware of a curious shaking sensation in her knees. She turned her head slowly to see the occupants of Resus 2 staring at her.

‘Woo-hoo!’ Chelsea called softly. ‘You go, girl!’

Mike had an astonished grin on his face but it was Luke who drew Beth’s gaze. He was staring at her as well, of course. Who wouldn’t be? He wasn’t looking shocked any more. He was looking as though Beth were a complete stranger.

A rather impressive stranger, in fact.

Straightening her back made that weak-kneed sensation subside almost completely. The calm, confident smile Beth was aiming for probably came out more like an embarrassed grin, but it didn’t seem to dull the respect she could detect from her small audience.

An audience that included Luke Savage.

How cool was that?

CHAPTER TWO

GOOD grief!

Luke was still shaking his head in disbelief as he scrubbed up for Jackal’s emergency laparotomy ten minutes later.

Seeing Beth again after all these years was unbelievable enough. Seeing her doing that warrior princess act with the gang members had been…

The sexiest damn thing Luke had ever seen in his life.

He scrubbed beneath his nails hard enough to cause real pain.

Beth was the only woman who had ever made him seriously consider marriage.

And she was the only woman who had ever dumped him.

The hurt and the ensuing anger that had caused should have been rendered inconsequential by the blows life had meted out since then, so it was incredibly disturbing to find how easily the years could be peeled back.

One good look into those bright blue eyes and there he was again. Not measuring up. Just not being good enough, no matter how much love he had to offer.

What the hell was Beth doing in Hereford of all places?

Luke took his foot off the water control and reached for a sterile towel. She’d probably come here to give her kids a nice, healthy rural upbringing or something. Snapping on gloves, Luke turned abruptly to let the scrub nurse tie up his gown. That flash of something astonishingly like jealousy at the thought of the father of those children was ridiculous.

So she was still an attractive woman. So what?

So she had grown up a bit and become brave about confronting things she didn’t like. Again, so what?

Luke had more than enough to deal with in his life right now, without complicating things by renewing any kind of relationship with Beth. The last thing he needed was to try poking an old scarred area when the potential to find a tender spot was so clearly possible.

A deep breath was called for here. And rational thinking. This disturbance was probably just part of the surprise factor of seeing Beth again. All he needed to do was ride it through and there would be no shortage of distractions if that proved in any way difficult. It was a relief to use the one immediately available.

‘Let’s get this show on the road, shall we?’

With his hands held carefully crossed in front of his chest, Luke used his shoulder to push open the swing doors into Theatre.

At just after 3 a.m. on a Tuesday morning, Ocean View’s emergency department was stretched to slightly over its full capacity.

One of the high-tech resuscitation areas was still occupied by a seriously injured patient, the other one having just been vacated by the hit-and-run victim, who had gone up to Theatre 2 for the attention of an orthopaedic surgeon. All the beds in the cubicled area were also full and half of those patients were still waiting to have bones X-rayed or lacerations sutured. The treatment rooms were full and there were no spare seats in the waiting area either.

A few people with minor injuries were in Reception but most of them were simply there to offer solidarity to their mates, and they included some of the loudest and most unpleasant women Beth had ever encountered.

They were all unkempt, tattooed, pierced in multiple places and inebriated, and only too happy to demonstrate their contempt of any authority figures or lack of appreciation for any medical assistance. But the police presence was strong enough to ensure the safety of staff and the background noise of obscene language and shouting was so constant Beth could tune it out now.

It had already become automatic to seek the company of a police officer before approaching or treating a patient, and all the nurses remembered to wait until a member of one gang had left the X-ray department before escorting a member from the rival gang down the corridor.

Hopefully, the stab victim who was currently in Resus 1 would also be sent up to Theatre soon. When the doctors could be freed from attending the critically injured patients they should be able to deal with the minor injuries rapidly. They would be able to clear the department and then they could all have a well-deserved break.

Oddly enough, the chaos and unpleasantness of her current environment had been quite enjoyable over the last hour or so. Not the patients, of course, but their uniform lack of co-operation or appreciation had provided a bond of camaraderie amongst the staff members that had only increased under pressure.

And Beth was very firmly one of them. Thanks to that inadvertent episode of venting her tension, having stepped into the path of the converging gang members, Beth had not only been welcomed into the ranks of Ocean View’s emergency department staff, she was currently being used as a lynchpin.

Even though it had only taken a few seconds and could quite easily have been a huge mistake, the fact that Beth had taken control had become a kind of emotional bank in which snippets of humour or stamina were being deposited and could be withdrawn whenever someone needed the lift of a shared smile or a pat on the back.

‘I’m just so not in the mood for this’ had become the catch-phrase of the night and never failed to produce a smile.

Dennis, the local cop, had claimed Beth as one of their own with a hint of pride.

‘Keep your eyes open,’ he had told one of the Nelson police officers about to accompany Beth when she needed an escort to Radiology. ‘You might learn something from our Beth they never thought to teach you at police college.’

How ironic that Beth could feel so at home in a new place so quickly when she was still having serious doubts about the wisdom of having come here at all. She even knew her way around the storeroom now, having gone in there so often to fetch new supplies, and she was there again now, checking the fridge, as requested, to see how much O-negative blood they had on hand. Then she moved towards the shelves supporting boxes of dressings.

A number of extra-large gauze pads had been needed to staunch the arterial flow from the blood vessel severed by a knife wound in the car-park skirmish. And a fresh intubation pack was needed to restock Resus 2. Searching for the location of cuffed endotracheal tubes, Beth’s eye was caught by the sterilised, draped rolls of surgical gear.

The obstetric pack was probably useful, but how often would they have the need for a thoracotomy kit here? Beth had only ever seen someone’s chest opened in an emergency department once, and that had only been done because it had been in a big hospital and they’d had a cardiothoracic surgeon available for back-up.

Luke had had ambitions in cardiothoracic surgery so why on earth was he working here? And how could Beth hope to start a new life when there would be such constant reminders of the past?

If she didn’t stay at Ocean View, though, would she end up being back in some emergency department large enough for the triage staff to wear headsets and microphones? Beth’s sigh was heartfelt. She had really been looking forward to the change of working in a much smaller and potentially friendlier environment. And what on earth was she going to say to the nurse manager?

Sorry. This is a great place to work but I can’t possibly stay because the man I was passionately in love with years ago happens to be working here as well, and I’m not sure if I could handle seeing him every day.

How pathetic was that?

Especially when it had been her that had broken up the relationship.

Beth added some other sizes of gauze dressings to the load she was carrying and wondered how the supplies of lignocaine were holding up. A lot of local anaesthetic was being used in the repair of lacerations. The thought was only fleeting, however, and Beth did not reach for any ampoules. She was too busy thinking about something else.

It hadn’t been her that had broken things up, though, had it? Not really. Ending it had been the last thing Beth had wanted. And having her nose rubbed in the puddle of her lost dreams by living in the same small town as Luke Savage was just unthinkable.

And finding him beside the bed of the stabbing victim in Resus 1 was unexpected enough to add considerably to those doubts about her new job. She had thought Luke would be tied up in Theatre for the rest of the night and that maybe encounters with the surgeon would be the exception rather than the rule. Beth averted her gaze hurriedly to avoid renewed eye contact but the surgeon was listening too intently to Mike to notice the arrival of a nurse carrying supplies.

‘…femoral artery,’ Mike was saying. ‘Class III haemorrhage. Estimated blood loss of around two litres, but we’ve finally got it under control with the pressure bandage.’

‘Blood pressure?’

‘Coming up finally. Ninety-five on fifty now. We’ve run in two litres of saline and I’m just waiting for blood results.’

Beth was behind Luke now. It was quite safe to risk a glance. Not that she needed to confirm the impressions gained earlier, but it was tempting to add to them.

The shaggy black hair was a little longer than it used to be and there was just a hint of silver at his temples. Thirty-six seemed a bit young to be going grey, but Beth had found the odd white hair amongst her own recently and she was two years younger than Luke.

His face was browner and leaner, which made him look more serious somehow. Judging by the arms and the smooth V of chest visible around the baggy scrub suit, the rest of Luke’s body was browner and leaner than it used to be as well.

Beth had to take a rather deep breath all of a sudden. No. Luke Savage had not lost his looks in the last ten years. Quite the reverse, really…damn it!

‘Beth?’

‘Sorry, were you talking to me?’

‘I just wondered how the supplies of O-neg were looking.’

‘There’s two units. Plus some packed cells.’ Beth continued putting the dressings into the drawer of the trolley but it would have been rude not to look up again. Mike was nodding. Luke was looking at the patient.

‘How are you feeling?’ he queried.

The gang member gave a noncommittal grunt.

‘We’re going to have to take you up to Theatre and repair that gash in your leg,’ Luke explained. ‘Have you had anything to eat or drink in the last four hours?’

‘Yeah. I had a feed.’

‘How long ago was that?’

‘Dunno.’

‘And you’ve been drinking?’ The question was superfluous, given the smell of alcohol that hung over most of their patients that night, but Luke managed to sound nonjudgmental.

‘Yeah. Had a few beers, man.’

The gang member actually smiled at Luke. ‘You going to fix up my leg, then?’

Beth was slipping out of the cubicle as Luke turned towards Mike. ‘Looks stable enough to go upstairs. We should be ready in twenty minutes or so, I guess. What about…?’

Beth was now far enough away for Luke’s voice to be covered by the general noise in the department. Or maybe it was because the noise level had suddenly increased out here. A wave of weariness hit as Beth wondered if she needed to call for more police assistance.

But it was a police officer who was doing the calling.

‘Help! We need some help here.’

Beth moved fast towards the reception area. She could see a woman lying on the floor near the seats in the waiting room. Another woman was struggling to get away from the grip the police officer had on her arm.

‘I told you Stella was sick,’ the woman shouted. ‘And you wouldn’t listen, you bastard!’ She kicked at the officer, who winced but held on.

Beth dropped to a crouch, reaching to shake the apparently unconscious woman’s shoulder.

‘Stella? Can you hear me?’ With no response to the shaking, Beth pinched the woman’s ear lobe. ‘Open your eyes.’

The woman groaned and rolled her head from side to side. Beth could see her chest rising and the groans were loud enough to suggest that her airway was clear. She was feeling for a pulse on the woman’s wrist as she heard a deep voice behind her.

‘What’s happened?’

‘She fainted or something,’ the police officer said. ‘One minute she was sitting on that chair and the next she was on the floor.’

‘She’s been bloody hurt, that’s why!’ The second woman was clearly furious. ‘She’s been feeling like crap but nobody would listen!’ With the stream of obscenities that followed this statement, it didn’t surprise Beth that nobody had wanted to listen. Still, there was no excuse for missing a potentially serious injury.

Luke was frowning as though he’d had the same thought. He crouched down close to Beth and put his fingers on the woman’s neck, feeling for a carotid pulse.

‘There’s no radial pulse,’ Beth told him quietly.

Luke nodded, acknowledging the information that the woman’s blood pressure had to be very low. He glanced up at the people standing nearby. ‘Can somebody tell us what happened to her?’

‘She got hit in the chest,’ the second woman spat. ‘With a bloody softball bat, that’s what happened.’

‘How long ago?’

But Luke’s query was ignored.

‘And it was that bitch over there that did it. And I’m going to do something about it.’

Fortunately, two more police officers arrived to deal with the woman who was making a new and more frenzied attempt to get free.

‘It must have happened in the car park,’ the first officer told Luke. ‘Probably well over an hour ago.’

‘Thanks.’ Luke slid an arm beneath the woman’s back, the other under her legs, standing up with apparent ease despite the weight of his burden. ‘Let’s go,’ he said to Beth. ‘What’s free?’

‘Resus 2.’ Beth led the way, relieved to move away from the tension in the waiting area, which was now escalating thanks to the screams of their new patient’s friend.

‘Let me go! Where are you taking her? She’s bloody dead, isn’t she?’

Stella wasn’t dead but she wasn’t looking at all well. Mike came into Resus 2 as Luke gently deposited the woman on the bed.

‘What’s happened?’

‘Collapse,’ Luke told him succinctly. ‘Possible blunt chest trauma from a softball bat more than an hour ago.’

Beth slipped an oxygen mask over the woman’s face and turned the flow up to 10 litres a minute, before swiftly turning her attention to pulling open Stella’s shirt. Then she grabbed a pair of shears to cut through the singlet top beneath the shirt.

‘She’s tachycardic,’ Luke told his colleague. ‘And she’s got JVD.’

Beth hadn’t noticed the distension of the jugular veins on the woman’s neck but she recognised the significance of the sign, reaching for the ECG leads as she dropped the shears.

‘Chest-wall contusion,’ she reported.

Stella groaned loudly, swore incoherently and tried to move as Mike put his hands on the obviously bruised area on the left side of her chest.

‘It’s all right,’ he reassured their patient. ‘We’re just checking you out.’ He looked up. ‘Do we know her name?’

‘Stella,’ Beth supplied.

‘I know it hurts, Stella. Hang in there.’ He looked up again. ‘Fractured ribs,’ he said. ‘But she seems to be moving air all right.’

Luke had wrapped a BP cuff just below the tattoo encircling Stella’s upper arm. ‘Hypotensive,’ he noted. ‘Systolic’s barely 80. Let’s get an IV started.’

‘Make it two,’ Mike said. ‘Beth, can you get a line in on your side, please?’

‘Sure.’ Beth stuck the last ECG electrode in place and turned to grab a tourniquet. Mike was watching the screen of the cardiac monitor.

‘Sinus tachycardia,’ he said. ‘And…yes, we’ve got electrical alternans.’

Luke’s grunt sounded almost satisfied as he pulled the cap off a cannula. ‘Thought so. Pericardial tamponade.’

Beth glanced up at the screen, noting the way the spikes of the QRS changed direction every few beats, indicating a change in the cardiac axis. She knew the first line of treatment for an acute pericardial tamponade was a rapid infusion of saline. Bleeding around the heart, trapped by the membrane encasing the organ, was interfering with its ability to pump blood. By increasing the fluid volume of the patient, the output of the heart could be improved.