Second Chance With Her Island Doc / Taking A Chance On The Single Dad

‘You know,’ she said thoughtfully. ‘These sheets are scratchy. My welfare decrees I should order non-scratchy sheets, just in case I’m ever admitted again. Could you put in a requisition? Linen can’t be kept apart in the hospital laundry so maybe enough for the whole hospital?’

‘Yes!’ Carla said, chuckling with delight. ‘I knew you couldn’t be as bad as your cousin. And what about coffee? You surely can’t be expected to drink…’ But then she paused. She put a hand to her head in a gesture Anna understood. Her own head hurt.

But this was suddenly more than that. Carla’s pain seemed to intensify. Her eyes widened and she grabbed for the foot of the bed, as if to steady herself.

And swayed.

And Anna moved as she’d never moved before. She reached her and hugged her under her arms, taking her weight as she sagged against her.

As Carla’s eyes became sightless. As her knees buckled.

As she crumpled to the floor.

Leo was in the nursery, checking the tiny baby who’d been born the night before. It was a good moment in what promised to be a frantic day. He gazed down at the newborn bundle and thought, This is what it’s all about. Forget Anna. Forget the Castlavarans. Focus on what’s important.

And then his buzzer…

Code blue.

He was out the nursery before he realised.

Room Twelve. Anna’s room.

Code blue meant cardiac or respiratory arrest, or similar medical emergency.

Anna?

What had he missed? Internal bleed? What?

He didn’t run—he didn’t need to. He’d pretty much perfected his hospital stride, so running would make him no faster.

He turned the corner to Room Twelve and Maria was in front of him, pushing the crash cart.

‘Anna…’ he said, and he couldn’t keep the fear from his voice.

‘Worse,’ Maria managed. ‘It’s Carla.’

She’d hit the call button and then she’d yelled. The junior nurse who’d helped shower her had arrived in seconds, taken one look and bolted for help.

Carla vomited as she reached the floor. The first couple of moments were frantic, clearing Carla’s airway, getting her into the recovery position, trying to assess her breathing. Anna was crouched on the floor, willing help to arrive. Trying to see what she was coping with. Cardiac arrest? No? Headache, pain, collapse…

And then blessedly Leo was kneeling beside her. The crash cart was being wheeled in behind him.

‘Carla…’ Leo said, and she heard his voice break.

Carla’s eyes were open but she wasn’t seeing.

‘I don’t think it’s her heart.’ Anna said it intentionally loudly, making her voice clipped and professional. Leo and this woman must be friends. She’d heard Leo’s instinctive distress, but she needed a doctor here, not someone emotionally involved.

And he got it. She felt the moment he hauled himself together. The moment he became one of a medical team.

‘Fall?’

‘Collapse,’ she told him. She glanced up at Maria, and Maria anticipated her needs by handing down a towel. Two. She used one to sweep the mess away from Carla’s head, the other to help clear her face. ‘She looked like her head hurt. She put her hand to her head like there was intense pain and then she passed out.’

‘The headache… Hell…’ He had his hand on her wrist.

‘It’s still strong,’ Anna told him.

They were squashed together. Maria started working around them, shoving the bed back, heaving the bedside table onto the bed to give them more room.

‘Defibrillator?’ Maria asked.

‘No.’ Leo was moving to the next stage. He checked her eyes, and Anna saw the slight sag of his shoulders, relief that he’d seen a corneal reflex. He’d seen her clear Carla’s mouth. He’d seen the gag reflex as well.

She wasn’t comatose, then, but the speed of the drop from alert to where she was now implied she soon would be.

‘It’s okay, Carla, we’ve got you,’ Leo said, loudly and firmly. ‘Relax, love, don’t fight it.’

That made Anna blink. He was assuming Carla could hear. It was good medicine, the assumption, unlikely as it was, that Carla would comprehend what was going on. But not all doctors did it, especially under the stress of an emergency like this one.

‘We need to stabilise your airway and get a scan,’ Leo said. ‘Carla, have you had a head injury? Banged your head?’ She didn’t respond—how could she?—but once again Anna knew the words had been said to reassure Carla that she was included in this conversation. ‘Carla didn’t say anything about an injury, Anna? Maria?’

‘Nothing,’ Maria said, and Anna heard her distress, too.

‘Just a headache,’ Anna said. ‘Leo, this looks like an internal bleed.’

‘You must have had a bump.’ Leo was back to speaking to Carla. ‘You told me you took aspirin last night.’

‘She has been taking aspirin,’ Maria ventured. ‘She’s been getting it from the hospital pharmacy. I saw her take a couple of boxes last week. She said she has a bit of arthritis. We were busy and I didn’t follow it up.’

‘Aspirin won’t have done this, though it might have made it worse,’ Leo said. ‘But if there’s a bleed it won’t help now. Carla, we’re going to have to have a look-see. Get a trolley, Maria. We’ll take her through for scans. Now.’

‘What can I do?’ Anna asked.

‘You’re a patient,’ Leo said roughly. ‘Thanks for your help, Anna. You should be right to go.’

The scan showed a bleed.

A big one.

The hairline skull fracture was bad enough. What was worse was the dark shadow underneath the fracture. A subdural haemorrhage. Blood vessels near the surface of the brain had obviously ruptured.

How the hell…?

But the cause of the injury was the least of his concerns. What was crucial was time. Blood had collected immediately beneath the three-layer protective covering of the brain. The brain was being compressed.

In young people a bleed like this was usually triggered by a significant impact. Older people could bleed after only a minor trauma.

Carla was hardly elderly but she’d been taking aspirin. The aspirin would have been thinning the blood.

The greater the pressure on the brain, the worse the bleeding would become. For her to lose consciousness so quickly…

‘I’m going in.’ He was talking to Carla, and to the nurse beside him. Maria was looking as terrified as he felt. ‘Carla, there’s a bleed under the surface. We need to get the pressure off.’ He needed to say no more. If Carla was aware enough to take it in then she’d know, and Maria had been a nurse long enough to realise the ramifications of a cranial bleed. Pressure on the brain caused brain damage, and it caused it fast. They had to get the pressure off now.

‘Leo, I’m asking again. What can I do?’

The voice came from the doorway. Anna still looked very much the patient. She was dressed in jeans and a T-shirt, but the white dressing showed starkly against her burnt-red hair.

‘You need to leave, Anna.’ It was an instinctive response.

‘I’m a doctor, Leo,’ she snapped. ‘Get over yourself. Let me help.’

‘You’re injured.’

‘I have stitches from a bump on my head. I imagine Carla’s haemorrhaging. Am I right?’

‘You’re not well. I can’t—’

‘Do you have another doctor on staff? An anaesthetist?’

He needed headspace and she was messing with it. He opened his mouth to snap back but sense prevailed.

His instinctive reaction to Anna had been that of a doctor to a patient. The internal war, how he was feeling about Carla’s illness, physician versus friend, could allow no other distractions.

Anna’s question, though, had cut through.

There was no other doctor within hours of travel. Carla collapsing so dramatically meant that the bleed was sudden and severe. The pool of blood under the dura must be causing damage.

Carla usually assumed the role of anaesthetist if he needed to operate. What now?

‘There’s no other doctor,’ he admitted.

‘Evacuation?’

‘It’ll take hours.’

‘Then she needs emergency craniotomy and drainage,’ Anna said. Her curt, professional tone helped. ‘If there’s no one else… Leo, can you operate if I do the anaesthetic? I’ve done additional anaesthetic training. The village where I work isn’t big enough to support medical specialists and there’s occasional urgent need.’

She had anaesthetic training? It was like a gift from the heavens. A colleague with anaesthetic skills…

‘You have a head injury yourself.’

‘I have stitches and bruising. I may also still suffer a bit of dizziness if I stand up fast, but I think I’m over it and I can cover it. I know it’s not ideal but given the circumstances… Give me a stool in Theatre and let’s move.’

He gazed down at Carla and saw no response. No glimmer of recognition. He looked again at Anna and she met his gaze with a determination that was almost steely. Treat me as a doctor, her gaze said. Get over your prejudices.

She was still a patient. He could hardly ask.

There was no choice.

‘Thank you,’ he said simply. ‘If you’re sure.’

‘I’m sure. Let’s move.’

The surgery sounded simple. Anyone with a decent handyman’s drill should be able to do it—in fact, Leo had heard of doctors in emergency situations using just such an implement.

Luckily he didn’t have to resort to such measures. Most of their of equipment was second-hand but it was functional. Leo had kept up with a lot of doctors he’d met during training, and when they had been purchasing shiny new medical toys they often remembered him and sent on usable older things. The X-ray department had been set up almost completely via donations from a friend he’d met in final year med school. For the rest they’d scraped and saved and cajoled the community, which meant the theatre he was working in was fully equipped.

And he had excellent staff. Maria, his chief nurse, was rigid about standards and ongoing training, and she ruled her nursing staff with a softly gloved fist of iron.

The only hole in the team was his lack of a trained anaesthetist and that hole had been plugged. In Anna he had an anaesthetist he could trust. From the moment he’d nodded his acceptance of her offer she’d turned almost instantly from patient, from heir to the powers of Castlavara, from his past lover—into a crisp, competent professional.

‘Do you have access to Carla’s medical history? I need to know what she’s taken, allergies… Family? Is someone on their way?’

‘Her husband died ten years back,’ he told her. ‘Her son’s in Italy. But we have her history. Maria…’

‘Onto it,’ Maria said, and so was Anna. Ten minutes later they were in Theatre.

‘Glasgow scale deteriorating,’ Anna told him. ‘I’m losing any eye response.’

He didn’t need telling. He knew the pressure would be building.

He needed to focus.

A handyman might be able to operate a drill but what was needed here was precision, care, knowledge. And confidence.

Confidence that Anna could keep Carla alive while he worked.

And strangely the trust was there.

If another doctor had walked in right now, someone he didn’t know… If they’d offered to help… Yes, he’d have had to accept their help but there’d be caution. He’d be checking all the time. He’d be torn, though, because the procedure he was performing was out of his comfort zone. He needed to work fast with skills he hardly knew he had.

Anna helped. Somehow just knowing she was here helped.

Carla was in the supine position, facing up. As soon as Anna had the IV line in, as soon as she was sure Carla was under, Maria did a quick shave.

Then it was over to Leo. Two small holes to expose the dura, then careful, painstakingly draining. Hell! The scan had showed a build-up but it shook him to see just how much fluid was in there.

He inserted a temporary drain to prevent more build-up. He’d rather not have—it increased the chance of infection—but with this amount of fluid and with the speed of onset of symptoms, he had little choice.

Then closing.

It sounded straightforward. It seemed the hardest surgery he’d ever undertaken. Why? Because the huge unknown was how much damage had already been done. Had they been fast enough? Had the pressure already caused irreparable harm?

He fixed the drainage tube, dressed the wound and finally stood back from the table.

He’d done all he could do.

Carla was his friend and he felt ill.

What would have happened if Anna hadn’t been here? Would he have had to administer the anaesthetic himself? Have Maria do it?

Or wait for evacuation?

He was under no illusion as to what waiting would have meant. Even now, as Anna reversed the anaesthetic, he was aware that they might have been too late. Cerebral haemorrhage was the most frightening of medical emergencies.

‘We’ve done everything we can,’ he said wearily. ‘A neurosurgeon will need to take over. We’ve put in a call for evacuation but that’s still hours away. Meanwhile, we just have to hope.’

Anna had finished reversing the anaesthetic. She’d removed the intubation tube. Carla was breathing for herself again, but would she wake up? And if she did, what damage had been done?

‘You went in as fast as you could,’ she said, maybe sensing just how close to the edge he was. ‘She has the best chance you could possibly have given her.’

‘Partly thanks to you.’ Then, almost huskily, ‘Thank you.’

‘Don’t thank me.’

He nodded, dumbly, as the imperatives of surgery faded and the fear for his friend flooded back. What if the damage from pressure was irreversible? What if Carla didn’t open her eyes again, or, if she did, what life would she be facing?

Surely they’d moved fast enough.

With this level of bleeding, with the speed with which things had overtaken Carla, there was no way of knowing.

There was nothing more he could do but wait. The pain he was feeling was fathoms deep.

‘The Italian neurosurgeons will take over,’ he said roughly. ‘We don’t have the facilities to do more.’ While there’d been medical need, he’d been able to put distress aside, but now there was little to do for Carla but wait, that distress was impossible to hide. ‘I need to speak to her son. Our receptionist will have contacted him already and he may well be on his way. But enough. Anna, you need to go home.’

‘Leaving you alone.’

‘Bruno will be back later today. He’s one of our nurse-practitioners but his six-year-old fell out of a tree last week. Comminuted fracture of his femur. He needed specialist orthopaedic care.’

‘So he was evacuated, too?’

‘Yes, but Bruno should be back.’

‘But he’s not a doctor.’

‘He’s good. Anna, you need to leave. I’ll take over here.’

‘And leave you to worry about Glasgow scores on your own.’

‘You’re a patient, Anna,’ he said, reminding himself as well as her. ‘Your place isn’t here.’

He saw her wince, but there was nothing he could do about it. He had room for nothing but distress for his friend.

And she seemed to accept it. She looked at him for a long moment and then nodded.

‘Okay. But you will call me if Carla needs me. If you need me.’

‘I will.’ He hesitated. ‘But the castle won’t necessarily put my calls through.’

‘What the…? Of course they will.’

‘Try and see,’ he said wearily. ‘The outside world isn’t permitted to intrude on the castle and its occupants.’

‘That might have been then,’ she said briskly. ‘This is now. If there’s any problem, I have my own phone and it’s on international roaming. I’ll leave my number at the desk. Call me. Promise?’

And he looked at her, a long look where questions were being asked that he didn’t understand and maybe she couldn’t respond to.

‘I promise,’ he said at last. ‘Not that I think it’ll happen, but I promise. Thank you, Anna, but you need to remember you’ve been injured yourself. It’s time for you to leave.’

CHAPTER FOUR

TO SAY VICTOIR was annoyed was an understatement. He’d come to collect her in one of the castle’s limousines. He’d been left kicking his heels for hours.

When she finally joined him he was leaning on the beautiful auto, glowering, looking almost startlingly out of place. The entrance to the hospital was serviceable but that was all that could be said about it. It was a narrow driveway, crammed with people coming and going, mothers and babies, the elderly in wheelchairs or Zimmer frames, people visiting with bunches of flowers or bags of washing.

The ambulance that had transported Anna to hospital the day before had backed into the entrance parking bay, in front of the limo. The limo was practically taking up the entire bay. Paramedics were trying to manoeuvre an elderly lady on a stretcher around Victoir. Victoir, in his immaculate dark suit and crisp white linen, with his hair sleeked back, a man in his forties in charge of his world, wasn’t about to move for anyone, not even a patient on a stretcher.

The sight made Anna wince. Not for the first time she thought helplessly about the terms of the castle Trust. Yes, she’d inherited but she had no power. Once upon a time one of her ancestors had mistrusted his heir and made the entailment bulletproof. It would be twenty years before she had any control over funds. She owned it all and yet she didn’t own it.

Her cousin hadn’t survived his inheritance for the twenty years needed to break the Trust. Her uncle and her grandfather…clearly by the time their twenty years had been up they hadn’t bothered. After all, why should they? All their needs were being met.

Men like Victoir had no doubt been lining their own pockets, but to find out how, to explore the complexities of things she probably could do nothing about…

‘Leave it and come home,’ Martin had suggested. ‘A decent legal team can look after your interests from over here. If in twenty years you wish to do something more, you can think about options then.’

It made sense. She knew little about this place except that she now—sort of—owned it. And it was poverty-stricken. And Leo was here and he was struggling.

Victoir was opening the car door for her. ‘You should have asked the nurses to carry your gear. That’s what they’re here for.’

Really? It was a small holdall. To ask one of the overworked medical staff to abandon their work to carry it…

‘I can’t believe they let you just walk out with it,’ he continued. ‘If they think they can treat a Castlavaran like—’

‘They treated me well.’

‘They asked you to work! When you’re ill yourself?’

‘I’m not ill and I asked to work.’

‘They’ve even demanded to come to the castle. A final check, the nurse said. As if we can’t take care of you.’

An offer of a follow-up visit by a district nurse was entirely reasonable, Anna thought. She’d have organised the same for a patient of hers. She didn’t need it, though. She was okay.

Except that she was angry.

Usually she was unflappable. She prided herself on her calm in the face of crises.

She didn’t feel calm now.

Get a grip, she told herself. Think of the whole situation.

Until now she’d floundered, bowing to Victoir’s assumed authority. What choice had she had? But his authority was starting to grate and grate badly. Surely she paid this man’s wages?

She didn’t know how much. By the look of his clothing and the gold rings on his flaccid fingers, a lot. She’d spent her short time here trying to come to terms with the vastness of her inheritance. Should she stay a few more days and check staff ledgers? She could do that as she lay on her day bed while the staff in question catered to her every whim, she thought, and then she grimaced. The only appealing part of that right now was the day bed.

‘You need to remember you’ve been injured yourself.’

That was what Leo had said and there had been gentleness in his tone.

Of course there had. She was his patient. His gentleness meant nothing.

She’d been judged ten years ago and he’d walked away. How much deeper would that judgement be now that she’d inherited?

‘Can you get that ambulance out of the way?’ Victoir called, power loading every word. And to Anna’s disgust, the paramedic left the old lady’s trolley where it was, and went to move the ambulance.

‘You’ll look after your patient first,’ she called, and Victoir’s authority was nothing compared to the power she put behind her words. Wow. Where had that come from? Was it the doctor in Anna, or was it the first stirrings of the long line of autocratic Castlavarans in her genetics? Regardless, her words held the weight of ancestry, plus a huge loading of a doctor accustomed to sorting chaos in the midst of medical emergency. It forced all those around her to go still.

The paramedic, the woman about to climb back into the driver’s seat, looked at her with doubt. Anna might sound authoritative but she surely couldn’t look it. Jeans, T-shirt, bandaged head. What remained of her copper curls tumbling every which way. No make-up. Compared to Victoir she looked a nothing.

But this was a test she needed to pass. Victoir was looking at her as if she’d passed the boundaries of what was permitted. Up until now he’d set the guidelines. He’d made it easy for her to follow his lead, impossible for her to do anything else.

Impossible had to start somewhere. Victoir was invoking the family name? So could she.

‘I’m Anna Castlavara and we wait until the needs of patients have been met,’ she said. ‘Your patient’s care takes precedence over my needs.’

‘We’ve waited long enough,’ Victoir snapped. ‘These people—’

‘These people are Tovahnans, just like me,’ she said. ‘What’s best for them is best for me. And what I say goes.’

And she seated herself—firmly—in the rear of the limousine and prepared to wait.

But what she hoped Victoir didn’t see was that she sat not because she needed to but because her knees were shaking.

What was she letting herself in for?

And then she glanced out of the window of the car and there was Leo. He was striding out to check on the new patient being admitted.

He’d paused like everyone else.

He’d heard.

So what? She turned away, putting her hands to her cheeks to try and subdue the slow burn spreading across her cheeks. Her knees were still trembling.

She needed that day bed.

She needed space.

She needed to get home to England.

The evacuation team was delayed and delayed again. It happened. Neighbouring countries assisted as they could, but their own emergencies took precedence over Tovahna’s. Finally, though, and before evacuation took place, Carla regained consciousness.

It was six at night. She’d been unconscious for almost ten hours. She was confused, her speech was a little blurred and she wasn’t sure what was happening or why, but she recognised Leo. She recognised Maria. Her vision seemed only slightly impaired. Her fingers and toes worked, albeit with a struggle.

‘What…what…? Tell me what’s happened.’

The spectre of unimaginable brain damage faded. It was so much more than Leo had dared hope that it was all he could do to hold back tears.

Maria couldn’t. She sobbed, openly. ‘Oh, Carla, we’ve been so frightened. You nearly died. And the Castlavaran, Anna, had to help save you.’