A Very Special Marriage

‘Why on earth did you take a job like that?’ she exclaimed.

‘Because I wanted to make a real difference to people’s lives.’ He led the way to the stairs, wondering if that had sounded as ridiculously idealistic to her as it had to him, even though it was the truth.

‘And did you? Make a difference to people’s lives, I mean?’ she asked quietly.

‘I like to think I did, but who can say for sure? The people I dealt with are so poor that death is an everyday occurrence. If they don’t get shot or stabbed then more often than not they die from malnutrition.’

‘It must have been difficult, working in conditions like those. I had no idea…’

She stopped and Liam saw a shadow cross her face. His heart ached because he knew immediately what had caused it. Once upon a time they’d been so close that each had known what the other had been thinking, and it hurt to realise how far apart they’d grown.

‘There’s no reason why you should have known where I was working, Sophie,’ he said gently.

‘No, I don’t suppose there was.’ She summoned a smile. ‘I must confess that I’m rather surprised, though, because you never mentioned that you were interested in doing aid work.’

‘It was only after we split up that I decided to find a new direction for my life,’ he explained. ‘It helped to put my own problems into perspective when I saw the difficulties other people have to contend with on a daily basis.’

‘And does Julia work for the aid agency as well? You said that you’d met her when you were both working overseas.’

‘She’s done aid work ever since she qualified,’ he explained flatly, wondering why he felt so uncomfortable talking about Julia. He forced a little more enthusiasm into his voice.

‘She’s a superb doctor and completely devoted to her work. It’s thanks to her that the agency has managed to establish a base in the region, in fact.’

‘I see. So does that mean you’ll be returning there to work after you’re married?’

Liam shrugged, not wanting to admit that he and Julia hadn’t reached a decision about where they would live. Julia was keen to continue her work but he wasn’t sure if it was what he wanted to do on a long-term basis. One of the reasons why he’d returned to England when his contract with the aid agency had ended had been because he’d hoped it would help him make up his mind. He needed to be sure before he committed himself to working overseas permanently, although how Julia would react if he decided against it was another matter.

‘I’m not sure yet,’ he said, hurriedly dismissing the thought because it was pointless worrying when there might be no need. It could turn out that his inability to make a decision was all tied in with the fact that he needed to resolve things with Sophie. In which case, all his problems would be resolved at once.

‘We’re still very much at the planning stage—’ he began, then broke off when one of the ship’s officers came hurrying to meet them as they reached the lower deck.

‘Dr Kennedy?’

‘Yes. I’m Liam Kennedy and this is Sophie Patterson, the ship’s nurse.’

‘I’m glad to meet you, Dr Kennedy. You, too, Miss Patterson.’

The man shook hands then quickly led them along a corridor. ‘I’m Mike Soames, the chief petty officer. I’m still trying to establish exactly what happened but, basically, two of the crew started fighting and one guy pulled out a knife and stabbed the other fellow.’

‘Whereabouts did the knife penetrate?’ Liam asked, wanting some idea of what they could be dealing with.

‘In the chest,’ Mike informed him. He opened a door and stepped back. ‘Alexei—that’s the chap who’s been stabbed—is in here, but I thought it would be best to separate them so I’ve put Grigorio in the next cabin. The men who would normally use these cabins are bunking down in the crew’s lounge for the night.’

‘Good. I was hoping we wouldn’t have an audience,’ Liam said gratefully, turning to Sophie. ‘Will you check out the chap next door while I see to this fellow? If you’re happy that he’s not too badly injured then you can come back and help me.’

‘Of course.’

‘I’ll go with you, Miss Patterson,’ Mike Soames said hurriedly.

Liam went into the cabin as the chief petty officer accompanied Sophie next door. The patient was lying on one of the lower bunks and Charlie Henshaw—the steward who’d shown Liam to his cabin when he’d arrived—was with him. He looked relieved when Liam appeared.

‘I’m glad you’re here, Doc. I’ve done a bit of first aid in my time but this is way out of my league.’

‘Let’s take a look, then.’

Liam crouched down beside the bunk. He could tell immediately that the man was in a very bad way. His pupils were fixed and dilated and his breathing was extremely laboured.

He quickly removed the blood-soaked towel from the man’s chest and whistled when he saw the knife wound. Although it was fairly small, it was obviously deep. ‘That doesn’t look so good. How many times was he stabbed, d’you know?’

‘Just the once. One of the other guys managed to break up the fight.’ Charlie shook his head. ‘It all happened in a flash. One minute they were arguing and the next second Grigorio had pulled out a knife and stabbed Alexei.’

‘Well, it’s certainly gone in deep. There could be all sorts of damage to the major organs.’ Liam glanced round when the door opened and Sophie appeared. ‘How’s the other fellow doing?’

‘A few bruises and a bump on the back of his head but he’ll live.’ She glanced at the man on the bunk and pulled a face. ‘He doesn’t look too good, though.’

‘He doesn’t. Can you check his blood pressure while I get a line into him? He desperately needs fluids. It also looks as though he’s going to need to be intubated so I’ll give him an anaesthetic to relax his muscles once everything is set up,’ Liam explained, quickly tapping up a vein and inserting a line into the back of the man’s hand.

Charlie took the bag of saline from him once he’d set up the drip, and hung it on the end of the top bunk. Liam nodded.

‘Thanks. I need to establish an airway now but I could do with a bit more light so I can see what I’m doing.’

‘Leave it to me, Doc.’

Charlie hurried away and returned a few minutes later with one of the huge torches that were normally used for signalling to other ships. Liam smiled his approval as the steward angled the beam so that he could set to work.

‘That’s great. I can see where I’m aiming for now.’

He administered the anaesthetic then quickly inserted an endotracheal tube and established an airway. Once it was secured, he immediately started the patient on oxygen.

‘Blood pressure is dropping,’ Sophie warned. ‘Pulse is very weak, too.’

‘Could be a haemothorax,’ Liam said, taking a scalpel out of his bag. ‘The knife appears to have entered the chest at an angle so it’s possible the left lung has been damaged. I’ll see if I can relieve the pressure.’

He made a small incision under the man’s left armpit then used a pair of forceps to open the muscles between the ribs, but there was no sign of blood in the pleural cavity. ‘That’s not it. How’s he doing now?’

‘BP is still going down rapidly.’

Sophie suddenly leant forward and checked the pulse at the base of the man’s neck. Liam held his breath because he had a horrible feeling that she wasn’t going to find one.

‘No pulse. He’s arrested!’

‘It looks as though his heart must have been damaged, then,’ Liam exclaimed. ‘If enough blood has collected in the pericardium, it will have stopped his heart beating. We need to get him on the floor so we can start CPR.’

Sophie grabbed the man’s legs while Charlie gave him a hand to lift the seaman off the bunk. Liam turned to Sophie. ‘I’ll need you to give me a hand opening him up.’

‘You mean you’re going to do a thoracotomy?’ she exclaimed incredulously. ‘Here?’

‘I don’t have a choice. External cardiac massage won’t work if the pericardium is full of blood so I’m going to have to open his chest to do it. We don’t have the time to get him up to Theatre because his brain will stop functioning in three minutes without any oxygen reaching it.’

He didn’t waste any more time on explanations. Slipping the scalpel into the hole he’d made already under the man’s armpit, he sliced horizontally across the patient’s chest. Sophie was searching through his bag—finding scissors and dressings—and he breathed a sigh of relief. It was reassuring to know that he had someone with her experience to help him and didn’t have to explain every little detail to her. It left him free to get on with his job.

‘Oh, my Gawd!’ Charlie muttered as Liam took the pair of scissors from her and began to cut through the tough layer of muscle beneath the patient’s skin.

‘I know it looks brutal but it’s his only chance.’ He reached the breastbone and felt beads of sweat gather on his forehead as he struggled to saw through the bone. Every second that passed meant that the chances of the patient surviving were decreasing. He grunted in relief when he felt the last bit of the bone give way so that he was able to complete the incision.

‘What I wouldn’t give for some retractors,’ he muttered, struggling to see inside the chest cavity.

‘What’s them, Doc?’ Charlie asked curiously.

‘Great big metal clamps that you use to open up the chest,’ he explained. ‘Where’s that torch? Thanks.’

He peered into the chest cavity while Charlie held the torch for him, and immediately spotted the cause of the problem. As he’d suspected, the pericardium—the sac surrounding the heart—was bulging with blood and preventing the heart from beating.

‘Definite signs of tamponade.’ He grasped the sac with a pair of narrow forceps and managed to cut through it. However, when it came to removing the blood clot, it proved impossible. His fingers were just too large to fit through the limited amount of space he’d been able to make.

He turned to Sophie. ‘See if you can get those clots out of there, will you? Your hands are smaller than mine.’

She quickly changed places with him and he saw the tip of her tongue poke between her teeth as she inserted her fingers through the opening in the chest wall. Liam felt a wave of heat rush through him and looked away because it shocked him that he should be so responsive to her at a time like this.

Why hadn’t he allowed for this when he’d taken the job? he wondered incredulously. He’d been attracted to Sophie from the first moment they’d met, when she’d been a student nurse and he’d been a brand new houseman, yet it had never crossed his mind that he might still feel the same about her. Why should it have done when he was committed to Julia?

His heart began to thud because that question had naturally led to a second, one it was even more difficult to answer.

If it was Julia he loved then why did he feel this desire for Sophie?

Sophie held her breath as she inched her fingers through the narrow gap. If anyone had told her she’d be helping to perform major surgery on the floor of a cabin, then she would have laughed out loud. But if Liam thought they could save the man’s life, she would give it her best shot.

Relief swept through her as she finally managed to reach the blood clot. She scooped it out of the way and dropped the bloody mass on the floor beside the bunk.

‘Got it!’ she declared triumphantly, glancing up. She frowned when she saw how abstracted Liam looked. He looked as though he was miles away, a worrying thought in view of the seriousness of what was happening.

‘Liam?’ she prompted anxiously, and saw him jump.

‘You’ve got it out? Good work!’ He made an obvious effort to collect himself. ‘Now, see if you can encourage the heart to start beating again. There’s not enough room to massage it so try flicking it with the tip of your finger.’

Sophie followed his instructions and felt her excitement mount when the man’s heart suddenly fluttered. She tried it again and laughed when she felt it start to beat. ‘It’s working!’

‘Right, we need to get him up to Theatre, stat.’ Liam was all business once more as he got up. ‘We need something to use as a stretcher. Can you sort it out, Charlie?’

‘No problem, Doc.’

The steward hurried away as Sophie sank back on her heels. ‘Do you think he’ll make it?’

‘With a bit of luck, but we’re going to have to stop that bleeding.’ He frowned in concern as he watched a few drops of blood ooze out of the man’s chest. ‘That wound needs stitching as soon as possible—can you get everything ready in Theatre? I don’t want to have to waste precious time setting up once we get him there. It’s going to be touch and go as it is.’

‘Of course.’ She scrambled to her feet and stripped off her blood-soaked gloves and dropped them on the floor then grimaced when she saw the mess they’d made. ‘This place is going to need a thorough cleaning before the crew can use it again.’

They both looked round when the door opened and Charlie appeared with Mike Soames in tow. Sophie saw Mike turn a delicate shade of green when he saw all the blood, and sympathised with him. The cabin must look like a scene from a horror film to the uninitiated.

‘Did you find us something to use as a stretcher?’ Liam demanded, oblivious to the petty officer’s distress.

‘I’ve commandeered one of the kitchen trolleys,’ Charlie explained. ‘It’s too big to get it in here so we’re going to have to carry Alexei outside.’

‘That shouldn’t be a problem with the three of us,’ Liam declared.

Sophie hoped he was right and that poor Mike wouldn’t pass out before they managed to get the injured seaman onto the trolley. It was amazing how many grown men she’d seen keel over at the sight of blood.

There was no time to worry about it, however, because she had more important things to do. She ran back upstairs to the hospital bay and quickly scrubbed up then slid on a gown and a fresh pair of gloves. She’d been a theatre nurse for a number of years and it was reassuring to slip back into the familiar routine. She laid out the instrument trolley then unpacked sterile drapes to cover the patient during the operation. By that time Liam had arrived.

‘I need to scrub up,’ he told her tersely, shooting an anxious look at the man lying on the stainless-steel kitchen trolley. ‘We’re going to have to be quick, though, because he’s losing a lot of blood.’

‘I’ll take him through while you get ready,’ Sophie assured him. ‘Who’s going to do the anaesthetic, though?’

‘Me.’ Liam’s tone was grim. ‘It’s times like this when you could do with an extra pair of hands, isn’t it?’

‘We’ll manage.’ She smiled at him and saw his grey eyes darken before he abruptly turned away.

‘I’ll be as quick as I can,’ he said gruffly.

Sophie wheeled the patient into Theatre, trying to decide exactly what she’d glimpsed in Liam’s eyes just now. She sighed when it struck her how pointless it was to worry about it. Once her replacement arrived she would be leaving the ship and she doubted if she and Liam would ever meet again. The thought gave her very little pleasure, oddly enough.

Liam must have got ready in record time because barely a minute had elapsed before he elbowed the door open. He had Charlie Henshaw with him and Sophie raised her brows when she saw that the steward was gowned and gloved as well.

‘Charlie has offered to help,’ Liam explained, going straight to the trolley. He nodded to Charlie. ‘Let’s get him on the table.’

Sophie didn’t question his decision as she hurriedly draped the patient. If Liam thought that Charlie would be of use then that was fine by her. He was preparing the anaesthetic now—checking the settings on the machines then attaching the tubes which would provide sufficient drugs to keep the patient unconscious during the operation. It was obvious that he knew what he was doing, too.

‘Looks as though you’ve done that a time or two,’ she observed lightly, swabbing the man’s chest. Blood was oozing out each time his heart beat so she checked the bag of fluid to see if it needed replacing.

‘More times than I care to count. I had to be anaesthetist, surgeon, physician and general dogsbody in my last job. There certainly wasn’t any point standing on your professional dignity when there was just Julia and me to deal with every patient who turned up at the clinic.’

‘It must have been tough,’ Sophie said quietly, because hearing him speak about the difficulties he and Julia had encountered made her heart ache. Once upon a time she would have been the one to share such experiences with him.

She shrugged off the thought as Liam instructed Charlie to keep an eye on the monitor that registered the patient’s blood pressure and heart rate, and to tell him immediately if there was any change. She and Liam had had their chance at happiness and it hadn’t worked. What had she told him earlier, that it was a case of once bitten and twice shy? Well, that applied doubly in this instance. She would never make the mistake of falling for her ex-husband again!

The operation progressed remarkably smoothly, given all the problems they faced. Sophie had to admit that she was impressed by Liam’s expertise. He handled the delicate operation of stitching up the hole in the patient’s right ventricle with a skill and panache that she’d rarely witnessed during her time in Theatre. By the time it came round to closing the patient’s chest, she was confident about the outcome.

‘You did a great job,’ she said sincerely as Liam administered the drugs which would reverse the anaesthetic. The patient was now ensconced on a proper hospital trolley and would shortly be moved to the sick-bay.

‘Thanks, but I couldn’t have managed without your help, or Charlie’s for that matter.’ Liam smiled as he stripped off his mask. ‘You two make a great team!’

‘All part of the service, Doc,’ Charlie observed cheerfully then chuckled. ‘Wait till I tell my missus that I assisted at an operation. She’s mad keen on all those hospital dramas on the telly and she’ll be really impressed!’

‘And so she should be.’ Liam clapped the steward on the shoulder. ‘Remind me to buy you a drink as a thank you.’

‘I’ll hold you to that, Doc.’ Charlie suddenly grimaced. ‘And now I’d better get that trolley back to the kitchen. The chef is going to be less than impressed when he finds out what it’s been used for.’

‘If you have any problems, just give me a call and I’ll sort it out,’ Liam told him. He turned to Sophie after the steward left. ‘Rather a baptism of fire, wouldn’t you say?’

‘I would. A bit more exciting than handing out tablets for sea-sickness.’

‘Just a bit!’ Liam chuckled, a throaty sound which made the tiny hairs on her arms stand to attention. ‘I’d forgotten about your dry sense of humour, Sophie. You always did make me laugh.’

‘Not always,’ she said, bending to pick up the bag of rubbish because she didn’t want him to see how much that comment had stung. In the weeks leading up to their divorce they’d had very little to laugh about and the memory still had the power to hurt.

‘No. We had bad times, too, didn’t we? Far too many of them at the end. But it wasn’t like that in the beginning, was it? We seemed to spend most of our time when we were together having fun.’

‘Did we? I really don’t remember.’

She quickly sealed the sack and elbowed her way out of the door. She wasn’t sure what the procedure was for disposing of surgical waste so she turned round to ask Liam and felt her heart ache when she saw the sadness on his face. Was he thinking about how much joy they’d found in one another’s company? She might have claimed not to remember how wonderful it had been, but it had been a lie.

She was filled with a sudden and overwhelming sense of loss. Liam had been her whole world at one time and she’d been his. How had they allowed themselves to lose all that they’d had?

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