The Playboy Doctor's Proposal

Too slow for Hannah’s peace of mind. And dropping. It could also be a worrying sign. ‘What’s your ETA?’

‘Approximately five minutes.’

‘We’ll be ready for you.’ Casting a glance over her shoulder, Hannah could see Ryan moving towards the resuscitation area she and Jennifer had just checked. Not that she was about to decline any assistance for dealing with the incoming case but she didn’t want Ryan taking over. It wasn’t as though there was only one victim arriving, was it? She pushed the button on the microphone again.

‘Do you know the ETA for the chopper?’

‘Negative. Fire service is on scene, though.’

It shouldn’t take them long to cut the second victim clear of the wreckage, then. ‘And that’s also a status-one patient?’

‘Affirmative. Chest trauma. It’s the mother of our patient.’

Ryan would be able to lead the team on that case. In resus 2. Or they could share the main trauma room if necessary. Hannah’s plan of action was forming rapidly as she replaced the microphone.

‘Put out a call for an anaesthetist, please, Wayne,’ she directed. ‘And let’s get a neurosurgical consult down here. Sounds like we might need someone from Plastics, too. Jenny, you’re on the trauma team tonight, aren’t you?’

‘Yes.’

‘And you, Wayne?’

‘Yes. Resus 1?’

Hannah nodded, already moving towards the area. She pulled one of the protective plastic aprons from the large box on the wall. Ryan was already tying his behind his back.

‘Could be a tricky airway management,’ he said.

‘Mmm. I’ve called for some anaesthetic back-up but I’ll see how I go.’ The direct look Hannah gave Ryan could leave him in no doubt that she intended to lead this resuscitation effort. The subtle twitch of an eyebrow let her know the message had been received and understood. It also hinted at amusement rather than intimidation.

‘I’ll stay until the mother gets here,’ he said calmly. ‘In case you need a hand.’

‘Thanks.’ The acknowledgement was perfectly sincere. There was a child’s life at stake here and Hannah would never let any personal considerations affect her performance. She would stand back in a flash if she thought Ryan’s skills would improve the management. Never mind that he would get the credit for managing a difficult case.

It was just annoying that people that mattered were keeping a count of those credits at present. And disappointing that a competitive edge of any kind had crept into Hannah’s working environment when one of the things she loved best about her work was the way a team of people could work together and the only kudos that really mattered was a successful outcome to that work.

The decision on the consultant’s position was only a week or two away. A position that represented everything Hannah was striving towards in a career she was passionate about. Why had Ryan decided to compete at the last minute like this? It wasn’t as if he really needed the position. He didn’t have a massive student loan, the repayments of which would benefit enormously from an increase in salary. He didn’t need to prove himself in a field that was still dominated by males in senior positions. He was an Australian. Auckland wasn’t even his home town.

She couldn’t help flicking a glance towards the tall man who had now donned protective eyewear and a pair of gloves and was lounging at the head end of the bed. Why hadn’t Ryan Fisher just stayed on his side of the ditch? In that Sydney emergency department where he’d honed his not inconsiderable skills? Life would be so much easier if he had. And it wasn’t just due to that professional competition.

Jenny pushed the IV trolley into an easily accessible position and then stood on tiptoe to check that the tubes attached to the overhead suction and oxygen supplies were firmly in place. It was still a stretch for her short stature and Ryan was quick to step forward.

Without a word, he saved Jenny the awkward task and then gave her one of those killer smiles in response to her thanks. The senior nurse turned back to the IV trolley but Hannah noticed the extra glance that went in Ryan’s direction.

Not that he had noticed. The registrar was lounging again, his keen glance taking in the mill of the gathering trauma team and registering the growing tension.

The few minutes before the arrival of a serious case was a strange time. A calm before a storm of unknown proportions. Equipment was primed and ready. Staff were wearing protective gear and waiting. Wayne stood behind a kind of lectern that had the paperwork necessary to document every moment of the resuscitation effort and he was fiddling with a pen.

Hannah had pulled on gloves and was unrolling the airway pack on the top of a stainless-steel trolley. Others were simply standing. Waiting. There was nothing to do until their patient came rolling through those double doors. Nobody liked to speculate in too much detail on what was about to arrive because that could give them tunnel vision. A conversation that required distraction of mental focus was just as unwanted. What usually happened was a bit of gossip or a joke. Light-hearted banter that could relieve tension before it achieved destructive proportions. Something that could be abandoned as easily as begun.

And Ryan could always be counted on to provide a joke that would make everybody laugh.

Everybody except Hannah. She made a point of never laughing at Ryan’s jokes because the vast majority of them were at the expense of women with blonde hair. Like hers.

Sure enough, he was telling one now.

‘So this blonde—Cindy—is in desperate financial straights and she prays for help. “Please, God, let me win the lottery or I’ll have to sell my car.” But she doesn’t win so she prays again, “Please, God, let me win the lottery. I’m going to have to sell my car and my house.”’

Everybody was listening. Or half listening. Waiting for the distant wail of the siren that would advertise that the calm was over. Hannah kept her gaze on the trolley, checking that there was a range of paediatric-sized tubes and that the laryngoscope was still working.

She didn’t have to look at Ryan to know exactly what the image would be. He would be standing completely at ease with just a hint of a smile and a twinkle in those dark eyes that advertised an upcoming punchline. It might be a terrible joke but everybody would be listening and would be prepared to laugh because Ryan commanded that sort of attention. And popularity. Without even trying.

Hannah lips pressed themselves into a thinner line as she made sure that the more serious gear that might be needed for a surgical airway was at hand. No, it wasn’t just the professional competition that irked her. It was the fact that she had been as attracted to Ryan as every other woman who’d set eyes on him from the moment he’d arrived in this department three months ago.

It had been so unexpected. He was the epitome of the type of man she had always steered very well clear of. Despised, even, thanks to the collateral damage she had seen them produce in the lives of women she cared about. One of life’s golden people. She had probably been the first woman ever to freeze out an advance from him. Was that why he was persevering for so long? Did she represent some kind of challenge?

‘She still didn’t win,’ Ryan was continuing. ‘She’s down on her knees, pleading and this time God speaks to her.’ His voice dropped to a deep rumble that Hannah could actually feel in her bones. ‘And he says, “Work with me here, Cindy. Buy a ticket!”’

Sure enough, there was a wave of laughter. A wave that faded with dramatic swiftness, drowned out by the faint wail of a siren. Then the sound of the approaching siren died as it sped onto the hospital grounds with just its beacons flashing. Seconds later, the stretcher appeared. A third crew member was moving rapidly beside the stretcher, a bag-mask unit over the face of the child, trying to keep oxygen levels up on the short journey between the ambulance and the trauma bay.

The team went into action as a unit. The transfer of the small body was smooth—made easier by the fact he was strapped to a backboard with a collar to protect his neck. And although this team was well used to seeing victims of major trauma, it was a shock to get their first close-up view of this little boy.

Waiting at the head of the bed to manage the airway, Hannah sucked in a quick breath that was almost a gasp. No wonder he hadn’t been intubated and it would have been far too dangerous to attempt a nasopharyngeal airway. His nose and mouth were almost lost beneath swollen and lacerated tissue. There were obvious facial fractures and the eyelids were so swollen it was impossible to open them enough to assess the pupils with a torch.

‘Do we know his name?’

‘Brendon,’ one of the paramedics supplied. ‘His mother was initially conscious enough to be calling for him.’

He was wearing pyjamas, Hannah noticed as she leaned forward. Bright red racing cars on a blue background. ‘Brendon, can you hear me?’ She reached over his shoulder. Why had he been in a car in pyjamas instead of safely asleep in his bed? ‘Squeeze my hand if you can hear me, sweetheart.’

A response hadn’t really been expected and Hannah moved swiftly to take the tip of the suction unit Jennifer was holding. The child was moving air but there was a nasty bubbling sound and the probe on his finger revealed an oxygen saturation level that was far too low to be acceptable.

‘Rapid sequence intubation?’

‘If it’s possible.’ Hannah’s gaze flicked up, relieved to find one of the senior anaesthetic registrars now standing right beside her.

Ryan was on the other side of the bed and farther down, moving in to assess IV access and flow and to look for other potential injuries as the pyjamas were cut clear of the small body.

ECG electrodes were being attached. Jennifer was using a bag mask to assist the delivery of oxygen. Hannah suctioned as much blood as she could from Brendon’s mouth and nose.

‘I can’t see anything that clearly looks like CSF,’ she said. Not that that discounted the possibility of skull fractures or spinal damage.

‘Saturation’s down to ninety per cent. Let’s go for the intubation,’ the anaesthetist advised. He took the bag mask from Jennifer and began to squeeze it rapidly, increasing the amount of oxygen reserves to cover the down time for trying to get a tube into Brendon’s throat. He was clearly prepared to provide back-up rather than taking over the procedure.

Hannah drew in a slow breath to dispel any nerves. She heard herself issue instructions for the drugs needed, like suxamethonium to relax muscles and atropine to prevent the heart slowing dangerously. The formula for determining the size of the endotracheal tube was there instantly—the diameter equalled the age of the child divided by four, plus four.

‘I’ll need a 6 millimetre, uncuffed tube,’ she informed Jennifer. ‘And I want you to hold his head while we ease this collar off.’

It was a challenge, easing the blade of the laryngoscope past the swollen lips, broken teeth and a badly lacerated tongue, and Hannah had to use the suction unit more than once. It was an unexpectedly easy victory to visualise the vocal cords and slip the tube into place.

‘I’m in.’ The tone was one of satisfaction rather than triumph, however. There was still a long way to go but at least they were on the way to stabilising a critically ill patient.

‘Well done.’

With her stethoscope now on Brendon’s chest to check for correct tube placement and equal air entry, the quiet words of praise were muted and, for a moment, Hannah thought they might have come from Ryan.

But he was no longer standing beside Brendon. Hannah had been concentrating so hard on her task she had managed to block the sounds of the second patient’s arrival and the stretcher was now being swiftly manoeuvred to the other side of the trauma room.

‘Blunt chest trauma with tachycardia and hypotension. No sign of a tension pneumothorax.’ she heard Ryan stating. ‘We could be dealing with an acute pericardial tamponade.’

Would Ryan attempt a procedure to drain off the fluid inhibiting the function of the young mother’s heart? It would be a very impressive coup as far as patient treatment if it was successful. Hannah couldn’t help casting frequent glances towards his side of the room as she worked with the anaesthetist to get Brendon’s ventilator setting right, supervised the amount of IV fluid that was being administered, started an infusion of mannitol, which could help reduce intracranial pressure, and arranged transfer for an urgent CT scan of the boy’s head and neck.

Sure enough, Ryan was preparing to intubate his patient, cardiac monitoring was established and kits requested for both pericardiocentesis and chest drainage. Ryan looked determined and confident but less than happy about the challenge he was about to face. And no wonder. From what Hannah could see, the woman’s condition was deteriorating rapidly.

Ominous extra beats were disrupting the line of the ECG trace on the screen of the monitor.

There was time for one more, rapid secondary survey on Brendon before he was taken to the CT suite.

‘Some of these bruises look old,’ she commented.

‘Maybe he plays rugby,’ Jennifer suggested.

‘You reckon his mother does as well?’ Wayne had been helping Ryan’s team in the initial preparation of his patient. ‘She’s covered in bruises as well.’

Hannah eyed the clothing remnants Wayne was putting into a patient property bag. ‘Dressing-gown?’ she queried.

He nodded. ‘I don’t think their trip was planned.’

A police officer was standing well to one side of the now crowded area. ‘Have any relatives been contacted?’ Hannah asked him.

‘We didn’t need to. The car she was driving had just been reported stolen.’ The police officer’s face was grim. ‘By her husband.’

Hannah absorbed the information like a kind of physical blow. Was her patient an innocent young victim caught up in a situation involving domestic violence? Had his mother’s desperate bid to protect him ended in a disaster he might never recover from? Would he even still have a mother?

It seemed unlikely. Ryan was sounding uncharacteristically tense as Brendon’s stretcher was taken through the double doors on the way to CT.

‘We’ve got VF. She’s arrested. Charging to 200 joules. Stand clear!’ He looked up as he recharged the paddles. ‘Hannah, are you free?’

Hannah’s hesitation was only momentary. She had been planning to follow protocol and accompany Brendon but he already had an expert medical escort in the anaesthetic registrar. She knew what Ryan would do if the roles were reversed and she asked for assistance. Hannah turned back.

‘I’m free,’ she said quietly. ‘What do you need?’

CHAPTER TWO

‘WE’VE got sinus rhythm.’

Ryan dropped the defibrillator paddles with relief. The same kind of relief he’d noted when Hannah had turned back to help before he’d delivered that last shock. Not that he’d doubted he could count on her in a professional capacity. He could see her pulling on gloves and positioning herself beside the tray containing the pericardiocentesis and chest drain kits as he reached to check his patient’s pulse.

‘Carotid is barely palpable,’ he reported grimly.

‘Systolic pressure is fifty-nine,’ Wayne confirmed.

‘Let’s shut down the IV. Just run it enough to keep the vein open,’ Ryan ordered. ‘There’s been no response to a fluid challenge and if we’re dealing with thoracic haemorrhage it’ll only be making things worse.’

‘Ventricular ectopics starting again.’ Hannah had an eye on the monitor screen. ‘And the systolic pressure is dropping. Down to fifty-five.’

The patient was threatening to arrest again. Ryan reached for a scalpel and Hannah had the forceps ready to hand him a moment later. Then the cannula for the chest drain. In less than a minute, blood was draining freely into the bottle. Too freely. All too soon, the bottle was almost full.

‘Have we got someone from Cardiothoracic on the way?’

‘No.’ Jennifer shook her head at Ryan’s terse query. ‘Sorry. They’re unavailable for fifteen to twenty minutes. They’re tied up in Theatre with a post-bypass complication.’

‘Have we got a thoracotomy kit?’ He could almost hear a collective intake of breath. ‘She’s exsanguinating from a chest injury and about to go into cardiac arrest again. A thoracotomy might be a long shot but it’s the only hope we’ve got.’ Ryan knew the statistics were not on his side but at least they would be doing something other than watching this woman bleed to death.

Hannah nodded once, as though she had gone through the same thought processes and was in agreement with him. ‘Want me to scrub as well?’

‘Yes. Thanks.’

Wayne was sent to find the rarely used sterile kit. Jennifer took over the task of manually ventilating their patient. Ryan scrubbed fast. Ideally he should have the chest opened in less than two minutes. Faster, if there was another cardiac arrest.

‘Have you done this before?’ Hannah squeezed soap into her hands beside him.

‘Yes. You?’

‘Never even seen it.’

‘Know the indications?’

‘Penetrating thoracic injury with traumatic arrest or unresponsive hypotension or blunt injury with unresponsive hypotension or exsanguination from the chest tube. Overall survival is between four and thirty-three per cent but higher for penetrating injury.’

‘We’ve got VF again,’ Jennifer warned. ‘No…it’s asystole.’

Speed was now critical. A flat-line ECG meant that the heart couldn’t be shocked into producing a rhythm again. Chest compressions on someone with blunt trauma were also contraindicated because it could worsen the injury. Opening the chest was the only option with any hope at all now.

It was good that Hannah had never seen the technique. Explaining things as he started this incredibly invasive procedure somehow eased the tension of a desperate measure to save a life.

‘We’ll make bilateral thoracotomies in the fifth intercostal space, mid-axillary line—same as for a chest drain.’ Ryan worked swiftly with a scalpel and then a heavy pair of scissors. ‘I’ll be ready for the Gigli saw in a sec.’

He showed her how to use the serrated wire saw, drawing a handle under the sternum with a pair of forceps and then joining the handles and using smooth, long strokes to cut through the sternum from the inside out.

Hannah was ready with the rib spreaders. For someone who hadn’t done this before, her calmness and ability to follow direction was a huge bonus.

‘You can see why this is called a “clam shell” thoracotomy,’ he said as he spread the ribs away from the anterior incisions. ‘Suction, thanks.’ Ryan sucked out blood and clots from the chest cavity, hoping it would be enough for the heart to start beating again spontaneously.

It wasn’t.

‘Where’s she bleeding from?’

‘Haven’t found it yet.’ Ryan placed both hands around the heart. ‘I’m starting internal cardiac massage. Can you find and compress the aorta against the spine, Hannah? We want to maximise coronary and cerebral perfusion. I’ll clamp it in a minute.’

She was totally out of her depth here. It was a huge relief when back-up from the cardiothoracic surgeons finally arrived. They were impressed with Ryan’s management of the case so far, which was hardly surprising. Hannah wouldn’t have had the confidence or skill to go further than the chest drain insertion.

The thought that Ryan might deserve the consultant’s position more than she did was not a pleasant one.

Edged out as people with far more experience than she had took over, Hannah could only watch. It was hard, feeling the tension and increasing frustration as they failed to get the young woman’s heart started again, having controlled the haemorrhage from the damaged aorta.

Maureen’s signal, with the message that Brendon was now in the paediatric ICU and an invitation to discuss the results of the CT scan with the consultant, was welcome. Hannah slipped, unnoticed, from the resuscitation area.

She couldn’t afford to stand around admiring Ryan’s skill and thinking how easily he might win the position she’d wanted for so long. Or to share his disappointment at the inevitable failure he was facing. Empathy would create a connection that was too personal. Even worse than laughing at one of his stupid jokes. It would only make it that much harder to maintain the necessary distance between them.

Any reduction in that distance could only make her vulnerable.

And Hannah Jackson did not do vulnerable.

She’d always been the strong one. Ever since she was ten years old and her father’s sudden death had made her small family almost fall apart. Hannah had been strong for her mother. For Susie. For herself.

The lesson had been hard but valuable. Strength was protection. The only way to get through life without being scarred too deeply.

Being too tired didn’t help when it came to being strong.

When Hannah entered the staffroom nearly an hour later, she could feel Ryan’s dejection all too easily. He had his back to her as he made coffee but his body language said it all. Slumped shoulders. Bent head. The way he was stirring his mug so slowly. If it had been any other colleague she wouldn’t have hesitated in offering commiseration. A comforting touch or even a hug. But this was Ryan. Distance was obligatory.

‘No go, huh?’

‘Nah.’ Ryan straightened his back. ‘Didn’t really expect to win that one but it was worth a try. Want coffee?’

‘Sure, but I’ll make it.’

Ryan was already spooning coffee into a second mug. ‘You take sugar?’

‘No.’

‘Milk?’

‘No.’

He’d been in the department for three months and didn’t know how she took her coffee but she was willing to bet he’d know the preferences of all the female staff who responded to his flirting. And that was every one of them.

Except her.

‘So how’s your little guy, then?’

‘Not flash. He’s in paediatric ICU but the scan was horrible. Multi-focal bleeds. If he does survive, he’ll be badly brain damaged.’

‘Might be better if he doesn’t, then. You saw the father?’

‘Yeah.’ There was no need for further comment. The glance Ryan gave Hannah as he handed her the mug of black coffee told her he shared her opinion that the man she’d had to talk to about the serious condition of his child was an uncaring brute. Responsible for the death of his wife and quite likely his son, not to mention the admittedly less serious injuries sustained by the other drivers involved, and he hadn’t given the impression of being overly perturbed about any of it. ‘And they can’t even charge him for anything.’

‘No.’ Ryan went and sat down on one of the comfortable armchairs dotted around the edge of the room.

The silence was heavy. Too heavy.

Ryan cleared his throat. ‘Hey, have you heard the one about the blonde who didn’t like blonde jokes?’

Hannah sighed. She sat down at the central table, deliberately putting Ryan out of sight behind her right shoulder. Maybe it wasn’t good to sit in a depressed silence but this was going a bit too far in the other direction, wasn’t it? She sipped her coffee without saying anything but Ryan clearly ignored the signals of disinterest.

‘She went to this show where a ventriloquist was using his dummy to tell blonde jokes. You know, like, how do you change a blonde’s mind?’ He raised his voice and sounded as though he was trying to speak without moving his lips. “Blow in her ear!” And what do you do if a blonde throws a pin at you? “Run, she’s still holding the grenade.”’

‘Yeah, yeah.’ Hannah allowed herself to sound annoyed. ‘I know.’

‘Well, so did this blonde in the audience. She was furious. She jumps to her feet. “I’ve had enough of this”, she shouts. “How dare you stereotype women this way? What does the colour of someone’s hair have to do with her worth as a human being? It’s people like you that keep women like me from reaching my full potential. You and your kind continue to perpetrate discrimination against not only blondes but women in general and it’s not funny!”’