Hot-Shot Surgeon, Cinderella Bride. Alison Roberts

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СКАЧАТЬ the count of three. One…two…three!’

      There was a reassessment of all the vital signs, like heart-rate and blood pressure and respiration rate. None of them was looking good. Monitors were being hooked up and requests being called for more equipment and extra personnel. No one had time to notice Kelly, still standing in the corner.

      She knew she had to leave. There was no way a nurse’s aide could be any use at all in the kind of life-and-death drama about to be played out in here.

      Bags of intravenous fluids were being clipped to overhead hooks. The doctor in charge of the airway was bag-masking the teenage boy, his eyes on the monitor screen that was showing him how much oxygen they were getting into his circulation. He didn’t look happy with the figures he could see.

      ‘Saturation’s dropping. We’re below ninety percent. And what the hell’s happened to that ECG?’

      An electrode had been displaced while moving the boy from the stretcher to the bed. Nursing staff were busy cutting away clothing and hadn’t noticed the lead dangling uselessly, tangled up with the curly cord of the blood pressure cuff.

      Without thinking, Kelly stepped forward into a gap, untangled the lead, and clipped the end back to the sticky pad attached beneath the patient’s right collarbone.

      ‘Thanks.’ The doctor hadn’t taken his eyes off the monitor, and Kelly could see why. The trace now travelling across the screen was erratic, and the unusual shapes of the spiky complexes suggested that this young boy was in imminent danger of a cardiac arrest.

      Another doctor had his stethoscope on the less injured side of the chest. Was it proving too hard for one lung to function well enough to sustain life? Was the heart itself badly injured? Or was this boy simply bleeding too badly from internal injuries to make saving his life an impossibility?

      Kelly was back in her corner. Transfixed. She could feel the tension rising with every second that ticked relentlessly past. With every command from the emergency department specialists, who were finding it difficult to gain extra IV access and infuse the blood volume that was so desperately needed, judging by the way the blood pressure was continuing to fall.

      ‘Didn’t someone page Cardiothoracic?’ a doctor snapped. ‘Where the hell are they?’

      ‘Right here,’ a calm voice responded. ‘What are we dealing with?’

      Kelly actually gasped aloud as Tony Grimshaw stepped closer to the bed, pulling on a pair of gloves. Not that there was the slightest danger of being noticed. At the precise moment the surgeon finished speaking, an alarm sounded on a monitor. And then another.

      ‘VF,’ someone called.

      ‘No pulse,’ another added.

      ‘Start CPR.’ The order came from the head of the bed. ‘And charge the defibrillator to three-sixty.’

      ‘Wait!’ Tony’s hands were on the patient’s chest, lifting a blood-soaked dressing to examine the wound. ‘Have you got a thoracotomy trolley set up?’

      ‘Yes, I’ll get it.’ An ED registrar leaned closer. ‘You’re thinking tamponade? What about a needle pericardiocentesis first?’

      ‘Wasting time,’ Tony decreed. ‘We’re either dealing with a cardiac injury or major thoracic blood loss that needs controlling. Can I have some rapid skin preparation, please? We’re not going to attempt full asepsis and draping, but I want everyone in here wearing a mask. And let’s see if we can get a central line in while I’m scrubbing.’

      Masks were tugged from the boxes attached to the wall as trolleys were moved and rapid preparation for the major intervention of opening the boy’s chest continued. Kelly grabbed a mask for herself. A perfect disguise—just in case she got noticed when she made her move towards the exit.

      Except she couldn’t move. A thoracotomy for penetrating chest trauma topped the list for emergency department drama, and staff who had no more reason to be here than she were now finding excuses to slip into the back of the room to observe. House surgeons, registrars and nursing staff were squeezed into the space behind the red lines, and Kelly was trapped at the back. Able to hear everything, and even find a small window between the shoulders of the people directly in front of her, that afforded a good view of the surgeon if not the procedure.

      He now had a hat and mask and gown over the Theatre scrubs he had been wearing on arrival. He seemed unconcerned by his audience. Ready to use an incredibly tense situation as a teaching tool, in fact.

      ‘I’ll use a “clam shell” approach,’ he told the closest doctors. ‘The one you guys would be using if I wasn’t here.’

      ‘Yeah…right,’ someone near Kelly muttered. An over-awed medical student, perhaps?

      She saw the flash of a scalpel being lifted from the sterile cover of the trolley.

      ‘Bilateral incisions,’ Tony said. ‘About four centimetres in length, in the fifth intercostal space, mid-axillary line.’

      Blood trickled down the yellow staining of hurriedly applied antiseptic on the boy’s chest. Kelly was struck by how frail the young chest suddenly seemed.

      ‘Make sure you breach the intercostal muscles and the parietal pleura. With a bit of luck we might deal with a tension pneumothorax and get some cardiac output at this point.’

      They didn’t.

      Tony took just a moment to watch the screen, however, and his voice was soft. ‘What’s his name?’

      ‘Michael.’

      ‘And he’s seventeen?’

      ‘Yes.’

      ‘Family here?’

      ‘His mother’s just arrived. She’s in the relatives’ room.’

      Tony simply nodded, but Kelly was allowing herself to stare at him in the wake of his rapid-fire surprising queries. How had he done that? Made this seem so much more personal? As though he cared more about the patient than demonstrating his obviously not inconsiderable skills? Maybe he wasn’t as hung up on his status as rumour had led her to believe.

      She held her breath, watching the swift and decisive actions of this surgeon as he used a fine wire saw to cut though the sternum and then opened the chest with retractors.

      ‘I’m “tenting” the pericardium,’ he said moments later. ‘Scissors—thanks. Make a long incision like this. If it’s too short, it’ll prevent access to the heart. Suction…’

      What would it be like, Kelly wondered, to have this man as a mentor in a career as a cardiothoracic surgeon? Or just to work alongside him as a nurse? To know him on a personal basis?

      Maybe she knew him better than anyone else in this room.

      A ridiculous thought, given the situation. Given reality. It made her memories of her time with him more dreamlike. Precious, but harder to hang onto. Kelly tucked them protectively into a corner of her mind.

      Into that empty space in her heart.

      Tony had both hands inside СКАЧАТЬ