The Playboy Doctor's Proposal. Alison Roberts

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СКАЧАТЬ 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 СКАЧАТЬ