Rivals In Practice

‘What’s happened?’

‘Car accident. We’re going to need some help, Wendy. Do any of the other nursing staff have cell-phones?’

‘Not that I know of.’

‘Get hold of Tom Bartlett, then, if you can. Let him know what the situation is.’ If he wasn’t already on the accident scene, their local police officer should be able to use his four-wheel-drive vehicle to round up some extra staff.

‘Do you want Brian called back?’

‘Not yet.’ Jennifer was determined to keep her partner as a last resort. She picked up the large tackle box that contained her resuscitation kit. ‘We need a bed made up for Sam. I want to keep an eye on him overnight. Run a neurological check every twenty minutes or so for now.’ She gave her nurse an anxious glance. ‘I hope I won’t be too long.’

‘Don’t worry. We’ll hold the fort,’ Wendy assured her confidently. ‘Rather you than me out in that lot. It’s not going to be pleasant.’

Pleasant was an adjective almost as far removed as possible from anything that could describe the conditions Jennifer found herself in. It was now only 5.30 p.m. but it felt like the middle of the night. The wind was strong enough to rock the solid four-by-four vehicle she was driving and the rain heavy enough to virtually obliterate visibility, even with the windscreen wipers on full speed. Waves crashed against the sea wall as she crawled slowly along the foreshore on the far side of the road. The force of the sea was enough to send a river of foamy water across the tarmac. Jennifer tried to dampen her alarm but her thoughts tumbled wildly.

She could imagine a newspaper headline. LOCAL DOCTOR WASHED OUT TO SEA IN STORM. What would the article say? ‘Thirty-two-year-old Dr Jennifer Tremaine is missing, presumed drowned, having been swept from the road by a fatal combination of a southerly storm and a high tide.’

Jennifer changed gears as she reached the first hill past the township. The water level was well below her now but her imagination had been caught by the notion of the article. ‘Dr Tremaine had been practising in her home town of Akaroa for nearly six years and was well used to attending emergency call-outs in any type of weather.’ That would be true enough. They could even go to town on some of the more dramatic rescues she had been involved in. Like that one on the fishing trawler right out in the headwaters of the harbour. They could probably find the photographs that had been published on the front page of the newspaper a few years back, where the bus full of tourists had gone over the bank thanks to the snowdrifts which had obscured the side of the road. Jennifer had had her share of drama over the years but she had never encountered weather quite this vicious.

Her progress was slowed even more as she passed Duvauchelle by the hail that clogged the windscreen wipers and bounced off the bonnet of the vehicle. She smiled wryly. ‘Dr Tremaine had never intended to practise medicine in a small rural hospital,’ she invented aloud. ‘After a highly commendable record at medical school, she had every intention of moving overseas. She planned to become a specialist surgeon, attached to a world-renowned unit—probably in the United States—and become famous for her incredibly brilliant skills and the unparalleled depth of knowledge in her field.’

Jennifer snorted and abandoned the mental game. She could see the flashing lights of the rescue vehicles ahead of her as the hail changed to sleet. She was about to get very wet and very cold, working under miserable conditions to save a life that could well belong to someone that she had known since childhood. The battles she fought were often personal and victory gave a level of satisfaction she would never had found anywhere else. Certainly not in the States and probably not even as a specialist surgeon. The fates that had delivered her home were probably a lot wiser than she had been. This was where she belonged and exactly where she was needed.

Robert Manson was directing a small but dedicated team of volunteers. They were using heavy cutting equipment on a badly crumpled car jammed against the bank. Another car was further up the hill, its windscreen broken and one side badly dented. The doors hung open and Jennifer could see a woman sitting sideways on the front passenger seat, her head cradled in her hands. Another person, presumably the woman’s companion, stood motionless beside her, watching the activity down the hill. Jennifer left her own vehicle’s engine running, with the heater on a high setting and the headlights helping to illuminate the rescue scene. She pulled her resuscitation kit from the back and joined the group of men between the fire engine and the car.

‘Hi, Jenny!’ Robert had to shout over the noise of the cutting gear. ‘Sorry to drag you out in this. We shouldn’t be much longer.’

‘What’s the patient’s condition?’

‘Still not conscious but he’s got a good pulse and he’s breathing OK. There’s a doctor in there, stabilising his neck. We’re just putting a neck collar on him.’

‘A doctor?’ Jennifer was taken aback, her position as the first medic on scene removed. ‘Not Brian, is it?’

Robert shook his head. ‘Don’t know who he is. Said he was a doctor and he seems to know what he’s doing. He arrived a few minutes after we did. He’s got a camper van.’

Jennifer’s gaze followed the direction of Robert’s arm. The rain had eased to a steady downpour and she could see the shadowy outline of the large van in the intermittent glow of the flashing rescue lights. Someone on holiday, then. Jennifer would need some reassurance of their qualifications but if they checked out she would be only too glad to accept some assistance.

‘Has anyone checked the other victims?’

‘Not properly.’ Robert looked back towards the second vehicle. ‘Damn. I told them to stay inside the car, out of the rain. That chap’s not even wearing a coat. He’ll be frozen.’

‘Get them into my truck,’ Jennifer suggested. ‘The heater’s on.’ She stepped back as the noise of the cutting equipment slowed and the fire officers pulled the mangled car door clear.

‘We’re ready for the backboard,’ someone shouted. ‘And the oxygen.’

Jennifer moved forward. The wind caught her hood, pushing it back and driving heavy rain into her face. She pushed her fringe back from her eyes, able to see the accident victim clearly for the first time. A young man, his face was injured and bloody but not enough to disguise his features. Jennifer felt a familiar twist of her gut. She knew the patient. He was Liam Bellamy—the son of the fisherman who had just had the hook removed from his hand.

‘Liam?’ Jennifer leaned closer and raised her voice. ‘Liam? It’s Jenny Tremaine. Open your eyes for me.’

‘He’s not responsive.’ The deep male voice came from the back seat of the car. ‘Except to painful stimuli. I’d put his GCS at about 8.’

‘Airway clear?’

‘It is now.’

Jennifer nodded. Liam’s mouth was closed around the end of the plastic oropharyngeal airway.

‘Here’s the oxygen.’ A mask was passed in beside Jennifer. ‘It’s running on 15 litres.’

Jennifer fitted the mask to Liam’s face. As she pulled the elastic strap behind his head her hands brushed the arms of the man still supporting Liam’s head. She glanced up, registering the stranger’s appearance for the first time. She blinked and stared, her jaw dropping. The man smiled without amusement.

‘Hello, Jennifer. Fancy meeting you here.’

‘Andrew!’ The name came out as an astonished gasp.

‘Here’s the backboard.’ Robert’s voice was right beside Jennifer’s ear. ‘How do you want to do this, Doc?’

‘Slide the end of the board onto the seat. I’ll look after his head and you take the legs. Let’s keep him as straight as possible.’ Jennifer nodded at the man in the back seat as he let go of Liam’s head. She supported the weight on her shoulder, her arms around the young man’s body as they turned and lifted their patient onto the backboard. The other members of the local rescue team crowded in to help lift the board onto the waiting stretcher and transfer it to the back of the modified Land Rover that served as an ambulance. Jennifer had her kit open and IV equipment already out by the time she was joined by her unexpected colleague. She didn’t glance up until she had inserted the IV cannula and flicked the tourniquet open again.

‘Andrew Stephenson,’ she said softly. ‘I just don’t believe this.’ Her gaze shifted. ‘Is that saline ready to go, Mickey?’

The young fire officer nodded. He handed the end of the tubing to Jennifer who connected it to the line in Liam’s forearm. She checked the flow as the bag was suspended, then reached for her penlight torch.

‘Have you got a spare dressing?’ Andrew was still standing outside the back of the vehicle. ‘I’ve managed to cut my leg on some metal.’

Jennifer nodded. ‘Find one for him, Mickey.’ She was still focussed on her patient. She pulled Liam’s eyelids open and shone the torch on his pupils. ‘Liam, can you hear me?’

The response was an incoherent mumble of words but Liam’s arms moved. Jennifer caught the one with the IV line in.

‘Try and keep still, Liam,’ she said firmly. ‘You’ve been in a car accident.’

‘He’s lightening up a bit.’ Andrew took a package from Mickey. ‘Thanks, mate.’

‘Why don’t you get in out of the rain?’ Jennifer suggested. ‘I’ll have a look at your leg.’

‘I’m all right.’ Andrew had his foot on the first step of the Land Rover. He enlarged the rip on the leg of his jeans.

‘That’s one hell of a cut.’ Mickey sounded impressed. ‘I think you’d better let the doc take a look.’

Andrew had already folded a large gauze pad and pressed it to his leg as Jennifer looked up. ‘Andrew is a doctor, Mickey. We went through medical school together.’

Not precisely together, she amended silently, fitting her stethoscope to her ears. More like at the same time. Competing fiercely for the top spot of their intake. Alternating their positions at the head of the class and taking intense satisfaction in proving themselves superior to the other in whatever field they were competing. Academic, practical or even social—the struggle had blurred the boundaries of all aspects of those years. Looking back, the antagonism had provided a memorable background to Jennifer’s tertiary education. It had been a fight she had revelled in. And the enemy had been Andrew Stephenson.

‘You sound like an American tourist,’ Mickey told Andrew.

‘I’ve been living in the States for a few years,’ Andrew responded. His tone was weary. ‘I suppose I’ve picked up a bit of an accent.’

‘Liam’s got a flail chest but breath sounds are equal at present.’ Jennifer’s attention shifted briefly to Andrew. ‘You’re a general surgeon, aren’t you?’

‘Not any more.’

‘What?’ Jennifer’s brow furrowed. ‘Have you specialised in something, then?’

‘Not exactly.’ Jennifer’s stare at Andrew wasn’t productive. His head was bent, his attention on the dressing he was holding to his calf. A dressing that was already soaked with blood.

‘Is that an arterial bleed?’ Jennifer snapped.

A figure appeared beside Andrew before he had time to respond. Tom Bartlett glanced at Andrew’s leg, then towards Jennifer.

‘I’ve got one of the boys to take your truck back to the hospital with the two people from the other vehicle, Jenny. They don’t seem to be injured badly but they’ll need checking. How’s Liam?’

‘He’s pretty seriously injured. Under normal circumstances I’d be calling for a helicopter to get him to Christchurch. We’ll have to get an ambulance in by road.’

‘No go, sorry.’ Tom’s face was grim. ‘There’s been a massive slip on the other side of the hilltop. Our access is completely cut off.’

Jennifer marshalled her thoughts rapidly. ‘You’ll have to come with me,’ she told Andrew. ‘I’m going to need some help.’

‘I can’t.’ Andrew shook his head. ‘I’m on holiday. My camper van’s over there.’

‘I don’t give a damn about your holiday.’ Jennifer couldn’t believe Andrew’s casual attitude to this situation. ‘This is serious,’ she told him coldly. ‘Liam’s life might depend on you sacrificing a few hours of your precious leisure time.’

‘What I meant was, I don’t have a current practising certificate for New Zealand.’ Andrew met her furious glare without blinking. ‘I’m not licensed to treat patients here.’

‘I don’t give a damn about that either,’ Jennifer said briskly. ‘You’re qualified to help. And you need medical attention yourself. You’ve already lost quite enough blood.’

‘What about the camper van?’

‘Stop arguing and get in,’ Jennifer ordered. She looked at Tom. ‘Can you sort out the van?’

‘Sure. Where do you want it?’

‘The hospital car park is blocked. Have it taken up to my place.’

‘Hang on a minute—’

Jennifer ignored Andrew’s protest. ‘Did Wendy get hold of you, Tom?’

‘About extra staff? Yes.’ Tom nodded confirmation. ‘I got hold of Janey and she’s going to round up Michelle and Suzanne.’

‘Great.’ Jennifer’s head swivelled. ‘Let’s get going, then, Mickey.’

The fire officer climbed down the steps and looked at Andrew. ‘You’d better get in,’ he told him, ‘so I can fold these steps up and shut the doors.’

Andrew paused for another moment, shaking his head in disbelief. Then he climbed into the back of the vehicle, sitting heavily on the bench seat that ran parallel to the stretcher.

‘I knew this holiday was going to be a disaster,’ he informed Jennifer. ‘I’ve known it for nearly a year.’

‘Why did you come, then?’ Jennifer was fitting the electrodes from the lifepack to Liam’s chest and a pulse oximeter to his finger. Her tone was unsympathetic.

‘I couldn’t miss it.’ Andrew gave a snort of laughter that held no amusement. ‘After all, it is my honeymoon.’

CHAPTER TWO

IT WAS not a moment to offer congratulations.

Jennifer Tremaine ignored Andrew Stephenson’s statement regarding his holiday and the odd implications it carried. Jennifer didn’t care about the reasons Andrew had returned to this side of the globe or why the trip might be proving less than satisfactory. If there was a new wife sulking in the back of the camper van because of some marital dispute, Tom could sort it out. Andrew certainly didn’t seem bothered but that was hardly surprising to Jennifer, given what she remembered about the man. She could put aside what she thought of his personality, however. The fact was, he was here, and Jennifer badly needed the professional skills he was capable of providing. When Mickey slammed the back doors of the Land Rover closed she almost smiled with satisfaction. She had Andrew Stephenson trapped for the moment and she was taking him in the direction she had chosen.

Despite the protective wet-weather clothing, Jennifer was soaked and cold. She took a moment away from her assessment of Liam Bellamy’s condition to reach for some towels in an overhead locker. The thick, dark blonde curls of her hair were plastered to her head and still dripping enough water to be a real nuisance.

‘Blood pressure’s 100 over 60,’ she informed Andrew as she roughly dried her face and hands. ‘Heart rate’s up to 130. He’s shocked, but his airway’s still clear and his breathing hasn’t deteriorated any further.’ She shoved a fresh towel towards her passenger. ‘Get yourself a bit drier,’ she ordered. ‘You must be frozen. Wrap yourself in a blanket as well.’

‘Thanks.’ Andrew took the towel with one hand. His other hand was still holding the dressing on his lower leg. The thick gauze wadding was saturated and a trickle of blood moved through the fingers holding the pad in place.

‘Put some pressure on that,’ Jennifer directed. ‘Thanks.’ Andrew’s tone was much less appreciative this time. ‘But I do remember the basics of haemorrhage control.’

‘Try to implement them effectively, then,’ Jennifer suggested. She turned back to Liam, her stethoscope in her ears again. The gap in time since she had last had any contact with Andrew Stephenson seemed to have evaporated effortlessly. A casual snipe at each other and they were back to communicating the way they always had. Time clearly hadn’t changed Andrew, but Jennifer was faintly ashamed that she could slip so easily into what she considered an immature and less than professional mode of interaction. She rose quickly, bracing herself against the stretcher as she pulled open another locker. She took out a bandage and one of the largest sterile dressings available, ripping open the packages as she turned back.

‘Fold this up,’ she directed Andrew, handing him the large gauze wadding. ‘I’ll put a pressure bandage on and maybe that will stop the bleeding.’ She tried to smile at Andrew as he looked up—a form of apology for her lapse in courtesy—but he didn’t return the gesture. As Jennifer stooped and began to bind the bulky dressing firmly to his leg, he picked up the towel and dried his face. Jennifer worked rapidly, taking only seconds to finish her task. It was long enough to gain a physical impression of the man, however. The muscle beneath her hands felt like iron. Andrew hadn’t gained an ounce of flab over the years. If anything, he was even leaner than he had been.

‘That saline’s almost run through. You’d better start another unit.’

‘OK.’ Jennifer reacted promptly. Perhaps Andrew was taking more notice of Liam’s condition than the impression he had given. Maybe he would be more inclined to offer his assistance when they had some better facilities available. If they ever got back to the hospital. Mickey seemed to have brought the Land Rover to a complete halt.

‘What’s going on, Mickey?’

‘I’m watching the waves,’ Mickey called back. ‘The wash is right over the road just here and I don’t want us stuck in the middle if we catch a big one.’

At least they were only minutes away from the hospital. They only had to head up the hill a little way and turn onto Napoleon Drive. There was a tense silence in the vehicle as they waited. Jennifer listened to the roar of the surf as it covered the sound of more hail on the roof above them. They moved with a jerk as Mickey accelerated to clear the patch of road between waves. Jennifer leaned closer to Liam.

‘We’re almost there,’ she told him. ‘Don’t worry, Liam. We’ll soon have you sorted out.’

Her patient moved convulsively, coughing and then retching. He was gagging on the plastic airway and the oxygen mask filled up with blood. Jennifer uttered a dismayed oath as she wrenched it clear of his face before he could inhale any of the contents. The airway tube fell to the floor and rolled beneath the stretcher.

‘Get him on his side,’ Andrew ordered crisply.

Jennifer was already doing her best but Liam was a well-built young man and hardly moved when she grasped his shoulders to pull him over. Suddenly it seemed as if Liam was rolling himself onto his side and Jennifer realised that Andrew was beside her, lifting and turning the heavy body with apparent ease.

‘Have you got a suction kit?’

‘On the wall behind you. There’s a clip underneath.’ Jennifer was holding Liam’s head, keeping his airway open. She hoped the rough manoeuvre hadn’t exacerbated any injury. ‘I hope he doesn’t have a pelvic fracture.’

‘I’d say his airway and breathing are more of a priority right now,’ Andrew responded coolly. ‘Here…’ He handed her the tube from the suction kit and switched the unit to full power.

‘You do it,’ Jennifer told him. ‘I need to find another OP airway and a bag mask.’

‘I’m not wearing gloves.’

‘Then put some on.’ Jennifer snatched the tube and cleared the blood from Liam’s mouth and nose. She noted the cut inside his lip, the broken teeth and the probable broken nose, but were they enough to explain the amount of blood in the mask?

‘I’ll find another airway for you.’ Andrew reached into the kit to extract one of the plastic devices. The abrupt halt of the Land Rover caused him to overreach.

‘There’s a bloody great tree blocking the driveway,’ Mickey shouted. ‘I nearly hit the damned thing.’

‘Sorry.’ Jennifer braced herself as the vehicle began reversing. ‘I should have warned you about that. We’ll have to go around the back by the kitchens.’

Andrew handed her the airway. He rapidly assembled the bag mask components and Jennifer plugged the tubing into the oxygen supply before fitting it over Liam’s mouth and nose. She glanced at Andrew.

‘GCS is dropping again. He’s lost his gag reflex and his breathing is getting worse. He’s going to need intubation as soon as we get him inside.’

‘He needs evacuation to the nearest major hospital. You can’t possibly have the facilities to deal with a patient in this condition here.’

‘We’ll have to,’ Jennifer said tersely. ‘We’re the only chance he’s got. There’s no hope of evacuation in this weather.’ She sent Andrew a warning glance. ‘And I’m including you in that ‘‘we’’.’

Andrew shook his head. ‘I told you—I’m no longer a doctor. I gave up medicine nearly a year ago.’

‘Why?’

‘That’s my business.’

The Land Rover had stopped moving again. The engine idled and Jennifer could hear rain on the vehicle’s roof in the silence that followed Andrew’s cool comment. She squeezed the bag she was holding again, turning her astonished stare back to her patient. ‘I don’t care what your reasons were,’ she announced. ‘And you don’t stop being a doctor just because you chucked your job in. Right now I need to assess and stabilise my patient. I need help and I’m going to use whatever resources I can find. Including you.’

The back doors opened and Jennifer moved swiftly, unhooking the end of the stretcher. ‘Bring the lifepack and the suction kit,’ she ordered Andrew. ‘And follow us.’

Wendy and Margaret were both waiting by the open door as Mickey and Jennifer raised the stretcher and wheeled it towards the back entrance of the hospital.

‘Tom Bartlett rang us,’ Wendy informed Jennifer in a rush. ‘Janey and Michelle are here, looking after the other patients. Sue’s coming in as soon as she’s dropped off her children. The treatment room’s clear.’ Wendy took a quick breath. ‘How’s Liam doing?’

‘Not great.’ It was Andrew who spoke as they moved past Wendy. ‘Sats are dropping fast. Probably a tension pneumothorax from the rib injuries.’

Jennifer let Margaret take her place pulling the stretcher. ‘I’ll get a chest-drain kit set up,’ she said, moving rapidly ahead and shedding her oilskin parka as she moved. The astonished stare directed at Andrew by both Margaret and Wendy had not been lost on Jennifer but she couldn’t afford to be distracted by introductions just yet. Within seconds they were all crowded into the treatment room. Mickey, Margaret and Wendy positioned themselves around the backboard as Andrew held the head end and directed the transfer of their patient to the bed.

‘On my count,’ he instructed. ‘One, two…three!’ Andrew reached for Jennifer’s stethoscope which had been left draped across Liam’s abdomen. He glanced up as he lifted the earpieces clear a short time later. ‘We’re going to need a drain on both sides,’ he informed Jennifer. His gaze raked Wendy. ‘You’re a nurse?’ he queried tersely. ‘I need some gloves.’

Jennifer could feel Wendy’s hesitation. She gave her nurse a reassuring glance as she reached for a second sterile chest drain package. ‘It’s OK, Wendy,’ she said calmly. ‘Andrew’s a doctor. A surgeon. He knows what he’s doing.’

The tension in the room wasn’t limited to the nurses’ wariness of the strange doctor. The situation was critical and both Andrew and Jennifer worked in a tense silence as they dealt with Liam’s respiratory collapse.

‘Got it!’

Jennifer had heard the characteristic hiss of air escaping from the side of the chest Andrew was working on. She concentrated grimly on inserting her own drain, dimly aware of a familiar frustration at Andrew achieving a successful result first. It lasted only seconds.

‘Haemothorax on this side.’ Jennifer attached the drain to the bottle that Margaret had prepared. She watched the flow of released blood. ‘Rather a large one.’