Hot-Shot Surgeon, Cinderella Bride

CHAPTER THREE

‘YOU’RE in luck, Kelly, love. They’re short in ED today.’

‘Cool. Thanks, Elsie.’ Kelly was still tucking the long coil of her braid under the elastic band of the oversized shower-cap-type hat that was part of her uniform. ‘For the whole shift?’

‘Yep.’ Elsie was giving her a curious look. ‘I thought you’d be rapt. Isn’t Emergency your favourite place?’

‘It is.’ Kelly nodded and smiled, but her brain had gone into overdrive.

No wonder Elsie had picked up on something being different. Only last week the prospect of a day in the emergency department would have been a treat.

A poignant treat, mind you—it was like having her face pressed to a shop window that contained something ultimately desirable but equally unaffordable—but still an irresistible one.

‘I’m just a bit tired,’ she told Elsie, by way of excusing her lack of excitement. ‘I didn’t sleep very well.’

‘Are you OK?’

‘I’m fine.’ Kelly’s smile was wider this time. Physically, the only thing that had disturbed her rest was the pleasure of experiencing the delicious tingles her body could conjure up with remarkable ease as she remembered the night with her musketeer. ‘Maybe I just had too much excitement the night before.’

‘Hmm.’ Elsie looked unconvinced. ‘You haven’t said much about that. You did have a good time, then?’

‘Magic,’ Kelly affirmed.

So fabulous she couldn’t begin to try describing it. And she didn’t want to, despite sensing that Elsie felt left out and maybe a little hurt.

‘I only went because of you,’ she added. ‘Thank you so much!’

It had been a night of pure magic. One that she intended to treasure for the rest of her life. And that was where the problem now lay. The repercussions that were going to affect a very large part of her life.

Reality couldn’t be allowed to intrude, because she knew without a shadow of a doubt that reality would tarnish, if not completely destroy, the joy of that magic. That was why she needed to keep it private, and not diminish its perfection by talking about it. It was also why the dreadful prospect of Tony Grimshaw recognising her at work had made sleep so elusive.

‘Is Flipper all right?’ Briefly mollified, Elsie was now frowning anxiously. ‘I did wonder if she had a bit of a sniffle on Saturday night. I noticed she was breathless going up my stairs.’

‘Was she?’ Kelly caught her bottom lip between her teeth, her mind whirling in a new direction. ‘I’ll mention it to Dr Clifford. She’s got a check-up scheduled for this week.’

‘But she’s not sick today?’

‘No. She couldn’t wait to get to crèche. As usual.’

‘What day’s her appointment?’

‘Wednesday. Sorry, Elsie. I forgot to say I wouldn’t be working.’

‘Not a problem. That’s why I keep you on the casual list and why you get sent all over the show. Speaking of which—’ Elsie glanced at her watch ‘—it’s seven-thirty already. They will have finished hand-over.’

‘I’m gone.’ Kelly stood on one foot and then the other to pull disposable shoe-covers over her old, comfortable trainers.

‘Report to the nurse manager when you get there. I’m not sure if they need you out front or in the observation area.’

Kelly took the shortcut of some fire escape stairs, as familiar with the layout of this vast hospital as she was with her own home. It was a world of its own in here, and she loved it despite the fact that her dream had never had her working in quite this capacity.

‘Hey, Tom!’ Kelly gave a cheerful wave to an orderly pushing an empty wheelchair in the opposite direction. Then she turned abruptly and chose a different direction when she saw the group of doctors coming behind Tom. She could take another route to the emergency department. She could use the service elevator and avoid any risk of recognition.

At least her uniform should be an effective disguise. The shower cap, the shapeless pink smock and the shoe-covers. Almost the same uniform the cleaners and kitchen staff wore—because, as a nurse aide, Kelly was part of the faceless army of people whose ranks stretched from groundsmen to technicians and kept this busy city hospital functioning the way it should. Making up the dark sky that allowed stars like Tony Grimshaw to shine so brightly.

Emergency should be safe enough, Kelly reassured herself as she sped down the final corridor, past the pharmacy and gift shop. It was rare for someone other than a registrar to make an initial assessment of a need for surgery. Being around the cardiology wards or theatre suites might be another matter, however. Kelly would need to stay on guard.

Not that she was likely to forget any time soon. Not when he was still in her head to this degree. When just a flicker of memory made her want to smile. Forgetting it enough to focus on her job might prove to be a problem, but it soon became apparent that her concern—for the moment, at least—was groundless.

The department was busy enough to keep her completely focussed. Fetching and carrying supplies, taking patients to the toilet or supplying bedpans, dealing with vomit containers and spills on the floor. She’d worked here often enough to be familiar with everything she needed to know. Many of the staff recognised her. One nurse looked particularly pleased to see her when she took a fresh linen bag to hang in the main resuscitation area.

‘Kelly! Just the person I need. You know where everything is around here, don’t you?’

‘Pretty much.’

‘Help me sort out this mess?’ The wave indicated a benchtop littered with supplies that hadn’t been put away. ‘We’ve got an MVA victim coming in, and if it’s still looking like this when they arrive, my guts will be someone’s garters.’

It was fun, working under pressure. Handling syringes and bags of saline and packages containing endotracheal tubes. Things that had once been so familiar. Part of the dream Kelly had been well on her way to attaining.

‘Want any sizes smaller than a seven on the tray?’ she asked the nurse. ‘Do you know what’s coming in?’

‘Something major.’

More staff were beginning to assemble in the room.

‘Where’s Radiology?’ someone called. ‘And the surgical reg—is she on her way?’

‘I’d better get out of here,’ Kelly said.

‘No! Look!’

Kelly looked. Cupboard doors were open below the bench, with supplies spilling into a heap on the floor. They encroached over the red line on the floor that was there to keep unnecessary personnel from the area around a patient. Right at the head of the bed, too, where the person responsible for the patient’s airway would be in danger of tripping over them.

Swiftly, Kelly crouched and began to stack the awkward packages back into the cupboards, so focussed on doing it as quickly as possible she barely registered the increasing level of activity behind her.

And then suddenly the double doors were pushed open and controlled chaos ensued.

‘Seventeen-year-old, pushbike versus truck,’ a paramedic informed the receiving doctor. ‘Handlebar of the bike penetrated the left side of his chest. Intubated on scene and decompression attempted for a tension pneumothorax. Oxygen saturation’s currently—’

Kelly was rising slowly to her feet, her back to the bench, and she slid sideways to get out of the way, horrified at being somewhere she had no right to be. Her gaze was none the less fixed on the scene so close to her. The transfer of the patient from the ambulance stretcher to the bed.

‘On 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 the boy’s chest now, massaging Michael’s heart. ‘Make sure you keep the heart horizontal during massage,’ he told the observers. ‘Lifting the apex can prevent venous filling. I’m aiming for a rate of eighty per minute here, and I’m looking for any obvious bleeding that we need to control.’

The people in front of Kelly were murmuring in awed tones, and they shifted enough to obscure her line of vision. She heard the request for internal defibrillation, however, and could envisage the tiny paddles that would provide a minimal jolt to the cardiac tissue but hopefully restore a more normal heartbeat.

A collective gasp of amazement rippled around the room seconds later, but she could sense no let-up in control of a difficult situation from the star at the centre of this drama.

‘Theatre’s on standby. Let’s get Michael up there while we’ve got a perfusing rhythm.’

There was a new flurry of activity as the open chest wound was covered, and the bed, the monitors and numerous necessary staff members all began moving as a connected unit.

Tony stripped off his gloves, dropping them to the floor and reaching for a fresh pair. His gaze scanned the assembled staff as he took a single step to put him within reach of what he needed. Kelly felt the eye contact like something physical. Almost a blow, the way it sent shock waves through her body. Despite the contact being so brief—less than a heartbeat—the connection was so strong she was sure Tony had to feel it, too. He’d glance back—with a frown, maybe. Needing a second glance without having registered why.