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‘BP one hundred and two over fifty-six, pulse rapid and weak,’ one of the nurses called out.
‘How was he this morning?’ Olivia asked. ‘Was he complaining of anything? A headache? Feeling dizzy? Sick?’
‘No, he’d just come back from his run before I left. He goes every morning before work—when he’s at home, that is.’
‘Does he travel much?’ ‘He’s a sales executive. He travels out of the country for a few days most weeks. Is he going to be all right? Please! You have to help him!’
‘We’ll do everything we can, I promise. But first we’re going to have to do a few tests to find out what exactly we’re dealing with. Would you like to wait in the family room?’
‘I want to stay with him. Please let me. I promise I won’t get in your way.’
‘Okay, Sally. He’ll probably find it reassuring to have you here. Talk to him. It’s possible that he can still hear what we’re saying even though he’s not responding. When was he last away?’
‘He just came back from Thailand yesterday.’
Thailand. Recent foreign travel added a long list of possible diagnoses they had to rule out. Although rare, Japanese encephalitis was one possibility.
‘Was he vaccinated for encephalitis? And did he take prophylaxis for malaria before he left?’ she asked. Cerebral malaria was something else she should exclude.
‘He always takes the meds he’s supposed to. He knows the risks if he doesn’t. He’s very particular about his health.’
‘Could we get a consult from Infectious Diseases?’ Olivia asked. Something wasn’t adding up. ‘In the meantime, let’s get a CT scan of his head and draw blood for a full infection screen, including malaria. Keep him on twenty-eight per cent oxygen.’
‘Dr Simpson?’ One of the interns popped her head through the door. ‘Dr Scutari is asking for help in room two if you’re free?’
Olivia peeled off her gloves and apron and chucked them in the bin. ‘I’m on my way.’ She turned to the nurses. ‘I’ll be next door. Call me if there is any change, or when the attending from Infectious Diseases gets here.’
This was typical of the ER on a weekday morning. Often it was busy and there was no predicting what they’d get in. It was what she loved about working here. Not everyone enjoyed the high-octane atmosphere, but most of them who worked in the department loved the buzz.
She helped the intern deal with his patient, a straightforward MI, then returned to Resus and was surprised to find Dr Stuart bending over her patient. However, if she was surprised to see him, he looked floored to see her.
‘You’re a doctor! Why didn’t you say?’ he said, glancing up at her.
Because you didn’t give me the chance. Because once you saw I was pregnant, I might as well have been invisible. Of course none of that could be said out loud but it didn’t mean she wasn’t enjoying his discomfort. That would teach him to go around introducing himself as a neurosurgeon to strange women.
‘I’m Dr Olivia Simpson. ER resident.’ She smiled briefly in his direction. In the time she’d been away, dealing with the other patient, Brad had lost some of his pallor. However, there was no improvement in his conscious level. ‘I didn’t ask for a neuro consult.’ She raised her voice. ‘Do we have Brad’s CT scan?’
‘I have it here.’ Candice, one of the ER nurses, flicked on a screen.
‘Besides, aren’t you supposed to be in Theatre—saving lives?’ Olivia couldn’t resist adding, sotto voce, as he stepped alongside her to study the scan.
He didn’t even look mildly embarrassed. ‘I was. Job done. I was at a loose end so I thought I’d come down to the ER to see if you had anything for me. Failing that, I hoped to scrounge a cup of coffee.’
Job done? She couldn’t have been in the department more than twenty minutes before her patient had arrived. Take another twenty-five when she’d been examining Brad and helping Dr Scutari—he was still done pretty quickly. What sort of neurological procedure took so little time? She hoped to hell Dr Stuart knew what he was doing.
‘Now you’re here, what do you think?’ She gestured to the screen.
‘I’m pretty sure he has an infarct of the right cerebellum,’ he said after only a few moments. He pointed to the area of the brain he was talking about. ‘But we need to find out what caused it. I’m guessing a clot. We should let the radiologists do an angiogram. If there is a clot they can be pretty good at aspirating it.’
Dr Stuart turned to Sally, who had been listening to the exchange with frightened, uncomprehending eyes.
‘We think that your husband might have a blood clot blocking an artery inside his brain. That’s what is making him so unresponsive. There is a procedure that can help. The radiologists put a catheter, a fine tube, into the artery in his groin and locate the blockage. If there is a clot present, they’ll try to suck it out.’
‘But …’ Olivia shot Dr Stuart a warning look ‘… you should be aware that the procedure carries some risks.’
‘What kind of risks?’ Sally’s voice rose to a squeak.
‘It’s possible that the procedure could well make whatever is wrong with your husband worse.’
‘On the other hand, if he doesn’t have it, he may not improve from where he is.’ Dr Stuart interrupted.
Typical of a surgeon, Olivia seethed. Any chance to intervene and they always took it over the more conservative approaches. She kept her voice level and matter-of-fact. ‘If Brad has had a stroke then he might well improve over the coming months.’
‘That’s true,’ David said easily. ‘But until we do the angiogram we won’t know for certain. Here’s what I suggest we do. We get him up to the MRI suite, ask the radiologists to take a look, and make a decision from there. How does that sound, Dr Simpson?’
It was, Olivia had to admit, a sensible approach. There was no point at this stage in giving the wife options and possibly scaring her further until they knew what the radiologists had to say.
‘Why don’t you come up and, if my diagnosis proves correct, watch the procedure?’ Dr Stuart said to Olivia. ‘You’ll find it interesting. The radiologists can do some pretty amazing stuff.’
‘Let me check what Kelly has waiting first, but if they can spare me, yes, I’d like to watch.’
Olivia took Sally by the hand and spoke soothingly to her. ‘Try not to worry too much until we hear what the radiologists have to say. Then we can decide how to proceed from there.’
Candice looked across at them. She was positively preening under the neurosurgeon’s gaze. ‘I’ll check that they’re free upstairs, shall I?’
David flashed her a grin and Candice blushed to the roots of her hair. ‘That would be helpful,’ he said.
Sally looked relieved that she didn’t have to make a decision just yet. Olivia gave her shoulder one final squeeze and went in search of Kelly. She had only got a few steps when she heard Dr Stuart’s voice coming from behind her.
‘Good thing I was in the department.’
She whirled around. ‘I’d have seen it eventually, Dr Stuart.’
‘It’s David.’ He cocked his head to the side and regarded her from his silvery eyes. ‘But you might have wasted time getting the Infectious Disease consult. You can cancel them.’
‘Shouldn’t we wait?’
‘Absolutely not. I’m almost certain. Brad needs the blockage cleared—either an angioplasty or clot aspiration—and the sooner the better. I’m the attending, so the decision is mine.’
Olivia’s pulse was racing and she wasn’t sure why. Perhaps it had something to do with the way his grey-blue eyes locked onto hers. She shook her head slightly in an attempt to regain her focus. He was right. This was his area of expertise. She was letting her peculiar reaction to him make her flustered, behave out of character and question his judgement.
‘I’m happy to wait to see what the radiologists have to say,’ David continued mildly, ‘but I’m convinced they’ll confirm my diagnosis. We can discuss it before speaking to his wife about his treatment options. Okay?’
Olivia forced a smile. ‘Fine by me.’
She turned to the head ER nurse, who had been watching the exchange with obvious amusement. ‘Kelly, is there anything you need me for in the next hour or so?’
‘If there is, I’ll page you. There are other doctors on duty, you know.’ It was a barbed reference to the fact that Olivia liked to be involved in as many cases as she could. Apart from Kelly, Olivia was often first in and last out. As chief resident, the work of the interns was her overall responsibility—a responsibility she took very seriously indeed. Just because she was going on maternity leave in a few months was no reason to let her standards slip.
David reached across Olivia and swooped down on the box of doughnuts. ‘Worth coming down here just for this,’ he said as he took a bite out of one.
Olivia glanced at her watch. ‘We don’t have time.’ She reached across and removed the remains of the doughnut from his hand and chucked it in the bin. David stared. He lifted an eyebrow and grinned.
Kelly looked at Olivia and then at David. ‘You’re causing a bit of a ruckus in my department, young man. I just hope you’re as good a surgeon as everyone says you are.’
Upstairs in Radiology, Olivia watched as they injected dye through the arterial catheter in Brad’s groin. David murmured something to the radiologist when almost immediately a blocked vessel showed up on the screen. ‘There’s our culprit. The vessel wall looks quite normal so it must be blocked by a fresh blood clot,’ David said. He turned to Olivia. ‘There’s no time to talk to his wife—we have to remove it.’
The radiologist inserted a suction adapter onto the groin catheter and Olivia held her breath as he carefully sucked out the clot. Within minutes Brad’s eyes opened briefly to the call of his name and he appeared to look at them purposefully.
David lifted his head and grinned at her. ‘Pretty impressive, huh?’
Olivia nodded. It was a procedure she hadn’t witnessed before. And as David had said, it was pretty dramatic.
‘I’ll let his wife know he’s regained consciousness,’ she said.
She left the X-ray suite and hurried back downstairs, Kelly’s words echoing in her mind. David might be as good a surgeon as everyone said he was. Pity about the rest.
Olivia tossed her car keys onto the table by the door before going into the kitchen and pouring herself a glass of water. The remainder of her shift in the ER had been hectic. Not long after she’d come back down from Radiology a multiple RTA had come in. It had been an hour after her shift was due to finish when they’d finally sorted everyone out and either sent them home or to the OR. Thankfully all the casualties had survived.
She tipped some dog food into Bouncer’s bowl, which he devoured in three quick mouthfuls. When he looked up at her hopefully she shook her head.
‘No, you know you’ll get fat, Bouncer. I’m doing this for your own good. I’ll take you for a walk in a moment.’ Bouncer, her three-year-old Labrador, attended doggy day care whenever Olivia was on duty. It meant a detour on the way to and from the hospital, but he was worth it. She shouldn’t really have a dog at all, she knew that, not with the hours she worked, but he was company for her and taking him for long walks kept her fit.
Taking her water through to the sitting room, she eased off her shoes and rubbed her aching feet. Bouncer plonked himself next to her and laid his head on her knee, nudging her arm with his wet nose.
‘Okay, bossy boots, I get the message. You want your head scratched.’ Rubbing Bouncer’s golden fur, she clicked on the TV remote. Not that she really wanted to watch the news or follow some trashy reality show, it was more to fill the house with noise. When she and Richard had first viewed the house in Sea Cliff, they’d both known instantly it was the perfect forever home for them. It had spectacular views of the Golden Gate Bridge and the Pacific, and with its six bedrooms and three reception rooms had been more than large enough to entertain Richard’s business colleagues and clients. Most importantly, though, it was spacious enough to be filled with the children they had both longed to have together.
Now, without him in it, it just felt big and cold and empty. She’d considered selling it several times since Richard had died, but at first she hadn’t wanted to leave the house that still smelled of him, still held his memory in every room—especially the uncompleted nursery. Then, when the shadow of grief had lifted and she’d returned to work, she’d simply been too busy. Perhaps now was the right time to find a new home for her and the baby? Somewhere cosy with a smaller, more manageable garden and a playroom? Of course she would always miss Richard, and she would have his baby to remember him by, but the life they had shared was in the past. Hadn’t she promised herself a new start? Wasn’t having this baby the beginning of that? But with work and her pregnancy it was unlikely she’d get around to finding somewhere else to live now.
It wasn’t as if money was a problem. Richard had left her so well off that she’d never have to work again if she didn’t want to. But she did want to work. It was what kept her sane. She’d have to stop, of course, for a while at least, when this baby came along, but eventually she’d go back. Being single, she’d have to employ a nanny but, assuming she found the right person, that would be okay. She’d already asked an agency to start looking.
She placed a hand over her swelling stomach. ‘Not too long now, baby,’ she whispered. She should be relishing this brief interlude of peace and quiet, because when the baby came there wouldn’t be much of it. Not that she didn’t yearn to hold her child. Even another twenty-two weeks seemed an eternity.
She rested her head on the back of the couch and unexpectedly an image of David filled her mind. What was it about him that made her react the way she did? She’d never been attracted to his type before. The type that thought all he had to do was smile and a woman would melt.
She grimaced. To be honest, she had melted. Just a little bit. She’d liked the frank and blatant approval in his eyes. It had made her tingle, and that had made her feel good. More than good—it had made her feel alive. What woman wouldn’t feel flattered being admired by such a devastatingly attractive man? Until he’d seen her bump, of course. Then she had disappeared so far off his radar she might as well have been in outer space. Olivia tutted. Dr David Stuart might be gorgeous but he wasn’t for her. Especially now. All her love, affection and attention were going to be devoted to the child growing inside her—Richard’s child and hers. All things considered, David would have to remain where he belonged. In the realms of fantasy.
Bouncer was snoring contentedly so Olivia eased herself off the couch, careful not to disturb him. She crossed over to the French doors and stepped out onto the balcony. The lights of the Golden Gate Bridge twinkled in the night sky and a gentle breeze carried the sounds of distant traffic. Strange how this view always seemed to soothe her and fill her with renewed energy and hope. Perhaps it was the reminder that life went on, no matter how much you wanted time to stand still. And, oh, my God, Richard, I wanted time to stop before you died. But it hadn’t and she’d had to come to terms with life without him. She wrapped her arms around herself. In a few months she would have their baby and at least a part of Richard would live on.
CHAPTER TWO
OLIVIA bent over her patient in Resus as the nurses cut away his shirt and trousers. The accompanying paramedic recited the known facts about the casualty.
According to witnesses, a truck had made a right turn and his wing mirror had knocked the cyclist from his bike. The lorry driver was shocked but unharmed. When it came to a battle between a ten-ton truck and a push bike there was only ever one winner.
The cyclist was already wired to the monitors. His pulse was slow and his breathing shallow. She opened an eyelid and shone her torch. The pupil of the left eye did as it was supposed to, but the other was blown.
Very gently she removed his helmet, noting the blood stains on the back. Quickly she palpated along the skull until she found what she was looking for—a depression a couple of inches above the neck. Unconscious, skull fracture, unequal pupils—it all added up. He must have a haematoma causing compression of the brain stem.
‘I need a consult from Neuro,’ she said briskly. But, as always, the nurse had anticipated her order and was already on the phone.
‘They’re just finishing in Theatre. Someone will be here as soon as they can.’
‘Tell them I need them here, stat,’ Olivia said. Her patient had to have the pressure in his head relieved, and as soon as possible. With every second that passed his brain was swelling, pushing against the rigid bones of the skull.
‘I’ve found some ID,’ one of the nurses called out. ‘Your patient’s name is Mark Lightbody. He’s thirty-three. There’s also a number for his wife. I’ll give her a call and tell her to come.’
Olivia nodded. Poor Mrs Lightbody was about to have her day—possibly her life—ruined.
Mark was unconscious, and although he was still breathing unaided, she had to intubate him to secure his airway and maintain his oxygen levels. The measures she’d taken would keep him stable for a while, but surgery was the only way to relieve the growing pressure on his brain. She glanced at the clock on the wall. Five minutes had passed since Kelly had phoned. Where the hell was the neurosurgeon?
Just when she was about to insist that Kelly phone again, the swing doors burst open and Dr Stuart strode in. She’d only seen him in passing since that first day and she was dismayed to note that her already escalated pulse upped another notch.
‘What do you have for me?’ he asked her as Candice stepped forward with a disposable gown.
‘Mark Lightbody. Cyclist with an occipital skull fracture. GCS six. Right pupil fixed and dilated. Left pupil responding normally. Apart from the injury to his head, he has only minor cuts and lacerations. He needs emergency surgery to relieve the pressure on his brain.’
David grinned. ‘Doesn’t the attending—as in me—usually make that decision?’
As he was talking he was examining Mark. ‘But I have to agree. Unfortunately the theatre is still being scrubbed after our last case. It will take at least ten minutes to get another ready. He needs a craniotomy, so we’ll have to do it here.’
‘Here?’ Olivia echoed.
‘No reason why not. I assume you have a tray set up for that purpose?’
‘Yes, but shouldn’t we wait to get him to the OR?’
‘It will take time to get him to the OR. Time he doesn’t have—not unless we want to risk him dying or ending up severely brain damaged. In my opinion, doing a craniotomy here and now is his best chance. Now, we can waste more time by arguing, in which case I suggest you step out and attend to other patients, or we can get on with the procedure.’
Olivia felt the blood rush to her cheeks. She hadn’t been objecting to carrying out the procedure, just querying whether it would be better to wait until they’d taken him to Theatre. However, every minute they wasted arguing was time Mark didn’t have. She bit back the sharp retort that had risen to her lips and nodded. ‘I’ll stay and assist.’
The insufferable arrogance of the man. However, she wasn’t about to rise to the bait.
‘In fact,’ he said, ‘why don’t you do it while I assist?’
Olivia felt a frisson of excitement. She always grabbed any opportunity to acquire additional skills. His confidence in her was flattering and his aura of self-confidence immensely reassuring. Not all the attendings were prepared to teach the ER residents. ‘Thanks. I’d like to,’ she replied.
She scrubbed while Kelly set up the tray and one of the other nurses shaved Mark’s blood-matted hair and prepped the surgical field.
‘Good. I’ll show you how to get started then you can take over.’
David made a wide incision in the scalp below the dent in Mark’s head and peeled back the skin to expose an obvious depressed fracture of the skull. ‘This is the interesting bit. Take these elevators …’ he handed her two ‘… and lift the bone fragments up out of the way.’
Everyone seemed to hold their breath as Olivia did as David asked.
As soon as she’d lifted the shattered bone out of the way, a fat red blood clot bulged out towards her. Slowly and very carefully she removed the clotted blood and a satisfied glow spread through her as Mark’s vitals immediately improved.
She grinned at David. When he smiled back something seemed to tilt inside her chest, making her catch her breath. She dipped her head and concentrated on replacing the bone.
