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Adrenaline surged as he drove toward Children’s Memorial, the short ride taking twice as long as usual. He didn’t doubt that the heavy fog had contributed to the MVA. Five peds victims was almost unheard of when the average was a couple calls a night. He supposed he should be thankful that the crash had taken place after Lizzy’s father-daughter dance had ended.
Fifteen minutes later he strode into the E.D. and found Naomi up to her pretty neck in pediatric trauma victims. There were three youngsters in the trauma room, ages ranging from eight to fourteen, each looking worse than the next.
A wave of guilt for asking Naomi to switch shifts with him hit him.
“Where do you want me to start?” he asked. Naomi was still the surgeon in charge, and he didn’t want to automatically take control of the situation she’d already begun to handle.
“Take a look at the youngest over there.” She pointed to the victims closest to the door. “I think he needs to go to the O.R. We’re going to have to split up, one operating on patients while the other continues triaging patients down here.”
He glanced around, noting the level of activity. “Split up? Are you sure that’s a good idea?”
“We don’t have a choice.” Naomi’s gaze was grim. “These are only the first three victims—there are still two more on the way. We need to clear a few of these patients out of here before the next ones arrive.”
CHAPTER TWO
NAOMI wished she could have avoided bothering Rick, but there were too many victims for one trauma surgeon to handle. This many pediatric trauma patients was unusual, but apparently there was a special kids’ night being held at the baseball park and lots of kids had been in the cars that had crashed. As she was already triaging, she decided to send Rick to surgery.
“You’d better take this patient to the O.R.” She gestured to the youngest patient, Jimmy Dupont, an eight-year-old with a tense abdomen. “I’m pretty sure he has a ruptured spleen, he’s lost too much blood. If you can take him off my hands, I’ll manage the rest of the triage down here.”
“All right.” Rick didn’t argue, but motioned to the nurse hanging another unit of blood. “Let’s go. I’ll change clothes when we get to the O.R.”
In the back corner of her mind she realized Rick was wearing a suit and tie, but there wasn’t time to resent how he’d used her to cover for a hot date, not when she had so many patients to care for. She turned her attention to the situation at hand, feeling as if she was standing in the middle of a war zone.
“All right, I want the twelve-year-old female, Chelsey Dupont, transferred to the ICU.” She’d already intubated Chelsey and placed a chest tube for the girl’s collapsed lung. Out of all the trauma patients they’d received so far, Chelsey had been the first to arrive and was the most stable of the bunch. The PICU residents upstairs could handle her care for a little while.
“I want Tristan Brown to get a CT scan of his chest and belly.” She suspected fourteen-year-old Tristan had a severe liver laceration, but needed to make sure it was nothing more. He also had a compound femur fracture and had already called the ortho surgeons to take a look at him.
“Doc?” Tristan reached out for her as the nurses began to wheel him away.
“What is it, Tristan?” She stopped them, and took his hand. “What’s wrong?”
“Where’s my sister? Where’s Emily?”
She bit her lip, hoping to heaven that Emily wasn’t the child who’d been declared DOA on the scene. “I don’t know. How old is she? There are still a few victims on the way.”
“Seven. Emily is only seven.” Tristan’s eyes were wild with anxiety. “You have to find her for me. Our parents were hurt, too. I need to see Emily.”
The whole family. She swallowed hard and gently squeezed his hand. “I’ll find Emily but we need to take care of you, too, Tristan. The nurses are going to take you to Radiology for a CT scan of your belly. I need to make sure there’s nothing more serious than a few broken bones.”
“I don’t care.” His eyes filled with anguished tears. “Find Emily, Doc. Please, find my sister. Tell her I love her.”
“I will.” She released his hand and stepped back so the nurses could wheel him away. She bit her lip, desperately needing to find out the name of the DOA patient. She didn’t know if the DOA was an adult or a child, and although no one deserved to die in a car crash, she found herself praying the dead patient wasn’t little Emily.
She hurried towards the unit clerk’s desk but was brought up short when the doors to the trauma room burst open and two more bloodstained patients were brought in.
Fleeting panic hit low in her belly. Never in her life had she ever faced such a massive influx of pediatric trauma patients at one time. She strove to remain calm, listening as the paramedics rattled off the pertinent details.
“Ten-year-old male with multiple fractures, including his pelvis, long extrication at the scene, blood pressure low-eighties over forty.”
“Do you have a name?” She wanted to know how many families they were dealing with here. So far they had the Duponts and the Browns.
“Mike Winthrop.”
Make that a third family. She filed that bit of information away for when the family members started coming in. “Start fluid resuscitation until Ortho gets here.” Naomi glanced at the second patient. With all the blood covering the child’s face, it was difficult to determine the gender. “What’s the story with this one?”
“Crushing chest injury, and another long extrication at the scene. The car that hit them was on top of their car, crushing the victims in the back seat.”
“Age and name?”
“Emily Brown. We almost had to sedate her brother who wasn’t doing very well himself yet was still trying to crawl back into the car to get her.”
Having just spoken to Tristan, she wasn’t surprised. Her gaze landed on Emily and she swallowed her fear, knowing the massive injuries stretched her limitations as a trauma surgeon. “Call the cardiothoracic surgeons, I need someone here to evaluate her asap.”
One of the nurses scurried off. Naomi did a quick examination of Emily, but she could see the poor girl’s ribs flailing from the foot of the gurney. Dear God most if not all of her ribs were broken. She hated to think of the damage that had already been done to her small heart. Most of the trauma surgeons could do a little open-chest surgery, but she’d only done it a couple of times and never alone. Given a choice, she’d rather have the experts with her.
“The CT surgeon is on his way in from home, but the weather may cause him to be delayed,” the nurse informed her a few minutes later. “He said he’d get here as soon as possible.”
She blew out a breath. No choice. Emily was her patient. “Okay, we can’t waste any more time. Get those labs sent off and we’ll take her straight up to surgery.”
“What about Mike Winthrop?” Missy, the charge nurse, asked, a harried expression on her face.
“Get the ortho trauma team to write the admitting orders on both Tristan Brown with his multiple fractures and Mike Winthrop with his crushed pelvis. Get them ICU beds and either Rick or I will be up to see them as soon as we’re finished in the O.R.”
“Okay.” Missy bustled off. Naomi didn’t waste any more time, but headed up to the O.R. with little Emily.
The O.R. team had Emily prepped, draped and ready to go. Anesthesia was there, putting the seven-year-old to sleep and monitoring her labile vital signs. Naomi scrubbed at the sinks outside the room and then donned her sterile garb. Her stomach clenched and she was glad she hadn’t eaten much for dinner because she felt sick at the thought of doing this alone. Taking a deep breath, she entered the O.R. suite.
“Ready?” she asked, taking her place at the patient’s chest. She wasn’t tall, and she generally used a step stool to perform surgery, which everyone had pretty much gotten used to by now.
“We’ve been giving blood as fast as possible, but she’s not gaining any ground,” the anesthesiologist warned. His name was Matt Granger and she’d done many cases with him before.
“Keep doing what you’re doing, and let’s see what we have.” Naomi reached for a scalpel and made the incision straight down the center of Emily’s small chest.
Her ribs were a mess and she didn’t need to cut the sternum as it was already broken. “Suction,” she barked when blood gushed, obliterating her view of the heart. Sweat trickled down the center of her back. “I need to find the source of her bleeding.”
“Need a hand?” a deep voice asked from behind her. She turned to see Rick standing there.
She wanted nothing more than to have Rick’s help, but the other five trauma patients needed him, too. And it was possible that Emily’s heart was beyond repair. No sense in putting the other patients at risk by tying up both of them. “I’m fine for now. The CT surgeon is on his way in from home. You’d better go and check out the ICU admissions. All of the trauma patients have been admitted to the ICU, the ortho trauma team should be evaluating the two with major fractures.”
“Sounds like everything is under control.” He gestured to the open chest. “Are you comfortable with this?”
“I’ve only done open-chest procedures a few times,” she admitted, “but hopefully I’ll find the bleeder.” She turned back to her patient and examined the chest cavity as well as she could, thinking it was possible Emily had a tear in her inferior vena cava, one of the major veins carrying blood to the heart.
“I’ll check on the ICU patients and then come back,” Rick said, his voice fading as he moved away. She didn’t bother to respond. If Emily’s vena cava was torn, things were going to get worse before they got better.
More suction, and she still couldn’t quite pinpoint the source of the hemorrhage.
“We’re losing her. I have maximum doses of three different vasopressors running with no response in blood pressure,” Matt informed her.
“Give more blood.” Sweat pooled at the base of her spine as she fought to slow the bleeding. The vena cava wasn’t an artery but its proximity to the heart made things tricky. “Does anyone know when the CT surgeon will arrive?” she asked, hoping the tremor in her voice didn’t betray her.
“I’ll check.” The circulating nurse left.
There was way too much blood. If she didn’t do something to get the bleeding under control soon, this poor little girl would die. “I want her placed on the heart-lung bypass machine.”
Matt’s gaze met hers over the supine body of their patient. “Are you sure?”
“I don’t have a choice. I can’t fix the tear in her vena cava without additional support for her heart.”
The second circulating nurse in the room wheeled in the heart-lung bypass machine. Naomi was out of her depth with the extent of this surgery and she knew it. “Call Dr Weber back, tell him I need help.”
“I spoke with Dr Yulton, the CT surgeon on call. He’ll be here in ten minutes.”
She wasn’t sure Emily had ten minutes to spare, but she nodded to indicate she’d heard. The techs set up the bypass machine while she began to cross-clamp the major arteries in preparation for the switch-over.
“I’m here.” Rick’s voice had never sounded so good.
“I’m losing her,” she said, her voice steady. “The CT surgeon will be here soon, but I need help now.”
Rick didn’t say a word but helped her perform the switch to bypass. They managed to get Emily safely transferred to the heart-lung machine just as the pediatric cardio thoracic surgeon walked in.
Naomi didn’t leave, but was more than happy to let the CT surgeon take the lead. Rick stayed too, and once Craig Yulton got Emily’s bleeding under control, she breathed a little easier.
“I’ll take her from here,” Craig said, glancing up at Naomi from the opposite side of the patient. “I heard about the multi-car crash after the ballgame, so I’m sure you have other patients to see.”
They did, so Naomi nodded gratefully and stepped down off her stool away from the table. Rick followed her out of the O.R. suite.
They stripped off their face masks simultaneously. The post-adrenaline rush hit hard and she struggled to breathe.
“Are you all right?” he asked, his voice full of concern.
She tried to nod, but her knees trembled and she suddenly felt weak. Taking a few steps, she sank into the nearest chair and buried her face in her hands.
“Naomi?” Rick’s hand on her shoulder was warm, when she was cold inside and out.
“I almost lost her.” Regret for every minute she’d wasted burned in the back of her throat. She took a deep breath and tried to pull herself together, but kept remembering how she’d sent Rick back to the ICU when she really should have handed Emily’s care over to him. “I let my ego get in the way and I almost lost her.”
“What are you talking about?” Rick asked in an incredulous tone. “You did everything exactly right. It was your decision to put her on bypass.”
“Too late. I should have made the decision sooner.” She lifted her head, forcing herself to meet Rick’s puzzled gaze. “I should have asked you to stay. I’ve never done an open-chest case on my own.” The truth weighed on her shoulders like a truckload of bricks and she glanced down, noticing how badly her hands were shaking yet powerless to make them stop. “It’s my fault if Emily dies.”
Rick stared at Naomi, realizing she was completely serious. Her hands were shaking and she was truly upset. Pediatrics wasn’t an easy specialty, not when their small patients had so much life yet to live. But even so he couldn’t remember the last time he’d seen a surgeon take a patient’s outcome so personally. “No, it’s not. Five pediatric trauma cases is a major disaster. There were several adults we sent over to Trinity, too. You did everything possible to save each and every patient. If this young girl dies, it’s because a car landed on her, not because of anything you did or didn’t do.”
She shook her head, refusing to believe him.
His heart ached for her, and if they were handing out blame, he knew he deserved a large portion for himself. If he hadn’t convinced Naomi to switch shifts with him, he would have been the one in charge and would have stayed in the trauma room to triage patients. The seven-year-old with the crushing chest wound would have ended up as his patient. But he didn’t honestly think he could have handled the surgery very differently than Naomi had. Heck, it was always easy to second-guess yourself after the fact, dissecting every little thing you could have done differently.
“We’d better get over to the ICU,” Naomi said in a low voice, clearly struggling to pull herself together. “There’s still a lot of work to do.”
She was right. They did have a lot of work yet to do, but he couldn’t stand to see her beating herself up like this. Especially when she didn’t deserve it. He took her hands and drew her to her feet. Naomi was a tiny thing, her figure hidden by the baggy O.R. scrubs, but he could see silky wisps of her ebony hair escaping the edges of her cap. There was something about her that drew him to her, something he couldn’t ignore. He gave her hands a gentle squeeze. “Naomi, you’re an excellent surgeon.”
“Thanks.” She didn’t meet his eyes and he knew she was simply being polite. She didn’t believe he meant what he said.
He had the crazy urge to fold her into his arms for a reassuring hug, but held himself in check. After all, he was her boss and he barely knew her, only having met her for the first time at their meeting that morning. He willed her to see he was telling the truth. “I’m not handing you a line, Naomi. I haven’t been here long, but this situation tonight would have put immense pressure on any member of the team. I’m impressed.”
“You wouldn’t be so impressed if one of the more experienced members of the team was here,” she pointed out. “I just happen to be the youngest and least experienced surgeon on staff.”
“No, actually, I’m most impressed because of how much you care.” Rick released her hands and took a step back, knowing he was treading on dangerous ground. For too long he’d been so lost in his own misery he hadn’t allowed anyone close. Hadn’t allowed himself to care about anyone except his sister Jess and his niece Lizzy. Yet suddenly, here with Naomi, he was feeling dangerously vulnerable. “You’re a trauma surgeon who truly cares. I think some of us tend to keep ourselves distant from our patients.”
She tilted her head, regarding him warily. “I guess I can understand. I mean, you’ve been treating pediatric trauma patients for years and after a while I’m sure it’s difficult to handle the loss.”
He swallowed hard, wishing he could tell her the truth. Was surprised he even wanted to. But he couldn’t force the words out of his throat. His wife and daughter were buried too deep in his soul to let them free. “Losing children is never easy.” He was impressed his voice was so steady when Sarah’s face was etched so clearly in his mind. “Now, come on, we have patients to see.”
She didn’t smile, but nodded and fell into step beside him as they headed out of the operating room and down the hall toward the pediatric ICU. She didn’t say much until they entered the unit, and then she began asking questions about the newest patients.
Together they made rounds, making sure all aspects of care were covered. They saw Tristan last, and he watched as Naomi approached his bedside. “Tristan, Emily is here at the hospital, in surgery.”
Tristan couldn’t respond verbally—they’d been forced to intubate him during the CT scan. The kid had a pretty severe grade-four liver laceration and multiple fractures. But Rick noticed the teenager clung to Naomi’s hand.
“Emily’s heart had a small tear next to it, and many of her ribs were broken, but she’s doing okay. You need to rest, Tristan, so you can be strong for Emily.”
The boy nodded and after a few minutes, Naomi reassuringly patted his hand and stepped back. After they’d reviewed Tristan’s orders, they headed down to the nurses’ station.
“Emily Brown is coming out of the O.R. in fifteen minutes,” the unit clerk informed them.
“I’ll stay until she’s settled in,” Naomi said.
Rick glanced at his watch, not surprised to see it was well after midnight. “Naomi, you can’t. You really need to go home and get some sleep. You’re on call tomorrow night, aren’t you?”
She nodded, fatigue evident on her face. “Yeah, I’m covering for Dirk. Another half-hour isn’t going to matter one way or the other. I want to see her before I go home.”
Suspecting more arguments would be useless, he gave up. He would have offered to take her call shift, but had a bad feeling he was going to be up most of the night as it was.
He helped himself to a cup of coffee and then headed down to bed fourteen, where Emily was due to be placed. The CT team had brought her out quicker than the promised fifteen minutes and he stood beside Naomi, watching as they settled Emily.
The young girl was stable, her heart was doing as well as could be expected. All they could do now was to wait and see.
“Go home, Naomi,” Rick said in a low tone. “I’ll be here with her all night.”
“I know.” She flashed a small smile and he was struck by how beautiful she truly was. His chest squeezed tight. “Promise you’ll call if you need anything.”
“I will.” He shoved his hands deep into the pockets of his lab coat as she turned and walked away, her shoulders slumped beneath the weight of her guilt.
He stood watching her leave, wishing she didn’t have to go. He liked working with her. Scary, considering he’d revealed more of himself to Naomi than he had to anyone else over the past two years, since he’d lost his wife and two-year-old daughter.
He shook his head. Since Gabrielle and Sarah had died, he’d kept his emotions in deep freeze. He’d stayed in peds because starting over in another specialty hadn’t appealed to him, but he kept himself emotionally isolated from everyone. It had been the only way he’d been able to survive.
Emily’s sweet face reminded him painfully of his daughter’s. Innocent Sarah, far too young to die. He blocked the image the best he could as he went to work.
