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He smiled, as if she’d amused him with her simplistic solution. “It’s a start, but, as I’ve already said, your people demand more than an apology. They want their prince back.”
Do you hear that, Dad? A pain shot through her heart. If only he’d lived long enough to see this day. “Impossible,” she said flatly.
He nodded. “Which is why the situation is complicated.”
“I was afraid you would say that,” she said dryly. “But, complicated or not, I can’t help you.”
He started to speak, but the door edged open and Lucy poked her head inside.
“We’re getting a couple of traumas in about five minutes. Two stabbing victims.”
Gina had never been so relieved to have patients coming into the ED before. She could deal with medical situations far better than she could sort out diplomatic problems of countries she’d only seen on the map and in occasional family photos.
“Thanks, Lucy,” she said. “We’ll be right there.”
Lucy vanished, apparently without noticing the tension in the office. From the look on Ruark’s face, he was clearly glad for the reprieve as well.
“We’ll discuss this further tonight,” he said. “When we won’t be interrupted or distracted.”
“There isn’t anything to discuss,” she protested.
“You need to hear everything,” he insisted. “The least you can do is listen.”
She wanted to refuse but, after seeing the fierce determination on his face, she knew he wouldn’t give up.
She faced him squarely. “OK, but in the meantime you will not breathe a syllable of this conversation to anyone. No one knows my background and I prefer to keep it that way.”
“You have my word,” he agreed. Immediately, he opened the door. “After you, Dr Sutton.”
Setting aside her host of questions to mentally gear up for her patients, Gina hurried toward the centrally located nurses’ station. “Page Frank,” she told Ruby, the desk clerk, referring to their surgical resident, Frank Horton.
With the phone tucked under one ear, Ruby mouthed, “I’m already on it.” Then she spoke into the receiver. “I don’t care where you have to find him, just do it. We need him in the ER, stat!”
Gina rushed into the opposite hallway to check if Trauma Room One was available, and found Ruark following her like a shadow. “What are you doing here? Bill didn’t—”
“It’s a new day. Bill isn’t here any longer,” he pointed out. “As I understand the job, I’m supposed to be available for traumas, and here I am.”
Only if I need you, she wanted to protest. But then, with two patients coming in and not knowing the condition of either, she might need an extra pair of hands. The only question was, would he function like Bill and be more hindrance than help?
“Afraid I’ll find your department doesn’t run smoothly?” he asked.
“We run just fine,” she defended tartly. “Feel free to observe for yourself.” Already dismissing him, she asked no one in particular, “Where’s Casey?”
Another nurse scurried past. “Dr Casey left for his dentist appointment ten minutes ago. Remember?”
How could she have forgotten? Of all the days for him to lose a temporary filling. But considering what had happened so far this morning, she would count herself fortunate if a natural disaster didn’t occur.
“Dr Powers is supposed to cover, but he can’t come until one-thirty.” Toby Powers was a physician who was close to retirement and worked two shifts a week.
“Staff problems?” Ruark asked.
“Nothing we can’t work around.”
The ambulance bay doors near the nurses’ station swooshed open and she rushed forward to greet the two paramedics and the gurney carrying her first patient.
“Twenty-five-year-old male with multiple wounds to the chest,” one of the paramedics, Tim Abbott, reported. “Open pneumothorax. BP is one ten over sixty-five…”
Gina listened to his recitation as she donned her protective gear, including a face shield, while following the gurney into the trauma room. Not only was the man’s blood pressure low and his heart rate increased, but his skin was cold and clammy and he appeared restless in spite of his cervical and thoracic spine immobilization. Tim had already inserted an endotracheal tube in the field, but her patient still struggled to breathe and showed jugular vein distension.
She raised the large bandage covering his bloody chest and saw eight puncture wounds, with the largest one near the heart showing frothy blood. Because air and blood were leaking into his thoracic cavity, his lungs couldn’t inflate properly. Her work was cut out for her.
To her surprise, a similarly gowned and gloved Ruark appeared in the room. “I’ve got it under control,” she said as she, Tim, Lucy, another nurse and now Ruark prepared to move her patient from the ambulance gurney to a hospital bed.
“Are you warning me away from your patient, Dr Sutton?” he asked coolly.
She mentally noted that she didn’t need to take charge, but old habits were hard to break. While she’d have to defer to him for the time being, she’d maintain a watchful eye until she assured herself that the royal doctor truly knew what he was doing.
“Not at all,” she answered. “One, two, three, lift!” On Gina’s command, their patient made the transition with minimal jostling. Seconds later, she began barking her orders to the nurses who were busy affixing a pulse oximeter, monitoring the IV and taking over ventilation duties. “Get me a chest tube on the double, a CBC and type and cross-match for four units. Where’s Horton?”
Becky answered. “He’s not here yet.”
“Page him again. If he doesn’t answer in the next sixty seconds, page Dr Ahmadi too.” Ahmadi was Frank Horton’s supervisor.
Gina wiped blood away from the largest and most worrisome puncture and revealed heavily tattooed skin. A closer look at his torso showed her what she’d missed before—his entire body was tattooed with mythical creatures. The detailed dragon which was prominently featured on his left bicep was quite distinctive.
“I see we’ve gotten another one of Picasso’s customers.”
“Who?” Ruark asked.
“Pablo Picasso. Pablo’s his real name and being a local tattoo artist, he calls his parlor Picasso’s,” she said as she began to palpate along the man’s rib cage to determine the chest tube placement site. “He thought the famous name would give his place some class. We see a lot of his work in here.”
“Doesn’t say much for his choice of clientele,” Ruark remarked.
“Pablo is interested in his art, not in people’s lifestyle choices,” she defended.
“How did you meet him? I wouldn’t think a physician and a tattooist would have much in common.”
“He came into the ER with pneumonia when I was an intern and we started to talk about all sorts of things. He invited me to his workplace—he dared me to visit, actually, and I did. His drawings are fantastic.”
“Did you pick one for yourself?” Lucy asked.
“Sure did. Lidocaine.”
Lucy slapped the required syringe into Gina’s hand. “Oh, my gosh. You have a tattoo?”
Conscious of Ruark listening intently, Gina wished she hadn’t said a word. Her tattoo was none of his business, even if she wasn’t ashamed of it. “Yeah.”
“You’re kidding.”
“Come on, Lucy, it isn’t that big a deal,” Gina defended.
“Hey, any time you veer off the straight and narrow path of respectability to walk on the wild side, it’s interesting,” Lucy announced. “So what did you choose, and where is it? Don’t keep us in suspense.”
“It’s a frog,” Gina snapped. “On my foot. Scalpel.”
“I should have guessed. You collect them, don’t you?” Lucy slapped the instrument into her hand.
“Yeah.” From the sheer volume of inked skin, Gina suspected her patient took as much pride in his body art as Pablo did, so she made the smallest incision possible to accomplish what had to be done. As she punctured the pleura with a Kelly clamp, blood spurted from the hole.
Working frantically, she hardly noticed the appearance of another nurse, and two more paramedics as they wheeled in a second victim who, like the first, had an IV line established and wore an oxygen mask.
“We’ve got problems here, Doc,” Andy Carter, one of the paramedics, announced.
“Tell me about it,” she muttered.
“What’s wrong?” Ruark abandoned Gina’s patient for the new arrival.
“He’s got a pneumothorax and I couldn’t intubate him before we brought him in. I tried, but couldn’t get through and I didn’t want to waste more time trying in the field.”
Gina inserted the tube into her John Doe’s chest. Immediately blood filled the line and ran into the attached drainage bag. “Hang on, buddy,” she told her patient. “We’re taking good care of you.”
“Give me an endotrachael tube,” Ruark ordered as he moved to the head of his patient’s gurney.
Andy glanced between her and Ruark. “Doc?”
“Where’s Frank?” she asked no one in particular.
“I asked for an endotrach tube,” Ruark ground out. “Must I get one myself?”
Everyone froze, including Gina. “What do you think you’re doing?” she asked.
“Trying to save this man’s life, if someone will give me a damn tube!” he roared as he stood over the second man, who was audibly rasping for breath.
Immediately, the nurses sprang into action.
Gina exchanged a brief glance with Lucy. Ruark would be furious that no one had instantly obeyed his orders. Apparently her days as staff liaison hadn’t ended yet but, in all fairness, what could he expect? No one knew of the official leadership change—it all had happened so fast. If he’d called his staff meeting instead of springing international problems on her that were beyond her control, none of this would have happened, she thought uncharitably.
“By the way,” Gina announced offhandedly as she tended her patient, “I’m afraid none of you have met our new emergency director, Dr Ruark Thomas. In case you haven’t figured it out yet, he’s replaced Bill.”
Under the wary greetings offered by the subdued staff, Gina muttered to Lucy, “Keep an eye on him and signal me if you notice he’s in over his head.”
Lucy obeyed, quietly trading places with the other nurse.
While Gina finished securing the chest tube with sutures and dressed the wound she’d created, she listened to the quiet conversation over the second gurney.
“We can’t get through,” Ruark declared. “His larynx is fractured and the upper airway is blocked.”
“Then he needs a cricothyroidotomy,” she interrupted from across the room. Having worked with her share of unseasoned physicians, she was accustomed to sharing her opinions during the trickier situations. “Can we get by with—?”
Ruark must have read her mind. “Ventilating him with only a needle and catheter is a temporary measure. The surgical method will make it easier for placement of a tracheostomy tube later, which he will definitely need.”
“OK. I’ll be there in a few seconds.” But as she watched the blood pour out of her patient’s chest into the drainage bag and heard only muffled heart sounds, she knew she couldn’t leave his side.
She hated to ask, but she had no choice. “Can you do it on your own?”
“I’m two steps ahead of you,” he answered. “Never fear. I’ve done this once or twice.”
Once or twice? Gina mentally groaned. Yet, for a man with such limited experience, he didn’t seem flustered or act out of his depth. And while she was relieved by his calm, matter-of-fact manner, she couldn’t squelch the irrational notion that he might need the benefit of her expertise. After all, a patient’s life was at stake.
“Find the cricoid cartilage, which is approximately two to three centimeters below the thyroid notch,” she instructed. “Once the membrane is exposed, puncture it midline. Be careful of the vocal cords and don’t puncture—”
“The back wall of the larynx and enter the esophagus. Yes, Gina, I know, but thanks for the reminder.”
He didn’t sound upset and wasn’t yelling at the nurses for not providing the proper supplies at the exact moment he wanted them, which was a one-eighty-degree change from working alongside Bill. Her fears that he was simply a more polished version of their previous director slowly faded as she listened to his calm voice ask questions and give directions. No, it was obvious she didn’t need to review his curriculum vitae—his actions spoke of his abilities far better than a list of positions held ever would. If he could handle his current patient’s condition, he was a colleague she could trust.
Within seconds, Ruark’s patient’s audible symptoms of respiratory stridor disappeared, and with it all of her fears about his medical skills. Suddenly, a burden she hadn’t realized she’d been carrying lifted.
“Airway’s in,” he said, sounding quite pleased. “His pneumothorax is next on the agenda.”
The activity on the other side of the room faded into the background as the nurse at her side interrupted with a terse “BP is falling”.
Gina immediately noticed her patient’s visibly distended jugular veins and muffled heart sounds—Beck’s triad—and knew the man’s heart was failing. “His pericardium or coronary artery must have been nicked,” she said aloud. “He needs his chest opened, but…”
“But what?” Ruark asked from across the room. Apparently he also had the ability to listen in on two conversations at once.
“But I’m not qualified to perform the procedure,” she admitted. “He needs a surgeon. We belong upstairs, now!”
Dr Horton suddenly nudged her aside. “He won’t make it as far as the elevator. Move over.”
“Nice of you to join us, Frank,” she replied caustically as she traded places with the tardy surgeon.
“Hey, I’m here now.” He turned to Candy. “It’ll ruin his tattoos, but get ready for a thoracotomy.”
“At least he’ll be alive to complain,” Gina muttered.
“Only if we stop the bleeding before he goes into cardiac arrest. Scalpel.”
While Frank began to work, Gina glanced at the paramedics hovering nearby. “Do we have names for these two yet?”
“I’ll check.” Andy slipped from the room.
Intent on assisting Frank and urging her patient to hang on, Gina didn’t notice Ruark until he stood at the foot of the bed. “How’s your fellow?” she asked.
“Better than yours,” he answered. “He’s on his way to an operating room as we speak. They’re also holding a suite open for your patient.”
“And here we have it,” Frank announced with distinct arrogance at discovering the problem. “His coronary artery is nicked. I’m cross-clamping the aorta and then we’re out of here.”
A few minutes later, Frank and the John Doe were gone. Lucy and Candy immediately began the unenviable task of dealing with the mess and, oh, what a mess it was. Instruments littered every available surface, paper wrappers and used gloves covered the blood-slickened floor.
