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“Well, I have a bit of work to do tomorrow. I better hit the hay,” she said awkwardly, rubbing the back of her neck and trying not to look at him.
“Yeah, of course. I …” Carson said, trying to excuse himself when there was banging on her front door. Incessant and urgent.
“Who in the world?”
“Just stay here.” Carson pushed her down into her chair, letting her know that he wanted her to stay put, before he headed out to the front door.
“As if,” she mumbled, following him.
“I told you to stay in the exam room,” he whispered as he stood in front of the door.
She crossed her arms. “You don’t know Krav Maga. I do.”
He rolled his eyes. “Fine.”
Esme stood on her tiptoes and peered around him. When he opened the door a man let out a sigh of relief.
“Thank God I found you, Doc Ralston.”
“Harry, what’s wrong?” Carson asked, stepping aside to let the man in.
The man, Harry, was sweating and dirty, dressed in heavy denim, with thick work boots and leaving a trail of wood chips on her floor. He nodded to her. “Dr. Petersen.”
“How can we help you … Harry, is it?”
“Yes, ma’am.” He was twisting a ball cap in his hands and it looked as if he was in shock. “There’s been an accident at Bartholomew’s Mill.”
“An accident?” Carson asked. “What kind?”
“Jenkins had a nasty incident with a saw, but there’s bad smoke from a remote forest fire and we can’t get a chopper in to airlift him to a hospital and paramedics are still two hours away.”
Esme reeled at that information. She knew they were far off the beaten path, but medical help was two hours away? Why wasn’t there a hospital closer?
“Let’s go. I’ll go grab my emergency medical kit.” Carson slapped Harry on the shoulder. “I hope you don’t mind driving, Harry. You know those logging roads better than me in the dark.”
“No problem, Dr. Ralston.”
“Can I help?” Esme asked.
Carson nodded. “Grab as many suture kits as you can.”
Esme panicked. “Hospitals take care of suturing. We’re not surgeons.”
Carson shook his head. “Not around here. I hope you have some surgical skills. We’re going to need them.”
Harry and Carson disappeared into the night. Esme’s stomach twisted in a knot. Suturing? Surgery? This wasn’t what she’d signed up for.
When she’d moved here she’d put that all behind her. She wasn’t a surgeon.
No.
Then she thought of Avery. Her brother bleeding out under her hands. She was being foolish. They needed her help. Someone was in pain. This wasn’t an OR. She would make sure she wouldn’t freeze up. She wouldn’t. She couldn’t. This was about sustaining a man’s life until paramedics arrived. Esme rushed into her supply room, grabbed a rucksack and began to pack it full of equipment. Her hands shaking as she grabbed the suture kit.
I can do this.
Besides, she might not even have to stitch him.
Carson could handle it and nothing was going to happen.
This man wouldn’t die.
This wasn’t a surgery case. At least she hoped it wasn’t.
CHAPTER THREE (#ulink_1dece917-374d-5d5c-9db9-6ff26af7ef0c)
ESME BIT HER lip in worry as they slowly traversed some windy hills up into the mountains. At least that was what she assumed by the bumps and the climbs that tried the engine of Harry’s truck. She couldn’t see anything.
She’d thought she knew what pitch-black was.
The sky was full of clouds and smoke from a forest fire, which Carson had assured her wasn’t any threat to them. California had wild fires, but not really in Los Angeles, at least not when she was there. Then again, she wasn’t a native Californian.
Fire, wilderness, bears, this existence was all new to her, but then this was what she wanted after all. This was a big wide place she could easily blend in. She was small here. A place she could hide, because who in their right mind would come looking for her here?
A large bump made her grip the dashboard tighter. She was wedged between Harry and Carson as they took the logging road deep into the camp.
Another bump made her hiss and curse under her breath.
Carson glanced at her. “You’re mighty tense.”
“Just hoping we don’t die.”
Harry chuckled. “We’re not on the edge of a cliff. Our only threat is maybe a rock slide or a logging truck careening down the road, but since there are no trucks running we’re pretty safe.”
“I’ll keep telling myself that we’re safe, Harry.”
He shook his head, probably at the folly of a city girl. Only it was a dark night like this when Avery had died. She’d only been ten years old, but the memory of her brother’s gaping chest wound was still fresh. The feel of his exposed heart under her small hands, the warmth of his blood felt fresh. It was why she’d wanted to be a cardio-thoracic surgeon.
Why she’d worked so hard to be the best, because Avery had been a constant in her parents’ strained marriage. Even though he’d been twelve years older than her.
He’d been her best friend and when he’d died, her world had been shattered. So she’d dedicated her life to surgery.
The nightmares of his death faded away but nights like this made it all rush back.
Carson slipped an arm around her shoulders and then leaned over. “Relax. You’re okay.”
She glanced at his arm around hers and she wanted to shrug it off, but it felt good there. Reassuring. It made her feel safe and she wished she could snuggle in. Esme let out the breath she hadn’t realized she’d been holding in trepidation and leaned back against the seat, shrugging off Carson’s arm. She could handle this. Alone.
“So what happened again, Harry?” Carson asked.
“Jenkins was overtired and nervous. Our new client, Mr. Draven, was headed out our way tomorrow. One wrong move and …” Harry trailed off.
Esme froze at the mention of the name Draven.
Dammit.
Though it couldn’t be Dr. Draven, her former mentor. Eli was a cardio-thoracic surgeon. Still the name sent dread down her spine.
Draven was a common name. So there was no way it would be Eli or Shane. Dr. Draven had money, but he invested it in medicine and science. All of Shane’s money was tied up in his company. She doubted he would invest in lumber or a hotel in Montana.
Harry slowed the truck down and she could see light through the trees as the forest thinned out. There were floodlights everywhere and people milling around one of the buildings, which looked like an administrative building. Harry pulled up right in front of it.
Carson opened the door and jumped out, reaching into the back to grab their supplies. Esme followed suit, trying to ignore all the eyes on them as they made their way into the building. The moment the door opened they could hear a man screaming in pain.
Esme forgot all the trepidation about anyone recognizing her. That all melted away. Adrenaline fueled her now as she headed toward the man in pain. There was blood, but it wasn’t the damage done by the saw that caught her attention. It was his neck, and as she bent over the man she could see the patient’s neck veins were bulging as he struggled, or rather as his heart struggled to beat. Only it was drowning.
She’d seen it countless times when she was a resident surgeon, before she’d chosen her specialty. Before she’d become a surgeon to the stars. First she had to confirm the rest of Beck’s Triad, before she even thought about trying to right it.
She didn’t want to freeze up. Not here. Not in her new start.
“Dave, you’re going to be fine,” Carson said, trying to soothe the patient. Only Dave Jenkins couldn’t hear him. “It doesn’t look like he’s lost a lot of blood.”
“He’s lost blood,” she said, trying not to let her voice shake.
Just not externally.
Carson took off his jacket, rolling up his sleeves to inspect the gash on Dave’s right arm. “It’s deep, but hasn’t severed any arteries.”
The wound had been put in a tourniquet, standard first aid from those trained at the mill. It wasn’t bleeding profusely. It would need cleaning and a few stitches to set it right.
“That’s not the problem.” Esme pulled out her stethoscope.
Carson cocked an eyebrow. “Really?”
“Really.” She peered down at Dave. His faceplate, his eyes rolling back into his head. He was in obstructive shock. “Who saw what happened? There’s more than a gash to the arm going on here.”
“A piece of timber snapped back and hit Dave here.” Esme glanced up as the man pointed to his sternum.
“The gash came after?” she asked.
“No, before, but Dave didn’t get out of the way and he didn’t shut off the machine after the first malfunction. He was overtired—”
“Got it.” Esme cut him off. She bent over and listened. The muffled heart sounds were evident. A wall of blood drowning out the rhythmic diastole and systole of the heart. Drowning it. Cursing under her breath, she quickly took his blood pressure, but she knew when the man pointed to his sternum what was wrong.
Cardiac tamponade.
Dave wouldn’t survive the helicopter coming. He probably wouldn’t have survived the trip to the hospital.
“What’s his blood pressure?” Carson asked.
“Ninety over seventy. He’s showing signs of Beck’s Triad.”
“Cardiac tamponade?”
Esme nodded and rifled through her rucksack, finding the syringe she needed and alcohol to sterilize. “I have to aspirate the fluid from around his heart.”
“Without an ultrasound?” Carson asked. “How can …? Only trained trauma surgeons can do that.”
Esme didn’t say anything. She wasn’t a trauma surgeon, though she worked in an ER during her residency. She’d done this procedure countless times. She was, after all, the cardio God. She knew the heart. It was her passion, her reason for living. She loved everything about the heart. She loved its complexities, its mysteries.
She knew the heart. She loved the heart.
Or at least she had.
“It’s okay. I’ve done this before. Once.”
She was lying. She’d done this countless times. She’d learned the procedure from Dr. Draven. It was a signature move of his that he taught only a select few, but they didn’t need to know that. How many general practitioners performed this procedure multiple times? Not many.
“Once?”
“I really don’t have time to explain. It’s preferable to have an ultrasound, but we don’t have one. I need to do this or he’ll die. Open his shirt.”
Carson cut the shirt open, exposing Dave’s chest where a bruise was forming on the sternum.
You can do this.
“I need two men to hold him in case he jerks, and he can’t. Not when I’m guiding a needle into the sac around his heart.”
There were a couple of gasps, but men stepped forward, holding the unconscious Dave down.
Esme took a deep breath, swabbed the skin and then guided the needle into his chest. She visualized the pericardial sac in her head, remembering from the countless times she’d done this every nuance of the heart and knowing when to stop so she didn’t penetrate the heart muscle. She pulled back on the syringe and it filled with blood, the blood that was crushing the man’s heart. The blood that the heart should’ve been pumping through with ease, but instead was working against him, to kill him.
Carson watched Esme in amazement. He’d never encountered Beck’s Triad before. Well, not since his fleeting days as an intern. It was just something he didn’t look for as a family practitioner. Cardiac tamponade was usually something a trauma surgeon saw because a cardiac tamponade was usually caused by an injury to the heart, by blunt force, gunshot or stab wound.
Those critical cases in Crater Lake, not that there were many, were flown out to the hospital. How did Esme know how to do that? It became clear to Carson that she hadn’t been a family practitioner for very long. She was a surgeon before, but why was she hiding it?
Why would she hide such a talent?
It baffled him.
Because as he watched her work, that was what he saw. Utter talent as she drained the pericardial sac with ease. She then smiled as she listened with her stethoscope.
“Well?” Carson asked, feeling absolutely useless.
“He’ll make it to the hospital, but he’ll need a CT and possibly surgery depending on the extent of his injuries.”
There was a whir of helicopter blades outside and Harry came running in. “The medics are here to fly him to the hospital.”
Esme nodded. “I’ll go talk to them. Pack the wound on his arm.”
