Aware he had shaken her, he left Annie to mull over his words. Snapping back into professional mode as the paramedics wheeled the stretcher inside the designated resus bay, and the patient was transferred to the trolley bed, his focus was now solely on the man who needed the team’s attention and medical know-how.
Dealing with Annie—and confronting their past—would have to wait a little longer.
CHAPTER TWO
ANNIE was shaking as she followed Nathan inside Resus Bay Two. If only she hadn’t been foolish enough to issue that meaningless challenge. Now she fretted over his words, worried about what he had meant. Surely he didn’t think there could be anything left between them? Anxiety tightened inside her, and she cursed herself for allowing him to fluster her, derail her. The last thing she needed was to have to work closely with Nathan in the days ahead.
‘This is Len Gordon. Age fifty-nine. Multiple lower limb fractures, plus femoral break and bleed. Query possible damage to his pelvis. He’s in shock and his blood pressure is low.’
Annie forced herself to set her private concerns aside, and listened as the paramedics finished their report on the patient’s condition, running through GCS score, level of consciousness at the scene and since, BP, respiration, pulse rate and oxygen saturation, plus details of the fluids and drugs already given. Her job as Team Leader was to coordinate rather than be hands-on, so she stood back and watched as the trauma team swung smoothly into action, each focusing on their individual role yet combining as one unit. Once the initial examination had been made, she would be called upon to make decisions about what to do next.
The department’s resus teams were well prepared, and the best Annie had worked with. While the anaesthetic nurse was calming and reassuring the patient, getting what details she could from the distressed, confused man and keeping him informed about what was going on, the anaesthetist concentrated on securing Len’s airway, breathing and circulation.
Annie checked the ECG and vital function monitors one of the nurses was attaching to the patient. She listened carefully as Len’s clothes were cut off and Nathan carried out his primary survey, with each member of the team calling out necessary information. The designated scribe recorded everything on the Trauma Sheet, including relevant timings, plus drugs, fluids and treatments given.
‘Airway clear, bilateral air entry…both lungs sound fine. Pupils normal and reactive. No sign of any upper body, neck or spinal injuries.’
Annie acknowledged the information, gathering updates on Len’s blood pressure, pulse, sats and respiration rate. Gus, aided by Gail, had gained additional IV access, and was administering the fluids Annie had requested to counteract Len’s shock and blood loss. Gus had also drawn up blood for cross-matching and for the tests she asked for, including full blood count, urea and electrolyte concentrations, as well as blood gases. A nurse runner was ready to go to the lab for those tests not able to be done in Resus, to request the cross-matching and order units of blood.
‘Gus, can you see to a urinary catheter next?’ Annie asked.
The young doctor nodded, accepting the items he needed from the trolley Gail had made ready before the patient’s arrival. ‘I’m on it now.’
‘Thanks.’
‘We’re going to need that orthopod down here.’
The sound of Nathan’s voice caused a ripple of awareness to run through her, but Annie fought against her reaction to him. ‘What have you got?’ she asked, moving closer as he delivered his verdict on the patient’s lower limb injuries.
‘Open tib and fib fractures of both lower legs, dislocation of the right patella, and the right femur is broken…probably in two places. X-rays will confirm the extent of the damage. We also need an idea of any pelvic injury before he can go up to surgery, but first I need to stem the femoral bleed at the site of this deep laceration,’ Nathan informed her, concentrating on his task to halt the haemorrhage in the man’s right thigh.
Annie couldn’t help but admire Nathan’s skill and calm composure. He was just as special a doctor as she remembered, always unflappable, whatever the extent and urgency of the crisis. She trusted him completely in terms of his clinical judgement, technique and treatment of patients. It was his treatment of her heart that had been so lacking. Thrusting that painful thought aside, she ensured that the replacement fluids were running correctly, then checked the stats and the time elapsed since the patient had been under their care.
‘How’s the bleed?’
‘Under control now. I just need to get this tied off. Thanks, Holly,’ Nathan added, as the competent young staff nurse assisted him. ‘Len’s going to need a lot of work in Theatre.’ He glanced up, and her breath caught for a second as she met his gaze. ‘I’d recommend a femoral nerve block.’
‘Yes, I agree. Then we can get his legs splinted before X-ray.’
Nathan accepted the syringe Holly handed him, checked the dosage, then deftly inserted the needle, injecting lidocaine in a fan pattern in the thigh. ‘Any idea how long the radiographer will be, Annie?’
‘I’m here,’ a voice announced, and Francesca Scott strode into the resus bay, pulling on her protective lead apron.
Tall and athletic, a riot of red corkscrew curls somehow constrained in the thick plait that fell to her waist, Francesca was unfairly dubbed the Ice Maiden by some of the hospital staff. Annie had always got on well with the other woman, however, and admired her friend’s skill and kindness to her patients.
Despite her more senior role, Annie remained silent and allowed Nathan to outline the extent of Len’s injuries. Once the femoral block had done its job, and splints had been fitted, Francesca went to work using the overhead emergency X-ray equipment now in use in the A and E department. As well as the standard precautionary lateral cervical spine and frontal chest images, she took specific pictures of Len’s pelvis and legs.
‘Can you scan his abdomen and pelvic region, too?’ Annie asked. ‘We’re querying any internal blood loss.’
Using the portable ultrasound, Francesca complied with the request, and within minutes the X-ray and scan images came up on the diagnostic screen.
‘The leg fractures are clear and extensive. But there’s no sign of pelvic fracture or internal bleeding, and no free fluids in the abdominal cavity. I think it’s just bruising,’ Francesca suggested, moving aside so that Annie and Nathan could assess the various images for themselves.
Annie frowned. The X-rays were pretty gruesome. One fibula had jagged splits and fragments in several places, while the other, and both tibias, had multiple but thankfully cleaner breaks. As Nathan had predicted, the right femur had snapped in two places—mid-shaft and just above the knee that had dislocated, its patella misplaced high and to one side, the joint swollen and distorted.
Annie was acutely aware of Nathan close to her. For an unguarded moment she found herself leaning in to inhale his unique and subtle musky aroma, masculine, sensuous and once so familiar. Horrified at her weakness, she straightened and struggled to concentrate on her job. She studiously watched the monitor readings, calling for more blood units as Len was slow to respond to the fluids he’d been given.
Thankfully, the orthopaedic registrar arrived then, tutting over the X-rays. ‘We’ll operate straight away,’ he said, before setting off with copies of the notes and images to brief his department’s senior consultant.
‘OK,’ Annie called, organising her team for their final duties. ‘Let’s get ready to transfer Len up to surgery. Thanks, Francesca. Good job, everyone.’
A further flurry of activity ensued before Len, stable but serious, was on his way to the theatre team, who would take over his care and do all they could to repair the damage to his legs.
Having taken off her protective clothing, Annie went with Holly to see the family, to explain what had happened and what was going to be done during surgery. She left Holly to escort the anxious