Stormbound Surgeon Page 2

  ‘Doc?’

  ‘The bloke she ran into says he’s a doctor.’

  A doctor… Well, thank heaven for small mercies. Amy let her breath out in something close to a sob of relief.

  ‘How badly is she hurt?’

  ‘Dunno. She’s unconscious and her head’s bleeding. We’re putting her into the back of my van now.’

  ‘Should you move her?’

  ‘Doc says we don’t have a choice. There’s a baby on the way.’

  A baby.

  Amy replaced the receiver and stood stunned. This was a nursing home! They didn’t have the staff to deliver babies. They didn’t have the skills or the facilities or…

  She was wasting time. Get a grip, she told herself. An unconscious patient with a baby on the way was arriving any minute. What would she need?

  She’d need staff. Skilled staff. And in Iluka… What was the chance of finding anyone? There were two other trained nurses in town but she knew Mary was out at her mother’s and she didn’t have the phone on, and Sue-Ellen had been on duty all night. She’d only just be asleep.

  She took three deep breaths, forcing herself to think as she walked back out to the sitting room.

  Thinking, thinking, thinking.

  The vast sitting room was built to look out to sea. Mid-morning, with no one able to go outside, it held almost all the home’s inhabitants. And they were all looking at her. They’d heard Kitty say the call was urgent and in Iluka urgent meant excitement.

  Excitement was something that was sadly lacking in this town. These old people didn’t play carpet bowls from choice.

  Hmm. As Amy looked at them, her idea solidified. This was the only plan possible.

  ‘I think,’ she said slowly, the solution to this mess turning over and over in her mind, ‘that I need to interrupt your carpet bowls. I think I need all hands on deck. Now.’

  Fifteen minutes later, when the police van turned into the nursing home entrance, they were ready.

  Jeff had his hand on his horn. Any of the home’s inhabitants who hadn’t known this was an emergency would know it now, but they were already well aware of it. They were waiting, so when the back of the van was flung wide, Joss was met by something that approached the reception he might have met at the emergency ward of the hospital he worked in.

  There was a stretcher trolley rolled out, waiting, made up with mattress and crisp white linen. There were three men-one at each side of the trolley and one at the end. There was a woman with blankets, and another pushing something that looked blessedly-amazingly-like a crash cart. There was another woman behind…

  Each and every one of them wore a crisp white coat and they looked exceedingly professional.

  Except they also all looked over eighty.

  ‘What the…?’

  He had barely time to register before things were taken out of his hands.

  ‘Charles, slide the trolley off the wheels-that’s right, it lifts off. Ian, that’s great. Push it right into the van. Push it alongside her so she can be lifted… Ted, hold the wheels steady…’

  Joss glanced up from his patient. The efficient tones he was hearing weren’t coming from a geriatric. They came from the only one in the group who didn’t qualify.

  She was a young woman, nearing thirty, he thought, but compared to her companions she was almost a baby. And she was stunning! She was tall and willow slim. Her finely boned face was tanned, with wide grey eyes that spoke of intelligence, and laughter lines crinkled around the edges that spoke of humour. Her glossy black hair was braided smoothly into a long line down her back. Dressed in a soft print dress with a white coat covering it, she oozed efficiency and starch and competence. And…

  Something? It wasn’t just beauty, he thought. It was more…

  ‘I’m Amy Freye,’ she said briefly. ‘I’m in charge here. Can we move her?’

  ‘I… Yes.’ Somehow he turned his attention back to his patient. They’d thrown a rug onto the van floor for her to lie on. It wasn’t enough but it was the best they could do as there’d been no time to wait for better transport. The thought of delivering a distressed baby in the driving rain was impossible.

  ‘Wait for me.’ Amy leaped lightly into the van beside Joss. Her calm grey eyes saw and assessed, and she moved into action. She went to the woman’s hips and slid her hands underneath in a gesture that told Joss she’d done this many times before. Then she glanced at Joss, and her glance said she was expecting matching professionalism. ‘Lift with me. One, two, three…’

  They moved as one and the woman slid limply onto the stretcher.

  ‘OK, fit the wheels to the base,’ the girl ordered of the two old men standing at the van door. ‘Lock it into place and then slide it forward.’

  In one swift movement it was done. The stretcher was on its wheels and the girl was out of the van.

  ‘Take care of the dog, Lionel,’ she told an old man standing nearby, and Joss blinked in astonishment. The top triage nurses in city casualty departments couldn’t have handled things any better-and to even notice the dog… He opened his mouth to tell Bertram things were OK, but someone was handing towels to the man called Lionel, the old man was clicking his fingers and someone else was bringing a biscuit.

  Bertram was in doggy heaven. Joss could concentrate on the woman.

  ‘This way,’ Amy was saying, and the stretcher started moving. Doors opened magically before her. The old men beside the stretcher pushed it with a nimbleness which would have been admirable in men half their age, and Joss was left to follow.

  Where was he? As soon as the door opened, the impression of a bustling hospital ended. Here was a vast living room, fabulously sited with three-sixty-degree views of the sea. Clusters of leather settees were dotted with squashy cushions, shelves were crammed with books, someone was building a kite that was the size of a small room, there were rich Persian carpets…

  There were old people.

  ‘Do we know who she is?’ Amy asked, and Joss hauled his attention back where it was needed.

  ‘No. There was nothing on her-or nothing that we could find. Sergeant Packer’s called in the plates-he should be able to get identification from the licence plates of the truck she was driving-but he hasn’t heard back yet.’

  She nodded. She was stopping for nothing, pushing doors wide, ushering the stretcher down a wide corridor to open a final door…

  ‘This is our procedures room,’ she told Joss as she stood aside to let them past. ‘It’s the best we can do.’

  Joss stopped in amazement.

  When the police sergeant had told him the only place available was the nursing home he’d felt ill. To treat this woman without facilities seemed impossible.

  But here… The room was set up as a small theatre. Scrupulously clean, it was gleaming with stainless-steel fittings and overhead lights. It was perfect for minor surgery, he realised, and his breath came out in a rush of relief. What lay before him started looking just faintly possible.

  ‘What-?’

  But she was ahead of him. ‘Are you really a doctor?’ she asked, and he nodded, still stunned.

  ‘Yes. I’m a surgeon at Sydney Central.’ But he was focussed solely on the pregnant woman, checking her pupils and frowning. There didn’t seem a reason for her to be so deeply unconscious.

  He wanted X-rays.

  He needed to check the baby first, he thought. He had two patients-not one.

  ‘You can scrub through here.’ Amy’s face had mirrored his concern and she’d followed his gaze as he’d watched the last contraction ripple though her swollen abdomen. ‘Or…do you want an X-ray first?’

  ‘I have to check the baby.’ She was right. He needed to scrub before he did an internal examination.

  ‘I’ll check the heartbeat. The sink’s through here. Marie will help.’

  A bright little lady about four feet high and about a hundred years old appeared at his elbow.

  ‘This way, Doctor.’

  He was
led to the sink by his elderly helper-who wasn’t acting elderly at all.

  There was no time for questions. Joss was holding his scrubbed hands for Marie to slip on his gloves when Amy called him back.

  ‘We’re in trouble,’ she said briefly, and her face was puckered in concern. She’d cut away the woman’s smock. ‘Hold the stethoscope here, Marie.’ Then, with Marie holding the stethoscope in position over the swollen belly, she held the earpieces for Joss to listen.

  His face set in grim lines as he heard what she’d heard. ‘Hell.’ The baby’s heartbeat was faltering. He did a fast examination. The baby’s head was engaged but she’d hardly dilated at all. A forceps delivery was still impossible. Which meant…

  A Caesarean.

  A Caesarean here?

  ‘We don’t have identification,’ Amy was saying. ‘Will you…?’

  That was the least of their worries, he thought. Operating without consent was a legal minefield, but in an emergency like this he had no choice.

  ‘Of course I will. But-’

  ‘We have drugs and equipment for general anaesthetic,’ she finished, moving right on, efficient and entirely professional in her apology. ‘The Bowra doctor does minor surgery here, but I’m afraid epidural is out of the question. I…I don’t have the skills.’

  After that one last revealing falter her eyes met his and held firm. They were cool, calm, and once again he thought that she was one in a million in a crisis.

  ‘What’s your training?’ he started, hesitating at the thought of how impossible it would be to act as anaesthetist and surgeon at the same time-but she was before him there, too.

  ‘Don’t get the wrong idea. I’m not a doctor,’ she said flatly. ‘I’m a nurse. But I’m qualified in intensive care and I spent years as a theatre nurse. With only one doctor in the district, I’ve performed an emergency general anaesthetic before. That’s why we have the drugs. For emergencies. So if you guide me, I’m prepared to try.’

  He stared at her, dumbfounded by her acceptance of such a demand. She was a nurse, offering to do what was a specialist job. This was a specialist job for a qualified doctor!

  But she’d said that she could do it. Should he trust her? Or not?

  He hardly had a choice. He’d done a brief visual examination on the way here. The baby was still some way away-the head wasn’t near to crowning-and now the baby’s heartbeat was telling its own grim story. If they waited, the baby risked death.

  He couldn’t do a Caesarean without an anaesthetic. The woman was unconscious but the shock of an incision would probably wake her.

  He needed a doctor to do the anaesthetic, but for him to perform the Caesarean and give the anaesthetic at the same time was impossible.

  Amy wasn’t a doctor. And she was offering to do what needed years of medical training.

  But… ‘I can do this,’ she said, and her grey eyes were fearless.

  He met her gaze and held it.

  ‘You’re sure?’

  ‘Yes.’

  ‘You realise insurance…’

  ‘Insurance-or the lack of it-is a nightmare for both of us.’ She nodded, a decisive little movement of her head as though she was convincing herself. ‘But I don’t see that we can let that worry us. If we don’t try, the baby dies.’

  It went against everything he’d ever been taught. To let a nurse give an anaesthetic…

  But she was right. There was no decision to be made.

  ‘OK. Let’s move.’

  It was the strangest operation he’d ever performed. He had a full theatre staff, but the only two under eighty years old were Amy and himself.

  Marie stayed on. The old lady had scrubbed and gowned and was handing him implements as needed. Her background wasn’t explained but it was assumed she knew what she was doing, and she handled the surgical tray with the precision of an expert.

  And she had back-up. Another woman was sorting implements, moving things in and out of a steriliser. A man stood beside her, ready with a warmed blanket. Every couple of minutes the door opened a fraction and the blanket was replaced with another, so if-when-the baby arrived there’d be warmth. There was a team outside working in tandem, ferrying blankets, hot water, information that there was no chance of helicopter evacuation…

  Joss took everything in. He checked the tray of instruments, the steriliser, the anaesthetic. He measured what was needed, then sized Amy up.

  ‘Ready?’

  ‘As ready as I’ll ever be.’ Still that rigid control.

  He looked at her more closely and saw she was holding herself in a grip of iron. There was fear…

  It would help nothing to delay or probe more deeply into her fear, he decided. She’d made a decision that she could do it and she had no choice. There was no choice!

  ‘Let’s go, then.’

  Amy nodded. Silently she held her prepared syringe up so he could check the dose. He nodded in turn and then watched as she inserted it into the IV line.

  He watched and waited-saw her eyes move to the monitor, saw her skilfully intubating and inflating the cuff of the endrotracheal tube, saw her eyes lose their fear and become intent on what they were doing.

  He felt the patient’s muscles relax under his hand.

  She was good, he thought exultantly. Nurse or not, she knew what she was doing, which left him to get on with what he had to do.

  He prepped the woman’s swollen abdomen, lifted the scalpel and proceeded to deliver one baby.

  CHAPTER TWO

  IT WENT like clockwork.

  This team might be unusual but their competence was never in question. As he cut through the abdominal layers the old woman called Marie handed over instruments unasked. When Joss did need to ask, her responses were instantaneous.

  And Amy’s anaesthetic was first class.

  All this was-had to be-ancillary to what he was doing. He was forced to depend on them: his attention was on the job. The anaesthetic was looking fine. All he knew was that he had what he needed and the woman’s heart rate was great.

  If only the baby’s heartbeat held…

  This was the moment of truth. He looked up to ask, but once again his needs were anticipated. The second of the older women stepped forward to push down on the uterus, giving him leverage as he slid one gloved hand into the incision.

  Please…

  ‘Here it comes.’ He lifted the baby’s head, turning it to the side to prevent it sucking in fluid. ‘Yes!’

  It was a perfect little girl.

  Joss had only seconds to see that she was fine-the seconds while he scooped the baby free. As soon as she was free of her mother-before he’d even tied off the cord-hands were reaching for her, the sucker was in her mouth and they were removing mucus and freeing her to breathe. These people knew what they were doing! The old man behind Marie ducked in to scoop the infant into the waiting blanket as the elderly nurse cleared her airway.

  ‘We’ll be fine with her.’ Amy motioned him back to the wound. ‘She’s looking good.’

  He had no time to spare for the baby. He turned back to deliver the placenta, to swab and clamp and sew, hoping his geriatric helpers were able to clear the baby’s airway in time.

  Amy would supervise. He knew by now that she was a brilliant theatre nurse. She was acting as a competent anaesthetist. Apart from a couple of minor queries about dosage, he’d rarely had to intervene.

  And as he began the lengthy repair process to the uterus there came the sound he’d been hoping for. The thin, indignant wail of a healthy baby.

  The flattening of its heartbeat must have been stress-induced, he thought thankfully. A long labour and then the impact of the crash could have caused it.

  How long had the girl been in labour?

  A while, he thought, glancing to where Amy still monitored the intubator. The new mother was as white as death and the wound on her forehead still bled sluggishly. He’d suture it before she woke.

  If she woke.

  Why was she
unconscious?

  Hell, he needed technology. He needed to know if there was intracranial bleeding.

  ‘We can do an ordinary X-ray here,’ Amy said, and his eyes flew to hers. Once again she was thinking in front of him. ‘We have the facilities. It won’t show pressure if there’s a build-up, but it’ll show if there’s a fracture.’

  ‘Is there no way we can we get outside help?’ He wanted a CT scan. He wanted his big city hospital-badly.

  ‘Not until this rain eases.’ Outside the window, the rain was still pelting down. ‘Given decent conditions, a helicopter can land on the golf course, but not now. There’s too many hills. The country’s so rough that with visibility like this they’d be in real trouble.’

  So they were still on their own.

  ‘We’ll be OK,’ she said softly as he worked on. Their eyes locked and something passed between them. A bonding. They were in this together…

  Joss felt a frown start behind his eyes. He didn’t make contact like this with theatre staff. He didn’t make contact with anyone. But this woman… It was as if she was somehow familiar…

  She wasn’t familiar at all. ‘We’re not finished yet. Let’s get this abdominal cavity cleaned and stitched,’ he said, more roughly than he’d intended, and bent back over his work.

  Finally the job was done. Under Joss’s guidance, Amy reversed the anaesthetic, concentrating fiercely every step of the way. At last, still rigid with anxiety, she removed the endotracheal tube and the woman took her first ragged breaths.

  Amy had done it, and until now she hadn’t known she could. She closed her eyes, and when she opened them again Joss was beside her, his hands on her shoulders and his face concerned.

  ‘Are you OK?’

  ‘I… Yes.’ She tried to draw back but his eyes were holding her in place as firmly as his hands were holding her shoulders.

  ‘Exactly how many anaesthetics have you given in your professional career?’ he demanded, and she gave a rueful smile.