Loe raamatut: «Surgeons, Rivals...Lovers»

CHAPTER ONE

THE SOUND OF screeching tires stabbed Dr. Kimberlyn Davis’s ear. One by one every one of her major muscle groups seized, stopping her cold on the Manhattan sidewalk, tensed for impact. One burst of sound, then another and another—rubber on asphalt, metal on metal—her every heartbeat shuddering in time with each bone-rattling sound.

Teeth gritted, she twisted toward the street in time to see a body arcing through the air, arms and legs flailing for purchase in the already warm morning sun. A man. A motorcyclist. He tumbled, rolled and came down chest first on the grille’s edge of a still-moving black SUV. The second impact tossed him back—a human pinball thrown and battered far more than flesh and bones could stand.

Her clamped jaw held back sounds she couldn’t control enough to stop, a whimper that burned like a roar—searing her throat and blazing a trail down her chest to the still-bothersome scar that would forever mar her cleavage.

She should’ve run when she’d heard the first sound of squealing tires. Away from the danger. But she had taken an oath.

Before the cascade of car horns died off, before the vehicle he’d flown into had even managed to stop moving, Kimberlyn forced herself to start. One stiff step, then another, each step loosening her muscles and allowing the next to come easier, faster. Off the curb. Onto the street. Within three paces she was running.

Moving cleared her mind. One act of willful defiance in the face of her fear, her memories, let the next one came easier.

“Someone call 911!” she shouted over her shoulder.

Please, don’t be dead.

She kept her gaze before her long enough to plot a course, then through the windows of every car she passed en route to the man.

She’s okay.

They’re okay.

Awake with head laceration.

Okay.

Okay.

Of course this was how her first week in New York should start.

By the time she reached the motorcyclist he was wholly beneath the SUV and several feet from where he’d landed. Dragged by the front bumper. The driver looked stunned through the shattered glass. He had a gash on his chin and another smaller cut above his left eye, but he was awake, moving…

Over the past year she’d gone from running from accidents to running toward them—but it always felt wrong. Even the times she’d come on the scene after the carnage had been wrought, her very soul had vibrated with the wrongness of it.

Wrongful death. All her fault.

From the first wreck she’d passed on the highway after her accident—when she’d been three months post-op, still in a cast, and on the way to yet another session with her physical therapist—she’d forced her mother to stop the car so she could get out and help. And she hadn’t stopped since that accident. Couldn’t stop.

Only the top of her current patient’s helmet showed his location under the SUV and the only thing she could feel at all good about was the lack of engine noises. It must have shut off during impact.

“Check breathing,” she whispered to herself, words slipping in a steady stream through her lips as she talked herself through the things she needed to do. Order of operations. Mental checklist for emergency scenarios. Only action could keep her focused, let her ignore the tangle of emotion rotting in her gut.

It was also the only way to try to block out Janie’s face, always with her—cut, battered and swollen—at the back of her mind. It became harder to ignore in situations like this.

“Bashing damage to chest. Get to his chest…”

If his heart still beat, he had a chance. If she got to him fast enough… Nothing could guarantee survival. Even if he appeared stable, some injuries just took longer to kill you than others.

“If the patient can’t come to you, you go to the patient. Gotta get under the car…”

She dropped her backpack as she fell to her knees and scrambled over broken glass. Craning her neck, she looked under the car to see if anything besides the helmet had been snagged.

She couldn’t see much besides that he wasn’t moving. To try to take control of her mouth, she began to narrate on purpose—the habit drilled into her as an intern so that the patient knew what you were doing. And on the off chance that he could hear her…

“Sir?” Sir, because this patient wasn’t Janie. Sir. A man. A man she didn’t know. Not her fault. Not her fault, not this time. “Keep still, I’m going to come under there with you.”

Her voice sounded shrill even to her own ears. Anyone would know she teetered on the edge of panic, but she wouldn’t fall headlong into it. She had control. Always. Always. But if her patient could hear her, she should be comforting him. Making him confident she’d help him, not squeaking like a cartoon mouse. Her throat refused to loosen, but she forced a few more words through. “I’m a doctor… We’re going to get you out of there.”

Her heart banged a couple times, popping out of rhythm as it tended to do when dosed with adrenaline. It would settle down. It was nothing, a flutter. Pay no attention…

“Not answering… not moving…” The whispering started again, and something new—the slow, hard beats of her heart, an insistent reminder of the emotion she tried so desperately to ignore. He was never coming out of this. There was nothing she could do.

Be optimistic…

Straightening, she looked around the street to the closest group of people, eyes skating from figure to figure. No police to help yet…

Get under the car. Take a light.

Ripping open her backpack, she fumbled inside for the kit, glad for once that she had to keep it with her.

Once the dented silver case was in her hand, she flipped it open and snatched out the penlight. With only her light clutched in her hand, she looked around again for help.

Running toward her through the scene she saw a figure in ceil blue, the color of the scrubs she also wore.

Someone with appropriate skills coming to help…

She flattened to her belly and crawled under the SUV with her patient. When she was beneath far enough to reach his wrist, she felt for a pulse. Present… but weak. She continued to narrate, as she’d been taught to do. The practice was supposed to help patients manage their own fear in emergency situations, but it saved her from drowning every time. Even now, when the man didn’t move or answer her.

She ran her light up and down the motorcyclist’s body, looking for points of contact with the vehicle. Nothing. No snags. No parts of his body pinned beneath wheels. It didn’t look as if he had any points of contact with the underside or the vehicle, except for where the bumper had snagged his helmet.

“Is he trapped?” a man’s voice yelled from beside her, his words only just registering above the noise of the street and the roar in her ears.

Kimberlyn backed up carefully, doing her best not to bloody herself on the broken glass. When she finally got out, she took the light out of her mouth and straightened to look at her helper. The embroidery on the left breast of his scrubs showed the name of her hospital, where she’d been headed for her first day.

The name DellaToro stood out on the tag beneath the logo for West Manhattan Saints.

Him. Enzo, her cousin Caren had called him. At least she knew he was knowledgeable and skilled. He’d help her.

From the narrowing of his gaze as it rolled over her own embroidered name, he recognized who she was, too.

Neither Caren nor her new friend Tessa had told her how good-looking the man was. Dark hair and olive-skinned, deliciously scruffy. Shockingly dark blue eyes beneath eyebrows built for brooding… No wonder he was so used to people doing what he told them to. Difficult to argue with a jaw that square—made him look hard and unyielding. Like granite. Sexy, sexy granite.

Perfect time to think about the man’s attractiveness. Goodness, what was wrong with her?

The answer hit like a slap in the face. His face had blocked out Janie’s. That was why she’d noticed, and why her cheeks tingled.

What she needed was for her patient’s face to replace Janie’s. He deserved all her attention. But DellaToro’s scruffy good looks would serve as a guilt shield until she could get that helmet off.

“The helmet is wedged under the bumper.” Breathlessness replaced her shrill tone. Was that better? “But it doesn’t look like there’s any crushed areas or snags. We have to get him out from under there.”

“But the helmet is wedged?” He bent to look, then felt around to where it was caught, apparently coming to the same conclusion she had: there was no foolproof way to get him out from under there. “We need to be careful of his spine.”

“I know, but a perfect spine never did anything for a dead man. I can’t even tell how he’s breathing like this. Or if his eyes are open.” Or show her inner demon that the motorcyclist wasn’t Janie, even though she logically knew that couldn’t be the case. “We might be looking at head trauma, too. We have to push the car off him.” She turned toward the sidewalk and the closest pedestrians and called, “Guys, we need some help pushing the car.”

DellaToro straightened to look at the group she’d called to. The group that wasn’t moving at all to help them. He then knocked on the hood and yelled to the driver, who had found cloth in his vehicle to put pressure on his bloody wounds. “Put it in Neutral.”

The man nodded, still mentally with it despite the blood on his face. Should she check on him? He could die from lack of attention while they worked on one man whose chances were much slimmer, by appearances.

She had to stop finding points of comparison. This wasn’t her wreck. That man wasn’t Janie, either.

Then, in a far more commanding voice, Enzo faced the rubbernecking pedestrians and pointed to two specific men. “You and you, help us roll the car.”

The authoritarian edge to his voice seemed to work. The men who had ignored her just moments before came down onto the street, shedding jackets and dropping whatever they carried to come to the front hood.

Figures. Also not worthy of examination right now.

Ignore the handsome doctor’s jaw, help the patient.

His attention turned to her and he continued giving orders. “Reach under and get your hands around the edge of the helmet. We’ll push it. You hold his head in place as well as you can.”

Kimberlyn maneuvered herself to the man’s head. With her cheek mashed against the front bumper, she strained under the car to get her hands around the edge of the helmet. “Got it.” A pause. “Don’t let it rock.”

If it rolled forward even an inch, it might also snap both their necks.

“We won’t.”

At least Dr. Granite Jaw had a plan for this. All she had was grime from the street, a lurking wave of panic and glass shards sticking to her scrubs.

With the three of them pushing the SUV, they managed to roll it smoothly back. Pressure was released from the helmet. She eased her hands loose and when his head held position she flipped the visor open.

Finally. Another face to quiet guilty echoes in her mind.

Young. Very young. Closed eyes. Fast breathing. Still no response.

Had that been how she’d looked? Blood loss sped up respiration and heart rate as tissues and organs became deprived of oxygen, so it stood to reason that it was. Except she’d been pinned inside a vehicle, and the blood loss had been mostly visible, not hidden inside the chest cavity.

As the SUV continued to roll, revealing the man’s body, she reached for her bag again and her kit.

DellaToro joined her, unzipping the man’s protective leather jacket. At least he’d had the protection of sturdy clothing.

“His breathing is labored,” DellaToro announced.

Of course it was. She’d take comfort in him still breathing if she didn’t know how quickly that could change, and give them all a really bad day. One heartbeat to the next, things could turn, and the person you thought was most stable…

Focus.

“I’ve got some…”

She stretched to where she’d dropped her backpack and then tore into it. “Here, Dr. DellaToro.” She produced a stethoscope and handed it to him.

“Thank you, Kimberlyn. Heard you were coming.” He used her first name while taking the instrument.

Was that some kind of dominance display?

Not the time. Correct later.

She dug into the engraved silver kit again. The fact that she could act now steadied her. Those images of her wreck were still there, always there, even a thousand miles away—but now they lurked on the periphery. The rabbit hole she never wanted time to go down.

Just a little longer.

She extracted the gauze scissors and began cutting down the front of her patient’s T-shirt, exposing an already forming bruise. Deep purple stippling slashed across pale flesh, right over the sternum. Bad bruise forming. No way would it be unbroken, and a broken sternum didn’t protect what was inside very well. Bruising organs at least. Heart. Lungs, maybe. Bashing damage could be more destructive than bullets.

She bent forward to listen to her patient’s breathing as Enzo listened to his heart.

Enzo. She could do it, too.

“Steady, but fast and faint…” he announced, pulling the stethoscope from his ears to hang from his neck, and bending to grab for the penlight she’d been using under the car.

“Faint?” She repeated the word—as if she didn’t already expect that exactly to be the case. As if it could be anything else.

Her fingers searched his wrist, and she could barely feel anything but her own thundering pulse. “You’re sure it’s beating?” She fumbled beneath the edge of the helmet to find the carotid, looking for a stronger throb. Her fingers tracked over corded vessels. The jugulars stood out as if he was straining.

Distended veins in the neck. Symptom number two that she’d both expected and dreaded.

The carotid didn’t stand out at all and she felt nothing pulsing in the general region. Blood backing up in the veins and not pumping through the arteries—reason for the distended veins.

“Pupils responsive,” Enzo announced, then listened again. “Faint, but still fast. Maybe speeding up.”

She should be doing that, announcing her findings as she went. Just one more second, one more symptom… Make sure…

He hadn’t picked up on the diagnosis yet. She’d share as soon as she confirmed the third. Even if she was already certain what her fingers and eyes told her, she needed something solid to reference.

Her hand shot into her backpack again, but books and sundries blocked her search. She upended it and dumped the contents onto the pavement. The wrist BP cuff she still carried with her rolled free—her second guilty security blanket. She grabbed it and wrapped it around the man’s wrist.

“You carry a cuff?” Enzo asked, but he was listening to her as he went back to the abdomen and began prodding gently, looking for injury.

Kimberlyn didn’t answer, just pressed the button to start the automated machine and leaned forward to listen to his breathing again. “We need an ambulance. Did anyone call an ambulance?”

A beep announced the measuring of vitals had finished and she looked at the small display.

Pulse one twenty-nine. Pressure ninety-five over seventy-five.

“Crap. Crap, crap…”

Enzo’s eyes snapped to her and then to the display on the little cuff. “That’s not good.”

“No,” she said, looking around again. “Did anyone call 911?” Repeated it louder.

No one answered. The ones who’d helped push the car had already abandoned them. Enzo fished his phone from his pocket and dialed.

“We need a large syringe, and I don’t have one of those in my bag.”

Either he wasn’t worried by the situation or he didn’t realize the extent of what was going on.

“Enzo, listen to me.” She used his first name this time to capture his attention. When his eyes met hers, she had to force the words through her clenched throat. “Cardiac tamponade.”

Attention captured. “How do you know?”

“See the veins in his neck? Fluid’s coming on fast, filling his chest, and there’s no time for the pericardium to stretch and accommodate it to let his heart beat right. Either blood or serum. Probably both. Preferably more serum than blood.” More blood would probably mean a tear, but serum could just be trauma.

A cold pit opened in Enzo’s middle. They were close to the hospital, but that was the kind of diagnosis you wanted to say after remedying it.

He barked their location into the phone and followed it with, “Possible cardiac tamponade.” After demanding two additional crews and the NYPD, he ended the call and stashed his phone again. The borrowed stethoscope replaced the phone at his ear and he listened hard. The faintness bothered him. “You think pericardial effusion from the impact?”

She nodded, and from the lack of color in her face he believed her. No one could go pale for show like that.

He hadn’t had a cardiac tamponade patient in his four years of residency, but she sounded certain and had the look of someone with first-hand knowledge.

Something had to be blocking the sound of the heart. If anything, the man was underweight, nothing else made sense besides a wall of fluid muffling the sounds.

Sam Napier, his best friend in the residency program, had warned him that one of the many women in Sam’s House of Gorgeous Roommates had a cousin transferring in to chase Enzo’s fellowship. He’d expected… well, someone sunnier in disposition and appearance. A duplicate of Caren’s golden-blond curls, dimpled cheeks and the too-cheerful smiles that made it hard for him to be around her before at least two cups of coffee. Not this soft-spoken, dark-haired creature with the delicate features and soulful brown eyes.

“He was hit chest first,” she said, taking the blood pressure again. “As in he landed with his chest on the front top edge of the grille of the car. Then bounced off. I’ve seen this before in another crash. Three big symptoms, Beck’s Triad. Muffled and faint heartbeat. Distended neck veins. A narrow difference in the blood pressure readings… One, two, three.” She pointed as she counted, chest, neck and the cuff. “There’s barely anything between the systolic and diastolic.”

The cuff beeped again, the new results darkening the screen. Pulse one sixty-two. Pressure eighty over sixty-five.

Damn. She really was right. He was either bleeding out or something else was filling his chest.

The sound of sirens close by caught his attention. They were only a couple of blocks from the hospital, and the sound came from the right direction. Closer than Dispatch, and coming toward them now. Lucky.

They’d have a defibrillator, and other tools…

He could hear her little cuff running again, beneath the blessedly loud siren of the ambulance as it rolled to a stop just ahead in the intersection. “You.” He jabbed a finger at a woman in a power suit who still stood nearby, watching, “Meet the ambulance. Tell them we need a huge syringe.” He placed the stethoscope on the patient’s chest again, doing what little he could do to monitor the situation as help arrived.

Before the suited woman even got to the ambulance, the medics came running with a bag of tools, defibrillator and a large hypodermic syringe they slapped into his hand. His order had done the trick.

“Have you aspirated a pericardium before?” Enzo asked, looking at Kimberlyn. He hadn’t. Normally he’d like to try, but she’d made the diagnosis. Even if it weren’t a professional courtesy, he wanted to see her perform so he could gauge her skill level. It was the best way to ascertain if she was simply another trauma resident or an actual threat to his fellowship.

Whether she had ever done it before or not, the small brunette crammed her hands into the gloves presented by the medic and indicated an area on the right side of the man’s chest, “I can do it. Swab around and between the fourth and fifth ribs.” She joined him on the patient’s right side.

He ripped into the alcohol prep and broke the canister within the squeegee to disinfect the area.

“Tell me if his heart starts sounding louder or if there’s any other change.”

Would chest compressions even work if the pericardium was full of fluid? It’d be like trying to squeeze a water balloon inside a larger, overfilled balloon…

Even with the stethoscope buds in his ears, he could hear the tremor in her voice. Still scared. Was she steady enough to perform the aspiration?

“I will.” He listened and directed the EMT, never taking his eyes off Kimberlyn, “Get him wired up and on the monitor.”

Cardioversion was possible now at least.

With the extra-large hypodermic in hand, she braced one elbow on her knee for support and explained. “I’m going from the right side because the heart juts to the left, and I don’t want to hit it.”

Yeah. Don’t hit the heart…

She looked steady enough now. Whatever had her fighting panic, it came and went in waves.

Enzo backed up enough to make room but stayed close enough to keep the stethoscope in place to listen while the monitor was hooked up.

This might have been a bad call. She seemed competent except for those nerves. Her nerves triggered his. If she ended up doing more damage… Maybe they should just move him now and hope he lasted another five minutes, or however long it took to get to the hospital.

With her arms steadied and braced, she waited patiently the long seconds it took for the electrodes and wires to be placed.

He listened hard, holding his breath to cut out as much sound as possible. His own pulse sounded in his ears louder than what he was hoping to listen for…

Closing his eyes helped, cutting down the external stimuli. Without vision in the way, he could hear the heartbeat faintly in the background. Fast. Very fast. And with an abnormal rhythm.

This heart didn’t just inch toward failure, it galloped. The man would never make it to WMS.

What kind of fibrillation—atrial? Ventricular? He opened his eyes and craned his neck to see the green line denoting the rhythm tracing across the black screen of the monitor.

The line swung wildly in an undulating wave that told him nothing.

Check the leads.

Okay, check the placement of the electrodes.

He grabbed an extra electrode and placed it beside the one that looked somewhat off-center, then reattached the lead. The line settled into the regular, horizontal position, allowing him to really see the points.

Ventricular fibrillation. And tachycardia. He listened again, with his eyes following the line. The sounds were almost too faint for him to hear—something that backed up her diagnosis: there had to be a massive amount of fluid compressing the heart. “He’s in V-tach.”

“Thought he might be. His time is running out.” She breathed in. When all hands were still, she breathed out slowly as she pushed the needle into the man’s chest.

She could’ve done this a thousand times. Smooth and slow enough to be cautious but quick enough to feel the texture of the different tissues she penetrated. Her eyes had taken on that out-of-focus quality that came with pinning all your attention on feeling your way to a site unseen. He’d seen that look on the real pros so many times—an amazing ability to visualize the path through and the imagination to picture the diagnosed problem. It almost felt like sorcery.

As she drew back the plunger, bright, arterial crimson began to fill the clear tube. As pressure was siphoned off, the heartbeats became a little louder, a little more distinct.

She withdrew the full syringe and looked at him, those eyes dark with fear… not the exhilaration he’d expected. But, then, he’d never been in this situation, either. Exhilaration was hard to come by. Something entirely more primitive took its place.

“No change?” So hopeful.

“Still in V-tach.” Enzo listened a few more seconds to give him time to convert. He tried counting beats but found it impossible and shook his head. “No change.” He gave the heart a few more seconds, listening again, then shook his head, “Clearer, but still distant-sounding and out of rhythm. Drawing off the fluid wasn’t enough to convert him to normal sinus.”

She paused another few seconds, pinned by those soulful eyes. Dr. Ootaka, his mentor, counseled distance. Emotions clouded reactions. Enzo had never had reason to doubt this mantra, though right now he couldn’t claim to have that distance. He wanted to give the hope her eyes begged him for.

Hoping wouldn’t get the job done. “I’ve never dealt with this. How did they do it at your old hospital?”

“The only one I saw treated was done in the hospital and they used imaging equipment to verify the diagnosis and location of the fluid before they aspirated.” She answered quickly, her focus returning, and her voice firmed as she spoke. One word led to the next, and she focused on the EMT. “I need another hypo. Bring two, just in case.”

She’d only seen it done once. Ugh. At least she didn’t look it. Move past it. Enzo gestured to the defibrillator and she followed his gaze.

“Not yet. He’s already banged up enough. Let’s give him one more chance to convert. Honestly, it’s not electrical, it’s the pressure in his chest. I doubt cardioversion would do any good for him unless his heart stops entirely.”

She rose on her knees and shouted toward the back of the medic, “Bring epi if you have it! Enzo, start the cuff again. I want the pressure before and after each draw.” With a fresh alcohol prep she swabbed the area where she’d just gone in, readying the chest for another puncture.

Long, torturous seconds passed and the other medic arrived. As soon as the pressure was displayed, she pushed through with the second needle.

Enzo watched another rush of bright red fill the tube. It looked thinner and more translucent than it had before. “It’s part serum, or he’s filling with more serum than blood now.”

“Good. The pressure might stop his heart still, but maybe it’s not an aortic dissection. Buys us some time.”

If it was only a small cut in the aorta rather than a hole through it, they had a chance of getting him stabilized and to the hospital before he crashed.

He concentrated on what he was hearing—the monitor couldn’t tell him how loud the heartbeats sounded so the stethoscope was still needed. It was easier to look at the monitor—or even the dark, eggplant-like bruise on the man’s chest—than at her worried face. He could tell from her complexion that she was normally a warm tan, but today she looked pale and fragile. Not a great look for a trauma surgeon. Even a trauma resident.

With the second round of pressure relief, the speed of the man’s heart slowly decreased and the rhythm began to convert to something closer to normal. First, a few normal beats amid the pre-ventricular contractions. Then louder. Then steadier.