Loe raamatut: «A Knight for Nurse Hart»

Chapter One

“RAINE! You’re here? Working Trauma again?” Sarah greeted her when she walked into the trauma bay fifteen minutes before the regular start of her shift.

Emergency nurse Raine Hart smiled at her co-worker. “Yes, I’m back. Working in the minor care area for a few weeks was a nice reprieve and a lot less stress. But I confess I’ve missed being a part of the action.”

“Well, we sure missed you, too. And I’m so glad you came in early,” Sarah said, quickly changing the subject from Raine’s four-week hiatus from Trauma to her own personal issues. “I have to leave right away to pick-up my son, he’s running a fever at the day care and there’s a new trauma coming in.” Sarah thrust the trauma pager into her hands as if it were a hot potato. “ETA is less than five minutes.”

“No problem.” Raine accepted the pager, feeling a tiny thrill of anticipation. She hadn’t been lying, she really had missed the excitement of working in the trauma bay. She scrolled through the most recent text message from the paramedic base. Thirty-year-old female with blunt trauma to the head with poor vital signs. Not good. “Sounds like it’s been busy.”

“Crazy busy,” Sarah agreed. “Like I said, we missed you. Sorry I have to run, but I’ll see you, tomorrow.”

“Bye, Sarah.” Raine clipped the pager to the waistband of her scrubs, and swept a glance over the room. It looked as if Sarah had everything ready to go for the next patient. She was secretly relieved to start off her first trauma shift with a new admission. She’d rather be busy—work was a welcome distraction from her personal problems. Raine was thankful her boss had kept her real reason for being away from Trauma a secret, telling her co-workers only that she’d been off sick, and then reassigned to Minor Care to work in a less stressful environment on doctor’s orders. After three weeks in Minor Care, she was more than ready for more intense nursing.

So here she was, back in the trauma bay. Raine took a deep breath and squared her shoulders, determined to keep the past buried deep, where it belonged.

She could do this, no problem.

“No sign of our trauma patient yet?” a low husky, familiar voice asked.

She sucked in a harsh breath and swung around to stare at Dr. Caleb Stewart in shocked surprise. According to the posted schedule, Brock Madison was supposed to be the emergency physician on duty in the trauma bay tonight. Obviously, he and Caleb must have switched shifts.

“Not yet.” Her mouth was sandpaper dry and she desperately searched for something to say. Caleb looked great. Better than great. Better than she’d remembered. But she hadn’t been prepared to face him. Not yet. She hadn’t seen him since they’d decided to take a break from their relationship just over a month ago.

She couldn’t ignore a sharp pang of regret. If only she’d tried harder to work things out. But she hadn’t.

And now it was too late.

Thankfully, before he could say anything more, the doors of the trauma bay burst open, announcing the arrival of their patient. Instantly, controlled chaos reigned.

“Becca Anderson, thirty years old, vitals dropping, BP 86 over 40, pulse tachy at 128,” the paramedic standing at the patient’s head announced. “Her GCS was only 5 in the field, so we intubated her. She probably needs fluids but we’ve been concerned about brain swelling, and didn’t want to make her head injury worse.”

Raine took her place on the left side of their trauma patient, quickly drawing the initial set of blood samples they’d need in order to care for Becca. Luckily, the rhythm of working in Trauma came back instantly, in spite of her four-week absence. Amy, one of the other nurses, came up on the right side to begin the initial assessment. One of the ED techs cut off the patient’s clothes to give them better access to any hidden injuries.

“Raine, as soon as you’re finished with those labs, we need to bump up her IV fluids and start a vasopresser, preferably norepinephrine,” Caleb ordered. “Shock can kill her as much as a head injury.”

“Left pupil is one millimeter larger than the right,” Amy informed them. “I can’t feel a major skull fracture, just some minor abrasions on the back of her scalp. It’s possible she has a closed cranial trauma.”

Raine’s stomach dropped at the news. Patients with closed cranial trauma had the worst prognosis. When the brain swelled there was no place for it to go, often resulting in brain death. And Becca was too young to die.

Suddenly, she was fiercely glad Caleb was the physician on duty. Despite their differences, she knew he’d work harder than anyone to make sure their patient survived. Determined to do her part, Raine took her fistful of blood tubes over to the tube system to send them directly to the laboratory. En route, she noticed two uniformed police officers were standing back, watching the resuscitation. It wasn’t unusual to have law enforcement presence with trauma patients, so she ignored them as she rushed back to increase their patient’s IV fluids and to start a norepinephrine drip.

“We need a CT scan of her head, stat. Any other signs of internal injuries?” Caleb demanded.

“Bruises on her upper arms,” Raine said, frowning at the dark purple spots that seemed to match the size and shape of fingertips. She hung the medication and set the pump to the appropriate rate as she talked. “Give me a minute and we’ll roll her over to check her back.” She finished the IV set-up and took a moment to double-check she’d done everything correctly.

“I’ll help.” Caleb stepped next to Raine, adding his strength to pulling the patient up and over onto her side, so Amy could assess the patient’s backside. Caleb was close, too close. She bit her lip, forcing herself not to overreact at the unexpected warmth when his arm brushed against hers.

Memories of the wonderful times together crashed through her mind and she firmly shoved them aside. Their relationship was over. She wasn’t the same person she’d been back then.

And they had a critically ill patient to care for.

“A few minor abrasions on her upper shoulders, nothing major,” Amy announced. Raine and Caleb gently rolled the patient onto her back.

“She’s the victim of a domestic dispute,” one of the police officers said, stepping forward. “Her husband slammed her head against the concrete driveway, according to witnesses.”

Dear God, how awful. A small-town girl at heart, Raine had moved to the big city of Milwaukee just two years ago after finishing college. But she still wasn’t used to some of the violent crime victims they inevitably cared for. She tried to wipe the brutal image from her mind.

“Raine?” Caleb’s voice pierced her dark thoughts. “Call Radiology and arrange for a CT scan.”

She nodded and hurried to the phone. Within minutes, she had Becca packed up and ready to go.

“I’m coming with you,” Caleb said, as she started pushing the cart towards the radiology suite next door. Thankfully the hospital had had the foresight to put the new radiology department right next to the emergency department. “I don’t like the way her heart rate is continuing to climb. Could be partially due to the norepinephrine, but it could also be her head injury getting worse.”

She couldn’t argue because Becca’s vital signs were not very stable. Usually the physicians only came along on what the nurses referred to as road trips, for the worstcase scenarios.

As Becca’s blood pressure dropped even further, Raine grimly acknowledged this was one of those times she would be glad to have physician support.

She was all too aware of Caleb’s presence as they wheeled the patient’s gurney into the radiology suite. There were unspoken questions in his eyes when he glanced at her, but he didn’t voice them. She understood—this was hardly the time or the place for them to talk about the mistakes they’d made in the past. About what might have been.

She kept her gaze focused on their patient and the heart monitor placed at the foot of her bed. They were only part way into the scan when Becca’s blood pressure dropped to practically nothing.

“Get her out of there,” Caleb demanded. The radiology tech hurried to shut down the scanner so they could pull the patient out from the scanner opening. “Crank up her norepinephrine drip.”

Raine was already pushing buttons on the IV pump. But then the pump began to alarm. She looked at the swollen area above the patient’s antecubital peripheral IV. “I think her IV is infiltrated.”

Caleb muttered a curse under his breath and grabbed a central line insertion set off the top of the crash cart the radiology tech had wisely brought in. “Then we’ll put a new central line in her right now.”

“Here?” the radiology tech asked incredulously.

Caleb ignored him. Raine understood—they couldn’t afford to lose another vein. A central line would be safer in the long run. Anticipating his needs, she quickly placed sterile drapes around the patient’s neck, preparing the insertion site as Caleb donned sterile gloves. Luck or possibly divine intervention was on his side when he hit the subclavian vein on the first try.

“Here’s the medication,” Raine said, handing over the end of the IV tubing she’d disconnected from the non-working IV.

The moment Caleb connected the tubing, she administered a small bolus to get the medication into her patient’s bloodstream quicker, since the woman’s blood pressure was still non-existent and her heart rate was dropping too. For a moment, Raine held her breath, but their patient responded well and her blood pressure soon returning to the 80s systolic. Caleb anchored the line with a suture and then quickly dressed the site.

But they weren’t out of the woods yet. Worried, she glanced at Caleb. “Should we complete the scan?” she asked.

He gave a curt nod, his expression grave. One of the things she liked best about Caleb was that he didn’t build a wall around himself to protect his emotions. He sincerely cared about his patients. “We have to. The neurosurgeons are going to need to see the films in order to decide whether or not to take her to surgery.”

The radiology tech didn’t look very happy at the prospect, but took his place to continue running the scan. Raine and Caleb together slid the patient back onto the exam table. She was startled when he took her arm, and instinctively pulled away. She winced when she realized what she’d done, knowing he’d done nothing to deserve her reaction. Her issues, not his.

His stormy gray eyes darkened with hurt confusion but she avoided the questioning look he shot her way. She felt bad about hurting him again, but at that moment her patient’s heart monitor alarmed so she was forced to go over to adjust the alarm limits. The ten-minute exam seemed excruciatingly long, but they finally finished the procedure.

Caleb didn’t say anything as they pushed the gurney back to the trauma bay. The moment they arrived, he crossed over to page the neurosurgeon to discuss the best course of action for their patient.

“Becca?” Raine glanced over at the shrill voice. She saw Amy bringing in a woman who looked to be a few years younger than their patient. “Oh, my God, Becca. What did he do to you?”

Raine had to turn away from the crying woman who clutched their patient’s hand.

“Her sister, Mari,” Amy said in a low tone. “I had to let her in because I’m betting Becca will be going to the OR ASAP.”

“Of course you did,” Raine said, but her voice sounded far away, as if she was speaking through a long tunnel. She’d wanted to be busy, but maybe she’d been overconfident. Maybe she wasn’t ready for the trauma room just yet. Maybe she should have stayed longer in the minor care area of the ED, where they didn’t deal with anything remotely serious.

Her eyes burned and she fought the need to cry right along with Mari. She turned away, to give them some privacy and to pull herself together. She went over to the computer to look up Becca’s most recent labs.

“Raine? Are you all right?” Caleb asked, coming up to the computer workstation.

“Of course.” She subtly loosened her grip on the edge of the desk and forced herself to meet his gaze, hoping he couldn’t tell how emotionally fragile she was. It was far too tempting to lean on Caleb’s strength. To confide in him. If things had been different…

But they weren’t. Reminding herself that she needed to find her own strength to work through her past, she waved a hand at the computer screen. “Did you see these latest results? Her electrolytes are way out of whack.”

He gave her an odd look, but then nodded. “Get her prepped for the OR. Dr. Lambert wants her up there ASAP.”

“Okay.” Raine abandoned her computer and jumped to her feet. She hurried over to Becca’s bedside and told Amy and Mari the news.

Within moments she and Amy transported Becca up to the OR, releasing her into the hands of the neurosurgeons. There was nothing else they could do for now but wait.

Raine tried to push Becca’s fate out of her mind since she and Caleb had done everything she could for the patient. But concentrating on her job wasn’t easy. Especially when she could feel Caleb’s gaze following her as she worked.

She could tell he wanted to talk. The very thought filled her with dread. She couldn’t talk to him now, no matter how much she wished she could.

It was too late. She’d missed her chance to take his calls weeks ago. Better now to focus her energy on moving forward rather than rehashing the past.

What she and Caleb had once shared was over.

“Dr. Stewart?” He glanced up when Raine called his name. “I think you’d better check Mrs. Ambruster’s chest X-ray. Her breathing has gotten dramatically worse.”

Caleb scowled at the formal way she addressed him. They’d dated for almost two months, had shared more than one passionate kiss. He knew it was his fault that she’d requested a break from their relationship but, still, hadn’t they moved well beyond the Dr. Stewart stage?

“Sure.” A surge of regret washed over him. Seeing Raine again made him realize he’d never gotten over her. Not completely. If only he’d handled things differently. If only he hadn’t been such an ass.

He’d heard she’d moved over to the minor care area because she’d needed a break from Trauma. He knew full well she’d really needed a break from him.

And he’d missed working with her, more than he’d wanted to acknowledge.

He gave himself a mental shake. This wasn’t the time or the place. He crossed over to the patient, who had come in with vague flu-like symptoms that he was beginning to suspect was something much more complicated. Using the closest computer terminal, he pulled up the patient’s chest X-ray. Raine was right, the patient’s breathing must be severely compromised as the X-ray looked far worse. He suspected the large shadow was a tumor and likely the cause of a massive infiltrate on the right side of her lungs, but she would need more of a work-up to be sure. “How much O2 do you have her on?”

“Six liters.”

He frowned. “Crank her up to ten liters per minute and prepare for a thoracentisis.”

Raine did as he asked, although he noticed she gave him a wide berth whenever he came too close.

He was troubled by the way Raine was acting. He regretted the way he’d overreacted that night and had tried to call her several times to apologize but she hadn’t returned his calls. Did she still blame him? Was it impossible for her to forgive him?

Seeing her tonight brought his old feelings back to the surface. Along with the same sexual awareness that had shimmered between them from the very first time they’d met.

But as much as that sensation was still there, something was off. He’d noticed right from the start of their shift how her usual enthusiasm was missing. Maybe it was just the seriousness of their domestic violence patient, but they’d shared tough shifts before. Somehow this was different, especially the way she seemed to avoid him whenever he came too close.

Maybe she was worried he’d ask her out again. And he had to admit, the thought had crossed his mind. More than once. Sure, he’d made a stupid mistake before, but didn’t he deserve a second chance?

Apparently, Raine wasn’t willing to grant him one.

He turned to their elderly patient, focusing on the procedure he needed to do. He put on a face mask and then donned sterile gown and gloves, while Raine prepped the patient. He lifted the needle and syringe in his hand and gently probed the space between the fourth and fifth ribs. He numbed the area with lidocaine and then picked up the longer needle used to aspirate the fluid. Slowly, he advanced the needle.

He hit the pocket of fluid and held the needle steady while the site drained. Once he’d taken off almost a liter of fluid, their patient’s oxygen saturation improved dramatically.

“Place a dressing over this site, would you?” he asked Raine. “And we need to send a sample of this fluid to Pathology.” Stepping back, he stripped off his sterile garb. Once she’d gotten the specimens sent to the lab and the patient cleaned up, he went back in to talk to the husband and wife.

“Mrs. Ambruster, I’m afraid your chest X-ray shows something abnormal and I believe whatever is going on is causing fluid to build up in your lungs.”

The elderly couple exchanged a look of dismay. “What is it? Cancer?” her husband asked.

Caleb didn’t want to lie but at the same time he didn’t honestly know for certain what the problem was. He was impressed by the mutual love and respect this elderly couple displayed toward each other, something missing from his own family life. He tried to sound positive. “That is one possibility but there are others that could be less serious. I’m not a thoracic surgeon, but I’d like to refer you to one. I can arrange for you to see someone first thing in the morning if you’re willing.”

The Ambrusters agreed and he made the arrangements with the thoracic surgery resident. By the time he wrote the discharge orders for Mrs. Ambruster, the oncoming shift had arrived.

He was free to go home. But he didn’t want to leave, not without talking to Raine.

He found her in the staff lounge, but stopped short when he realized she was crying. Immediately concerned, he rushed over. “Raine? What’s wrong?”

“Nothing.” She quickly swiped at her eyes, as if embarrassed by her display of emotion.

“Raine, please. Talk to me.” He couldn’t hide the desperate urgency in his voice.

There was a slight pause, and he found himself holding his breath when she finally brought her tortured gaze up to meet his. “Becca died. She never made it out of surgery.”

Caleb grimaced beneath a wave of guilt. Here he’d been worried about himself when Raine was grieving over their patient. “I’m sorry, Raine. I didn’t know.”

“Doesn’t matter. We did what we could.”

The despair in her tone tugged at his heart. He wanted to reach out to her, but knew he’d given up that privilege when he’d accused her of cheating on him.

He wanted to apologize. To explain he now knew he’d been wrong, but where to start?

“I have to go,” Raine muttered, swiping at her face and attempting to brush past him.

“Wait.” He reached out to grasp her arm. “Please don’t go. Let’s talk. About us. About where we went wrong.”

“There’s no point. What we had is over,” she whispered, wrenching from his grasp. The hint of dark desperation shadowing her eyes hit hard. She hesitated only for a moment, before ducking out of the room.

Shocked, he could only stare after her. Something was definitely wrong. This wasn’t just Raine wanting to take a break from their relationship. There was something more going on.

He’d screwed up before, but he wouldn’t give in so easily this time. He was determined to uncover the truth.