According to witnesses, a truck had made a right turn and his wing mirror had knocked the cyclist from his bike. The lorry driver was shocked but unharmed. When it came to a battle between a ten-ton truck and a push bike there was only ever one winner.
The cyclist was already wired to the monitors. His pulse was slow and his breathing shallow. She opened an eyelid and shone her torch. The pupil of the left eye did as it was supposed to, but the other was blown.
Very gently she removed his helmet, noting the blood stains on the back. Quickly she palpated along the skull until she found what she was looking for—a depression a couple of inches above the neck. Unconscious, skull fracture, unequal pupils—it all added up. He must have a haematoma causing compression of the brain stem.
‘I need a consult from Neuro,’ she said briskly. But, as always, the nurse had anticipated her order and was already on the phone.
‘They’re just finishing in Theatre. Someone will be here as soon as they can.’
‘Tell them I need them here, stat,’ Olivia said. Her patient had to have the pressure in his head relieved, and as soon as possible. With every second that passed his brain was swelling, pushing against the rigid bones of the skull.
‘I’ve found some ID,’ one of the nurses called out. ‘Your patient’s name is Mark Lightbody. He’s thirty-three. There’s also a number for his wife. I’ll give her a call and tell her to come.’
Olivia nodded. Poor Mrs Lightbody was about to have her day—possibly her life—ruined.
Mark was unconscious, and although he was still breathing unaided, she had to intubate him to secure his airway and maintain his oxygen levels. The measures she’d taken would keep him stable for a while, but surgery was the only way to relieve the growing pressure on his brain. She glanced at the clock on the wall. Five minutes had passed since Kelly had phoned. Where the hell was the neurosurgeon?
Just when she was about to insist that Kelly phone again, the swing doors burst open and Dr Stuart strode in. She’d only seen him in passing since that first day and she was dismayed to note that her already escalated pulse upped another notch.
‘What do you have for me?’ he asked her as Candice stepped forward with a disposable gown.
‘Mark Lightbody. Cyclist with an occipital skull fracture. GCS six. Right pupil fixed and dilated. Left pupil responding normally. Apart from the injury to his head, he has only minor cuts and lacerations. He needs emergency surgery to relieve the pressure on his brain.’
David grinned. ‘Doesn’t the attending—as in me—usually make that decision?’
As he was talking he was examining Mark. ‘But I have to agree. Unfortunately the theatre is still being scrubbed after our last case. It will take at least ten minutes to get another ready. He needs a craniotomy, so we’ll have to do it here.’
‘Here?’ Olivia echoed.
‘No reason why not. I assume you have a tray set up for that purpose?’
‘Yes, but shouldn’t we wait to get him to the OR?’
‘It will take time to get him to the OR. Time he doesn’t have—not unless we want to risk him dying or ending up severely brain damaged. In my opinion, doing a craniotomy here and now is his best chance. Now, we can waste more time by arguing, in which case I suggest you step out and attend to other patients, or we can get on with the procedure.’
Olivia felt the blood rush to her cheeks. She hadn’t been objecting to carrying out the procedure, just querying whether it would be better to wait until they’d taken him to Theatre. However, every minute they wasted arguing was time Mark didn’t have. She bit back the sharp retort that had risen to her lips and nodded. ‘I’ll stay and assist.’
The insufferable arrogance of the man. However, she wasn’t about to rise to the bait.
‘In fact,’ he said, ‘why don’t you do it while I assist?’
Olivia felt a frisson of excitement. She always grabbed any opportunity to acquire additional skills. His confidence in her was flattering and his aura of self-confidence immensely reassuring. Not all the attendings were prepared to teach the ER residents. ‘Thanks. I’d like to,’ she replied.
She scrubbed while Kelly set up the tray and one of the other nurses shaved Mark’s blood-matted hair and prepped the surgical field.
‘Good. I’ll show you how to get started then you can take over.’
David made a wide incision in the scalp below the dent in Mark’s head and peeled back the skin to expose an obvious depressed fracture of the skull. ‘This is the interesting bit. Take these elevators …’ he handed her two ‘… and lift the bone fragments up out of the way.’
Everyone seemed to hold their breath as Olivia did as David asked.
As soon as she’d lifted the shattered bone out of the way, a fat red blood clot bulged out towards her. Slowly and very carefully she removed the clotted blood and a satisfied glow spread through her as Mark’s vitals immediately improved.
She grinned at David. When he smiled back something seemed to tilt inside her chest, making her catch her breath. She dipped her head and concentrated on replacing the bone.
‘Good job, Dr Simpson. I’ll get him into the OR, patch up the skull fracture properly and repair the scalp incision.’
David peeled off his plastic apron and dropped it in the bin. The two ER nurses who were standing by exchanged smiles.
‘Could we get him up to the OR pronto?’ David asked. He removed his protective goggles and winked—winked!—at one of the nurses, who blushed furiously.
‘Thank you, Doctor,’ Olivia said stiffly. ‘We’ll get that organised.’
David indicated with a nod of his head that she accompany him outside. Olivia went with him, knowing if she didn’t he was likely to have his say in front of the staff.
But to her amazement he didn’t launch into an attack. ‘I meant what I said back there. Good work,’ he said. ‘You have the steady, delicate touch of a surgeon.’
Instinctively Olivia looked down at her hands. Did he guess that at one time she’d thought of being a surgeon? But that had been before Richard had become ill. Then the long hours and years the training would have required had been out of the question. She’d never regretted the decision, and when Richard had gone into remission and they’d decided to grab the chance to have a family, her dream of becoming a surgeon had faded into second place. The hours she’d worked in the ER had been long and hard enough as it was.
‘I wasn’t trying to argue with you earlier,’ she said quietly. ‘I was only wondering whether it would be better for our patient to wait until we got him to ER.’
His grin grew wider. ‘Hey, think nothing of it.’ He winked again, then his smile vanished and he lowered his voice. ‘Despite anything you might have heard about me, or will hear, I’m a bloody good surgeon. It is the one thing I take seriously. I expect we will brush up against each other in ER pretty often, so it is as well that you know.’
Brush up against each other! To her mortification an image of them brushing up against each other flashed into her mind. And it didn’t have anything to do with being in the emergency room. The blood rushed to her cheeks. Good God, did every pregnant woman’s brain turn to mush like this? Or was there something wrong with her?
‘I don’t intend to tussle with you every time we disagree about how to treat a patient,’ David continued. ‘Just as I won’t argue with you when you make an ER decision.’ He shot her a quizzical look but his eyes were glinting. ‘Hey, is it warm in here or what?’
‘They always keep the ER too warm,’ she said as nonchalantly as she could.
Candice came