Алисон Робертс – At His Service: Her Boss the Hero: One Night With Her Boss / Her Very Special Boss / The Surgeon's Marriage Proposal (страница 13)

‘Have a listen,’ Tama invited, moving to make room for Mikki to crouch closer to their patient. ‘I’m going to check his belly.’

The injured part of the chest was on the left side. Low enough to make an internal injury to the spleen a distinct possibility, along with bleeding that could well be contributing to low blood pressure.

Josh was attempting to gain IV access and Tama’s hands were palpating John’s abdomen but Mikki focussed on what she was hearing with her stethoscope. Or not hearing.

‘Breath sounds well down on the left side,’ she reported. ‘And heart sounds are muffled.’

‘I can’t find a vein,’ Josh said. ‘You want to try, Tama?’

‘In a sec.’ Tama was holding Mikki’s gaze. ‘What are you thinking?’

There was respect in that gaze. A willingness to let her make decisions about treating a man who was critically injured. Mikki didn’t want control, however. She wanted teamwork.

‘Narrow pulse pressure,’ she said, instead of offering a diagnosis. ‘Tachycardia. His jugular veins are distended, see?’

Tama glanced at the bulging veins in John’s neck and nodded curtly. ‘Tamponade?’

Mikki tapped the chest wall. ‘Could be a tension pneumothorax. Or a combination of both.’

‘Chest decompression or a pericardiocentesis?’

Mikki touched John’s neck. ‘No tracheal deviation.’ Her gaze travelled to a face partially covered by an oxygen mask. ‘He’s going blue. What’s the oxygen saturation now?’

‘Ninety per cent.’

‘John? Can you hear me?’ Mikki rubbed his collar-bone. ‘Can you open your eyes?’

There was no response.

The farmer was in shock and deteriorating fast. If air was entering the chest outside the lungs because of trauma to the ribs, it could be compressing his heart and lung and would be fatal if that air wasn’t removed. If he was bleeding around his heart as a result of the crush injury, that vital organ would cease to function and he would die very quickly.

‘What would you do first?’ she asked Tama.

‘Your call,’ he responded quietly. He wasn’t testing her. She could see that he was weighing up exactly the same considerations she was. If one procedure didn’t help, they would have to try another anyway. What was paramount was making a decision and getting on with it.

‘Pericardiocentesis,’ Mikki decided swiftly. ‘Followed by a chest decompression if it’s needed.’

‘You happy to do it?’

Mikki nodded. ‘I’d like a monitor on.’

There was a narrow space around the heart where blood could create enough pressure to stop it functioning. A space that was easy to miss with the point of a needle. Not going far enough would mean not removing the blood. Going too far would mean pushing a needle into cardiac tissue and potentially creating further complications.

Tama put the leads of the monitor on. Josh pulled out the kit she needed. Mikki put on a fresh pair on gloves and didn’t allow her thoughts to go anywhere near the idea of failure, even though this was technically a lot more difficult than an intubation.

‘Keep an eye on the trace, please,’ she asked Tama. ‘I’m going in slowly and I want to know if you see any changes in rhythm.’

Their patient was unconscious. He didn’t feel the needle entering his chest just under his breastbone. Mikki angled the needle at forty-five degrees, aiming for the left shoulder blade. She pulled back on the plunger as she kept advancing the needle.

‘Ectopic,’ Tama warned, his voice very close behind her. ‘Ventricular.’

Mikki slowed. She was close. She pulled back on the plunger as she kept advancing the needle, a millimetre at a time.

‘Bingo,’ she said softly, seconds later. It was easy to draw back the plunger now. The syringe filled with blood. ‘Twenty mils should be enough to make a difference if the tamponade’s the main culprit.’

They all watched for a minute to see John’s respiratory efforts improving and his blood pressure creeping up.

Another minute and he began to regain consciousness. Less than five minutes later they had intravenous access established, fluids running and their patient stable enough to transport. The short flight to the hospital was a busy time of reassessment, monitoring and further treatment and it wasn’t until well after the handover to emergency department staff that Mikki discovered how impressed her colleagues were.

‘He would’ve died if you hadn’t been there,’ Josh told her. ‘That was awesome, Mikki Mouse.’

‘It’s an effective procedure when it’s needed.’ Mikki tried to sound modest. ‘But it’s not that different to a chest decompression for pneumothorax. I’m surprised you don’t have it in your procedures.’

‘It’s coming in.’ Tama’s voice had a curiously rough edge as though the words were hard to get out. ‘I wouldn’t mind getting a head start on it, though.’

‘I’ll run through it with you on a manikin any time you like.’

‘Cool.’

Josh wanted to discuss the case as they flew back to base. To go over the signs and symptoms and talk more about the lifesaving procedure, but Tama was curiously quiet. Mikki caught him watching her with an oddly assessing gaze.

Had she passed muster this time, perhaps?

She got the impression she had and the sheer joy that gave her was startling enough to make her want to sit quietly and savour it. She let Josh continue talking and just made the right noises when needed. Even after they landed and climbed out of the helicopter, Josh was still talking.

‘Man, I’m starving,’ he announced. ‘Did we have lunch?’ He didn’t wait for Tama’s response. ‘So long ago it doesn’t count, anyway. I’m going to make a mountain of toast.’

He set off towards the messroom.

Steve was still busy shutting down the helicopter.

Mikki was suddenly alone in the hangar with Tama and, without looking, she knew he was staring at her.

She ducked her head. ‘I’m pretty hungry myself. I’ll go and help Josh with that toast.’

‘No.’ The single word stopped her in her tracks. ‘Wait a sec. I … want to talk to you.’

Mikki turned. That odd note was in his voice again. As though he was saying something he would rather not be saying but felt compelled to.

There was certainly something compelling about his gaze. Mikki couldn’t look away.

Tama looked as though he was seeing her for the first time.

She could see respect.

Acceptance.

And something more.

Something that made her toes curl and her blood tingle.

It was Tama who broke the eye contact. Slowly. Deliberately. He cleared his throat and stared fixedly above her head. Mikki didn’t follow his line of vision. She wanted to watch his face when he said whatever was important enough to make him look like this.

‘I know you’re keen,’ he said gruffly. ‘But I have to be seen to be careful about following the rules, you know?’

Keen? Mikki focussed on Tama’s face, her mind one step ahead of him.

Dear Lord, he’d noticed the way she’d been watching him. The attraction wasn’t mutual, as she’d thought, and he was about to tell her he couldn’t teach someone who fancied him.

‘But I’ve changed my mind,’ Tama continued. ‘If you really are that keen, we can … you know … do something about it. The boss doesn’t need to find out.’

The flush of colour entering Mikki’s cheeks got rapidly hotter. Was he offering her sex?

‘How ‘bout it?’ Tama finally looked down and caught her transfixed gaze.

‘Ah …’ Mikki couldn’t think of a thing to say. Talk about direct! ‘Yes, please’ might be equally direct and honest, but it lacked a certain something.

Tama lowered his voice to a sexy rumble. ‘You want to, don’t you?’

Oh … help! There was no denying that. And Tama was doing that thing with his lips again. That quirky half-smile that went with the twinkle Mikki was coming to recognise. Pure mischief. She sucked in a breath.

‘I guess I could …’

Her hesitation was all too plain.

‘I know it’s more than a bit out of order. Way too soon and all that, but you know what?’ The twinkle gained intensity. ‘I reckon you’ll do OK.’

Mikki’s jaw dropped. ‘Oh …’ Maybe she hadn’t measured up as well as she’d imagined.