New Surgeon at Ashvale A&E (9 page)

She frowned. ‘I would hate for things to go wrong here just because I’m in charge, but I’m a novice at all this. I love being here, but it takes some getting used to, making sure that I follow all the feeding and grooming routines. Gran wrote me out a schedule, but there’s a lot of ground to cover, and only so many hours in the day. I suppose it could be that my timing is off, and that’s why Candy is ill. It’s probably the reason the ducks are losing their feathers too.’

Perhaps it was her sorrowful tone that diverted his attention
from the pony. His gaze shifted over her, warmth shimmering in the depths of his blue-grey eyes. ‘You shouldn’t blame yourself. I’m sure you’re doing the very best you can.’ He reached for her, lightly stroking her arms in a gesture of sympathy. ‘It can’t be easy for you with young Becky taking up so much of your time.’

‘Yes, well, none of us had counted on that.’ She was very conscious of those hands circling her arms. She felt the warmth of his fingers on her bare skin, and her whole body was beginning to stir in response to that gentle touch.

‘Isn’t there anyone else who could help out—your parents, perhaps?’

She nodded. ‘They’ve been doing as much as they can. They’re both working, but they come over every day to take over for a while and give me a bit of a break. It’s the only way I can find the time to write my magazine articles or fit in the Internet work.’

He shook his head in wonder. ‘You’re a truly amazing woman, Ruby.’ His mouth curved, lightening his features in a way that made her heart begin to thump in an erratic rhythm. ‘I knew you were special when I saw how well you handled things at the meeting on that first day we met. You stuck to your guns and had no intention of backing down, even with a roomful of people looking on. I knew then that you were up for a challenge, and when I saw you at work in A&E, it only confirmed it for me. You have a way of meeting situations head on, without letting the pressure get to you.’ He frowned. ‘That’s why I couldn’t understand you giving up on us at the hospital.’

‘I didn’t give up on you. I just couldn’t see how I could do right by my family and give the whole of my attention to my work as well. Something had to give, and it turned out that it was my responsibility to A&E that had to fall by the wayside. I’m only one person, and I don’t believe I’m indispensable.’

His mouth flattened. ‘I don’t agree with that. You have a unique way of motivating everyone at work. They all miss you.’

She gave a soft sigh. ‘I’m sorry about that. But the fact of the matter is, you’d already decided that you could lay off staff and still make a go of it, whereas I wasn’t so sure I could work under those conditions.’ He was stirring up emotions in her that she would rather lie dormant: restlessness, guilt and a faint sorrow for what she had abandoned. She was torn by all the demands being made on her. There was frustration, too, a sense of helplessness, of not knowing how to do things differently, that made her want to turn away from him and avoid his censure.

He wouldn’t let her turn away, though. Instead, he drew her closer to him, so that she had no choice but to listen to what he had to say. She was all too aware of the warmth emanating from him, of the sheer male energy and drive that gave him an inherent authority over everyone who happened to come within his orbit. ‘That’s just it, Ruby,’ he murmured. ‘I’m discovering every day exactly how much the department needs you at its helm. I can only do so much, but with you on my team we can work wonders.’

‘It isn’t possible,’ she said. ‘I’ve made my choice.’

‘And if your sister was to come back within a day or so, how will things be then? You’ll have given up everything…and for what? A few weeks of being able to cuddle your niece and commune with nature? I don’t believe that’s a strong enough reason to give it all up, Ruby.’

‘It’s more than that. It’s peace of mind, taking the chance to opt out from the mindless whirl of administrative solutions that make no sense.’ She was finding it hard to think straight while he was holding her this way. His hands were slowly smoothing over the silk of her skin, as though he would mesmerise her and coax her into accepting what he had to say.

‘You’re confused, emotionally torn, and I think that means
you aren’t thinking rationally. I don’t believe you really want to give up everything you’ve worked so hard to gain.’ He studied her closely, his gaze meshing with hers. ‘If I were to offer you a solution to all your troubles, would you consider coming back to the hospital?’

She blinked in shock. ‘What solution could there possibly be?’ She was startled enough by his suggestion that she moved away from the paddock fence and began to walk slowly along the footpath towards the duck pond. He went with her, not letting go of her, but sliding his arm around her shoulders in a warm embrace.

‘I could arrange for a couple of the workers from the family estate to come down here and take care of the animals and tend to the plants during the day time. My maintenance man could come and look at your roof problem and fix your central heating for you. That would take a huge weight off your mind, wouldn’t it?’

She made a vaguely dismissive movement. ‘That’s very kind of you to offer, but if I could afford to pay outside workers, I would have done it already. I’m just not that well off.’

‘You won’t have to pay them. I’m loaning them to you in return for your help at the hospital. We have a team of people with various skills on the estate, and I’m sure we can spare a couple to come over here to work for a while. Besides, it wouldn’t necessarily need to be full time, would it?’ He studied her closely, seeing the debate going on in her mind. ‘And I’m pretty sure that the matron in charge would be able to find room for Becky to stay in the crèche while you’re at work. Failing that, we could always take a look at the private nurseries.’

She raised a dark brow. ‘And what about the fact that I like looking after Becky? Where does that come into your calculations?’

He had the grace to look uncomfortable at that, but he
gave it some deeper consideration. ‘What about coming back to work part-time?’ he suggested after a while. ‘With a view to increasing the hours if it suited you?’

They had reached the duck pond by now, and Ruby stopped to look over at the ducks, who were skimming the surface of the water, dipping their beaks into the pond every now and again to capture a tasty morsel.

‘See, their wings are drooping,’ she murmured, pointing out a couple of birds that swam close to the reeds surrounding the pond. ‘They don’t look right to me. How will your workers know if something’s wrong?’

‘Because they’re good at what they do, otherwise I wouldn’t be employing them—and you’re changing the subject,’ Sam admonished her. ‘The vet will sort out the livestock’s problems, won’t he? I need you to concentrate on how much happier you’ll be when you’re back in A&E where you belong.’

She smiled at that and swivelled around to face him. ‘You’re so sure that’s the right thing to do, aren’t you? Well, you needn’t think it’s going to be as easy as that to get me to accept what you say. I wouldn’t even consider coming back unless it was on my terms.’

Now he looked less sure of himself. ‘And those would be?’

‘For a start you would have to agree to set on some more nurses. I’m not talking agency nurses, who can be expensive, I grant you. I mean speculate to accumulate, and give us extra staff so that we can cover all eventualities.’

He began to shake his head. ‘I’m not sure that’s possible. Management would probably object.’

‘You are management,’ she said. ‘You’re on the board, for heaven’s sake. You can fix it.’

He moved his head in a ‘maybe’ sort of way. ‘Is that it?’ he asked. ‘If I sort that out, would you consider coming back?’

‘Certainly not.’ She warmed to her theme. ‘If I were to do
that, and I’m making no promises, I’d need your agreement that we would work together to make sure the unit had a good chance of survival…and I mean work together, not just you paying lip service to what I have to say. I had a notion that it would be a good idea to organise a charity fair to raise funds…and we would definitely have to do away with some of the more expensive outsourcing contracts. Bring more of the contractors into the employ of the hospital rather than using outsiders.’

‘It sounds as though you’re at least giving the idea some thought.’

‘I’m giving it a fair consideration.’

He gave her a rueful smile. ‘I’d almost go so far as to say you had a ready-made bargaining stance hidden up your sleeve. I wouldn’t put it past you to have planned all this right from the start.’

‘Now you’ve cut me to the quick.’ She gave him what should have been an indignant frown, but she struggled to keep it up for very long. ‘I’m hurt that you think I could be so devious.’

‘I wouldn’t want you to be hurt in any way,’ he murmured, moving closer. ‘I already feel bad that I took the job you wanted. Perhaps I should try to kiss you better,’ he added softly, leaning towards her and allowing his lips to brush hers as though testing for a reaction.

She was too stunned by his actions to have time to put up any kind of resistance, and perhaps he read her lack of response as acquiescence because in the next moment he moved in on her, drawing her close and wrapping his arms around her. Then he kissed her firmly on her mouth.

It was a warm and vibrant experience, one that unexpectedly thrilled her to the core. She felt the aftershock of that kiss tingle along her nerve endings, sending small spirals of sweet sensation as far as her extremities, so that her pulses throbbed and her toes curled in delicious expectation.

It was a wonderful feeling being gathered up into his arms and soundly kissed, even as it was totally astonishing, and her whole body responded by going into complete meltdown. His kiss simply took her breath away.

Slowly, reluctantly, he dragged his mouth from hers, and she stared up at him in bemused wonder, her head reeling with a myriad of questions.

‘Is something wrong?’ he asked, looking down into her eyes and seeing her dazed expression.

‘I…uh…I’m not exactly sure,’ she murmured. ‘What was that all about?’

His mouth made a rueful twist. ‘It seemed like a good idea at the time,’ he said. ‘Have I blown my chances?’

‘Chances of what?’ she asked.

‘That you’ll come back to A&E.’

‘Ah,’ she said on a wavering sigh. ‘A&E, of course.’ Actually, she reflected, that was probably the best place for her right now because somehow her rational mind seemed to have detached itself from the rest of her body and was off floating somewhere in the ether. Was it going to be possible to put her back together again? ‘I’ll have to get back to you on that one.’

He frowned, shooting her a quizzical glance.

For her part, she decided it was just as well that he had let go of her because only then with some small space between them was she able to start functioning properly again. And her senses were telling her that they were no longer alone.

She glanced towards the farmhouse and saw that Craig, the vet, was coming into view, calling her name as he stepped onto the terrace at the back of the house.

‘Over here,’ she said, lifting a hand in acknowledgement. ‘I’m over by the pond.’

Craig started towards her. Long and lanky, with dark hair and grey eyes, he had been a friend for as long as she could remember.

She sent Sam an oblique glance. ‘I need to explain to him what’s going on with the animals.’

Sam nodded. ‘I’ll leave you to it, then. Will you think about what I said?’

‘I will.’

‘Good. I’ll be in touch in the next day or so if that’s okay?’

‘Okay.’ By now Craig had reached them, but before she had time to make the introductions, the young vet had gathered her up in his arms and was hugging her fiercely. She was vaguely aware of Sam looking on with a frown.

‘It’s good to meet up with you again, Ruby,’ Craig said. ‘We don’t get to see enough of you these days.’ He drew back a little and looked into her eyes. ‘I know how busy you are. Sophie’s always telling me how hard you work.’ Then he frowned. ‘It’s a real worry that she’s disappeared, isn’t it? You must let me help you in any way I can. Anything I can do, you know I’m here for you.’ He draped an arm around her shoulders and turned to look expectantly at Sam.

For some reason, Sam’s frown had deepened as he looked Craig over, and Ruby hastened to introduce the two men. ‘Sam’s taken over the A&E department,’ she told the vet. ‘He has to try to lick it into shape or risk it closing.’

Craig winced. ‘I don’t envy you that task,’ he said, nodding towards Sam. He lightly squeezed Ruby’s shoulder. ‘I know how hard Ruby worked to keep things together for as long as she did. Her boss was retiring, so he didn’t have too much of an input in that direction towards the end.’

Sam nodded. ‘Everybody sings her praises.’ He glanced towards her. ‘I should go,’ he said. ‘I’ll call you.’ He inclined his head briefly towards both of them and then began to walk away, his long stride covering the ground in quick time.

Ruby sensed he was troubled, but whether that was because of the vet’s arrival or because of her unwillingness to give him an answer to the work situation, she didn’t know.

‘W
E’RE
not collecting so many eggs these days,’ Ruby said, scattering a handful of grain on the rough ground where the hens were pecking for food. ‘Gran says it’s because the hens are getting on a bit.’

‘That may be so, or it could be that you need to introduce new breeds to the farm.’ Craig glanced around, watching the hens as they scratched in the dirt and hunted for food amongst the stones in the yard. It had been a few days since Ruby had first called him out, but now Craig was back on the smallholding to see if the animals were doing any better.

‘Rhode Island Reds are not always the best choice for egg production these days,’ he told her. ‘You could try introducing other breeds, like Welsumer or Marans if you prefer brown eggs…Leghorns if you want white eggs.’

‘Hmm. I’ll give it some thought. It might actually be down to me to make the decision in the end because my grandparents are thinking of giving up the smallholding for good. They’ve found a lovely little retreat on the coast, and they offered me the chance to buy this place at a more than reasonable price, rather than let it go to strangers. I must say, I’m seriously tempted.’

Craig grinned. ‘You’re getting used to this way of life, aren’t you? I could see it happening, even years ago when you came
over here to visit in the summer holidays or whenever you had a weekend free. You’ve always loved the rural atmosphere, haven’t you? It occurred to me that you had a dilemma years ago between choosing medicine or opting for life on the farm.’

‘Well, medicine won in the end, didn’t it? I suppose I thought saving lives would be more satisfying in the long run.’

‘True. I wonder if you’d still be at the hospital if your new boss hadn’t come along? He’s not exactly a people person, is he? Strange that, in a doctor…but, then, I heard the odd snippet about him when I was at university. He comes from a boarding school background, by all accounts. His parents spent most of their time abroad, while he and his brother were looked after by relatives for a good part of the holidays. It doesn’t really make for an all-round happy, integrated soul, that kind of upbringing, does it?’

Ruby frowned, thinking about that. ‘No, possibly not. Are you saying that he studied at the same university as you?’

‘Only for a short time. I just heard of him in passing, so to speak. He was the top student of his year. His family’s fabulously wealthy—old money, and all that, going back through generation after generation.’

‘I see.’ Her brows lifted briefly in acknowledgement. ‘That explains the country estate, I suppose.’ She quickly shrugged off thoughts of Sam’s origins. Thinking about him only reminded her of the way he’d kissed her, and that only served to make her unsettled and added to her indecision. It had been totally unexpected, given the kind of man he was.

‘It’s only now that Sophie has taken off that I’ve had a chance to rethink my options,’ she said. ‘Before she went, I was torn about what to do for the best, but now this whole way of life is beginning to grow on me once again.’

Despite the fact that Sam had offered her the chance to go back to work in A&E, Ruby had still not made up her mind what she ought to do. Becky took up a great deal of her time,
and until the situation with Sophie was brought to a satisfactory conclusion, she simply couldn’t settle to anything else. She was worried about what was happening to her sister, and each day Sophie stayed away her fears for her safety intensified. She’d told Sam she needed more time, and he’d had no choice but to accept that.

‘I think you’re a natural farmer,’ Craig said, smiling. ‘You sensed that something was wrong with the animals and took steps to put it right. It was only a question of changing the food mix and generally making them feel comfortable after their routine was changed, and things seem to be getting back to normal once more. Candy’s looking his usual self again, and the ducks are none the worse for wear. They sometimes drop their feathers because they’re getting too much protein in their diet, but we’ve done what we can to put that right. I’m sure everything will be fine before too long.’

‘You’re an eternal optimist,’ Ruby said. ‘You always were inclined that way.’

‘Better that than the opposite,’ Craig murmured. ‘I like to think that Sophie will come back into our lives at any moment. Anything else is too worrying to contemplate.’

‘Yes, you’re right, though she did send me a brief text message, so I know that nothing terrible has happened to her. I just wish I knew where she was, so that I could go and bring her home.’

‘At least you know she must be reasonably safe,’ Craig commented. ‘Did she give any clue as to what was wrong?’

Ruby shook her head. ‘All she said was that she’s sorry she had to leave and that she’s missing Becky. I had the impression she felt she wasn’t able to look after her properly because she was unwell. It’s all so unsettling. It could be that she’s going through a bad case of postnatal depression, but I tend to think there’s more to it than that. I sent a message in return, begging her to come home, but there’s been nothing since.’

She finished feeding the animals and then walked back with him towards the house. Becky was spending the day with her parents, which left her free for a while, and gave her a chance to catch her breath. These last few weeks it had felt as if her world was spinning out of control and she had been powerless to stop it.

‘I’d better go on with my house calls,’ Craig said, pausing to give her a goodbye hug. ‘Keep your chin up. You’re not on your own in this. Remember, I’m just a phone call away…and if you hear anything more of Sophie, let me know, won’t you?’

‘I will. Thanks, Craig.’ She saw him out and then went back to the kitchen, where she looked around and contemplated the stack of chores that still needed to be done. She switched on the radio before setting about loading the washing machine, and the sound of a haunting melody filled the room. Somehow, it made her think of Sam, and perhaps that was because there was a brooding quality to the music, a restrained theme that reminded her of the way he held his thoughts close to his chest. It must have taken a lot for him to seek her out and ask her to come back. He wasn’t the sort of man who would be comfortable showing any sign of vulnerability.

Some half an hour later, she was putting the finishing touches to her weekly magazine feature when snatches of the local news bulletin filtered through to her from the radio. ‘Ambulances are being called out to a major accident on the motorway. It is feared that there are many casualties as a result of the incident, which occurred when a lorry collided with a camper van and crossed the central reservation. It is believed that several people are still trapped in their vehicles. Local hospitals have been put on standby.’

Ruby stopped what she was doing and felt a cold shiver run through her. This was bad. An accident of that kind meant that all the emergency units would be under pressure, and lives
were at risk. How could she sit here and do nothing? It was unthinkable.

A few minutes later, after a brief phone conversation with the triage nurse on duty, she was on her way to the hospital.

‘Ruby, thank heavens you’re here,’ Olivia greeted her. ‘You don’t know how much we’ve missed you. It’s so good to have you back—though I wish it could have been under different circumstances.’ The senior house officer was dressed in green scrubs, ready to receive the first of the casualties as they came in by ambulance.

Ruby nodded. ‘Me too. I wish it didn’t have to be this way, but I suppose things will never change. We’ll always be needed here. I’ll go and get ready.’

She changed in the locker room, emerging just as Sam was passing by on his way towards the ambulance bay.

‘Hi there,’ he said with a smile, lightly touching her arm and sending a surge of instant heat racing through her veins. ‘It’s great to have you here. Is Becky in the creche?’

‘No. She’s with my parents for the day. When I heard the news of the accident, it was a question of whether to finish off my magazine article, gather in the last of the crop of raspberries…or come here. Not much of a choice, really.’

He smiled. ‘It was a good decision. We’re expecting at least a dozen injured people to arrive, including a young child—a five-year-old who was in the back seat of his parents’ car. Would you take care of the boy? As far as we know, he suffered a chest trauma. He’s still conscious, but he’s complaining of chest pain, and he’s having difficulty breathing and talking. There’s a swelling in his throat, according to the paramedic who phoned in a report. His mother has shoulder and leg fractures, while the father has multiple injuries. James and I will supervise their treatment in the same resus room as the boy. There’s also a little girl, two years old…but she came out of it unscathed, apparently.’

‘That was something of a miracle, given what I’ve heard about the pile up,’ she murmured. ‘Of course I’ll take care of the boy.’

‘Good. Let’s go, then. They should be arriving at any minute now.’

The boy was in a very bad way, she discovered, when the paramedics wheeled him into A&E a short time later. He was already turning blue from lack of oxygen, his breathing was noisy and laboured, and he was making moaning sounds.

‘I’m going to intubate him,’ Ruby told Michelle, who came to assist her. ‘As soon as I have the tube in place in his throat, and we have him back on oxygen, we’ll get a chest X-ray.’

She worked swiftly, securing the child’s airway and examining him thoroughly to ensure that she missed nothing.

‘Jason—my son—how is he?’ his mother asked from the next bed. ‘He couldn’t breathe properly. He wasn’t talking. What’s happening to him?’ The woman was in a lot of pain, but her thoughts were centred on her child and her husband. Beside her, still in her baby car seat, her two-year-old daughter was screaming loudly as a doctor tried to examine her.

‘We’re looking after him,’ Ruby told her. ‘I’m going to put a tube in his arm so that we can replace any fluids that he’s losing. Be reassured that we’re doing everything we can for him.’

She was desperately worried about this boy, who was failing fast, but nothing would be served by causing his mother more anxiety. She suspected that his condition was worsening because of internal bleeding, but the problem was in finding where the blood loss was coming from. As it was, his heart rate was sky high, his peripheral pulse was weak, and his breathing difficulties were increasing by the minute.

Michelle wheeled the portable X-ray machine into place, and Ruby checked the images on screen. ‘There’s a contusion to his lung,’ she told the nurse, ‘and air has leaked out from
both lungs into the chest cavity. I’ll put in drainage tubes to see if that will clear the problem.’

As soon as that was done, she left the boy in Michelle’s care, under intense observation, and went to assist with the rest of the injured.

Sam was still working with the boy’s father, and now he called for a trauma team to assist as the man went into cardiac arrest. His patient’s injuries were severe, but up to now Sam had managed to deal with the various fractures he’d presented with, and he had done what he could to stop the bleeding. Now, though, the man’s heart had given out under the strain.

Sam remained calm and efficient the whole time, doing his utmost to save the man’s life, and using the defibrillator to shock his heart back into a normal rhythm. It didn’t work.

‘Asystole,’ James said, checking the monitor, and Ruby was dismayed to see the flat line across the screen that showed no output from the heart.

The team was deflated. All their efforts were for nothing, and this man, who had a young wife and children, was unlikely to survive.

‘Continue with the chest compressions,’ Sam said tersely. ‘Ruby, intubate him and put him on the ventilator. Olivia, we’ll give him intravenous adrenaline. Check the monitor every two minutes. I need to figure out if he’s bleeding internally.’

‘An abdominal bleed?’ Ruby asked, and he nodded.

‘That’s the most likely cause of his problems.’

They worked with him for the next few minutes, and then, just as they were beginning to think all was lost, the monitor bleeped. ‘We have a rhythm,’ Olivia said. ‘He’s back.’

There were smiles of relief all round, but Sam was on the move. ‘I’m going to do an ultrasound scan of the abdomen to see if I can find the source of the bleeding. With any luck I can use an endoscope to seal the leaking blood vessel.’

Ruby would have liked to stay and help with that, but
Michelle came hurrying towards her from across the room. ‘You need to take a look at little Jason. His vital signs are worsening.’ Her expression was concerned, and Ruby realised that the situation was urgent.

‘All right, let’s get a CT scan,’ Ruby said after examining the child once more. ‘It’s possible that he has a ruptured bronchus and that he’s bleeding into his airways. We need to find out for sure.’

‘That’s very rare, isn’t it—a rupture to the main branch of the airway?’ Michelle frowned.

‘Yes, it is, but it’s something we need to check, all the same.’

Sam glanced at her. ‘Are you going to be okay dealing with that?’ he asked, and she nodded.

‘If I have any problems, I’ll call you,’ she said, though he looked as if he had enough on his hands right now.

The CT scan confirmed her worst fears. ‘We need to get him up to theatre,’ she told Michelle. ‘I’ll do a thoracotomy—open up his chest and stop the bleeding that way, otherwise he has little or no chance of survival. You’ll need to scrub in…and find me an anaesthetist, will you?’

A little more than an hour later, Ruby came out of the operating room, tossed her protective overgarments into the bin, cleaned up and went into the annexe. She was suddenly bone weary, the last of her adrenaline draining out of her, and she leaned back against the wall for a moment or two, sucking in air.

‘Are you okay?’ Sam said, walking into the room and coming to stand beside her. ‘I came to see how you were doing. You’re very pale.’

‘I’m fine,’ she told him. ‘I don’t usually react this way when we’re under pressure, but somehow the thought of that small family being torn apart is beginning to get to me.’