Книга - Rivals In Practice

Rivals In Practice
Alison Roberts


When a storm throws a rural New Zealand town into chaos, Dr. Jennifer Tremaine's professional prowess is put under pressure.Understaffed and overworked, she is relieved to see surgeon Andrew Stephenson step into the fray. She and Drew haven't seen each other since medical school, where they were in constant competition. But now things are different, as beneath the rivalry stirs a new sensation….









“Liam?” Jennifer leaned closer and raised her voice


“Liam? It’s Dr. Jennifer Tremaine. Open your eyes for me.”

“He’s not responsive.” The deep male voice came from the back seat of the car. “Except to painful stimuli.”

Jennifer nodded. Liam’s mouth was closed around the end of the plastic airway.

“Here’s the oxygen.” A mask was passed in beside Jennifer. “It’s running on fifteen liters.”

Jennifer fitted the mask to Liam’s face. As she pulled the elastic strap, her hands brushed the arm of the man still supporting Liam’s head. She glanced up, registering the stranger’s appearance for the first time. She blinked and stared, her jaw dropping. The man smiled without amusement.

“Hello, Jennifer. Fancy meeting you here.”

“Andrew!”




Dear Reader (#ulink_fc210462-b8a1-56be-a21e-64c0ca1bee45),


Akaroa has to be one of the prettiest small towns in New Zealand. It’s one of my favorite places to visit because of its beautiful scenery and the distinctive essence that still remains from its French settlement. I’ve wanted to set a story here for a long time, and the fact that Akaroa’s geography lends itself to the potential of being cut off provided a good starting point.

Jennifer Tremaine has excellent reasons for her reluctance to leave Akaroa, and Andrew Stephenson finds his own compelling reasons to stay in such an attractive location. They could be perfect partners in more ways than one, but the circumstances that bring them together could just as easily drive them apart.

Separating a small rural hospital from high-tech backup provides opportunities for challenging situations. The challenges can become even more dramatic when two doctors who spent their training years as fierce rivals are forced to spend time with each other both professionally and personally.

I’m sure you’d love to visit Akaroa. I hope you enjoy Andrew and Jennifer’s story as much as I loved writing it.

With love,

Alison




Rivals in Practice

Alison Roberts







www.millsandboon.co.uk (http://www.millsandboon.co.uk)




CONTENTS


Cover (#ud8ba8225-d11a-5004-b7a7-bf37d03c84bc)

Excerpt (#u1852afed-f5c3-5c90-b703-b63804b8f0e8)

Dear Reader (#uab6ddd65-27d1-54ed-96e2-862fbb25a96c)

Title Page (#u20f56a0e-9a78-5d02-bbbd-a5cffb8cd671)

CHAPTER ONE (#u2dd62880-f7a7-5655-a68d-08fe83dc06cf)

CHAPTER TWO (#u23436854-c86b-5f73-b376-2875fd742287)

CHAPTER THREE (#u016e39ab-ac72-597d-ac15-836f8d6bf38d)

CHAPTER FOUR (#litres_trial_promo)

CHAPTER FIVE (#litres_trial_promo)

CHAPTER SIX (#litres_trial_promo)

CHAPTER SEVEN (#litres_trial_promo)

CHAPTER EIGHT (#litres_trial_promo)

CHAPTER NINE (#litres_trial_promo)

CHAPTER TEN (#litres_trial_promo)

Extract (#litres_trial_promo)

Copyright (#litres_trial_promo)




CHAPTER ONE (#ulink_1609a615-00d8-56e3-a427-67701cb05db1)


THE crack split the airwaves as unnervingly as gunfire.

‘My God, what was that?’ The fear in the woman’s eyes had nothing to do with the reason she was lying on a hospital bed.

Dr Jennifer Tremaine turned away from the window with a reassuring smile. ‘Nobody’s been shot, Liz. It’s just a branch coming down on that old twisted willow by the front gate.’

Elizabeth Bailey settled back onto her pillows reluctantly. ‘Must have been a pretty big branch.’

‘It was. I think some of these wind gusts are getting over a hundred kilometres an hour.’

A nurse smoothed the final piece of clean linen into the bassinet with a satisfied pat. Then she straightened, turning suddenly as a fresh gust of wind rattled the window viciously and sent droplets of water against the glass with enough force to sound like a shower of small pebbles.

‘I thought this was supposed to be the tail end of that southerly storm.’ The nurse, Wendy Granger, peered out of the window. ‘It looks a lot closer to the head end to me.’

‘At least we had plenty of warning. The fishing boats should all be in and they closed the school early.’ Jennifer Tremaine frowned as she picked up the chart lying on the end of Elizabeth’s bed. The small rural community of Akaroa, nestled into a peninsula on the South Island of New Zealand, wasn’t used to winter weather of such severity but preparations had been a focus all day. The young doctor’s immediate concerns were much closer. If she needed back-up for any complications with Elizabeth’s labour, the nearest large centre was Christchurch. Evacuation by air was clearly out of the question already, and even in good weather transport by road took an hour and a half.

‘That branch has blocked the front driveway completely,’ Wendy announced. ‘I hope no one’s been injured.’

‘You and me both.’ Jennifer glanced at her watch. ‘I must ring home. I want to check that the children are all back from school safely.’ She frowned again, her attention still on her watch. ‘It’s over ten minutes since your last contraction, Liz. You’re slowing down again.’

‘Oh, no! Is this going to be another false alarm?’

‘I guess we’ll have to wait and see.’ Jennifer smiled at her patient. ‘One thing’s for sure, we won’t be sending you home in a hurry in this sort of weather. As I explained to you yesterday, the position your baby is in is likely to make the first stage of labour quite a lot longer than usual. The backache you’re getting is the other major disadvantage.’

Liz sighed heavily. ‘Trust Peter’s child to be difficult before it’s even born. Like father, like son—or daughter,’ she added.

‘Have you heard from Peter again?’

‘He rang half an hour ago. The airport at Dunedin is closed because of the weather. There’s no chance of him getting back tonight. I hope it is another false alarm.’

‘How’s your back feeling?’

‘Sore, but no worse than it’s been since I came in yesterday morning. What was it you called the position?’

‘It’s called a right occiputo posterior position. It means that the baby’s facing the front. The most normal presentation is when the back of the head is pressing on the abdominal wall. The back of your baby’s head is pressing against your sacrum.’ Jennifer smiled wryly. ‘Commonly known as ‘‘backache labour’’, I’m afraid.’

‘What’s going to happen?’

‘The baby will most likely turn itself around at the very end of the first stage or the beginning of the second and then things will go a lot more smoothly and quickly.’

‘How long will it take?’

‘I can’t say,’ Jennifer apologised. ‘You’re still only three centimetres dilated so we can’t even be sure whether labour is established yet or not. Try moving around as much as you can for the moment. If you stay upright, it will tip the baby down and might ease the pressure on the small of your back. Kneeling, being on your hands and knees and lying on your side, curled up, might help the pain and encourage the rotation of the baby. We’ll give you a hot pack, and ask Wendy for a massage any time you like.’ Jennifer turned to her nurse. ‘Why don’t you put the kettle on first, Wendy? I think we could all use a cup of tea. I’m just going to pop up to the office and give Saskia a ring. She should be back from collecting the children by now.’

The wide, wood-panelled hallway and the impressive height of the ceiling could have graced a stately home. The small hospital had been built in an era when function and budgets couldn’t overrule aesthetic considerations. More recent additions were modern, and Jennifer was proud of their maternity suite, treatment and consulting rooms but she loved the older part of the hospital. The rooms were spacious, most opened onto verandahs that were more than welcome in the hot, summer months and the marginal plumbing could be forgiven because they were never stretched to use their entire ten-bed capacity.

The hospital office was near the front of the old weatherboard building and the room was large enough to accommodate Jennifer, her older partner, Dr Brian Wallace, and the secretary who worked weekday mornings. The ancient carpet was still thick enough to muffle the sound of Jennifer’s approach and she stopped in the doorway with a small groan of dismay. The room had enough windows to give a clear view of the worsening storm and the impressive pile of debris from the willow tree could be seen covering the driveway, but Jennifer wasn’t looking outside. Her dismay was directed at the man sitting in front of a computer screen.

‘How bad is it, Brian?’

Brian Wallace shoved a desk drawer shut with a startled bang. ‘Bloody awful,’ he growled. ‘I’ve lost the report I’d just finished because of some power disruption and the damned thing’s vanished. I’m sure I saved it.’

‘That’s not what I’m talking about.’ Jennifer crossed the room quickly. ‘I saw you drop your spray into the drawer. Why didn’t you tell me you had your angina back again?’

The older man sighed with resignation. ‘I didn’t want to worry you, Jen.’ He looked up and smiled. ‘It’s not so bad—really.’

‘And it came on while you were sitting here quietly at the computer?’

‘It came on thanks to the stress these infernal machines are capable of generating. I’ve spent a week on that report. We should never have tried to get so modern. We did just fine in my day before technology started to take over. I want my typewriter back.’

‘Oh, sure.’ Jennifer grinned. ‘You use the Internet more than any of us do. You’d be totally lost without it.’ Her smile faded. Jennifer wasn’t going to allow complete distraction. ‘Come with me. I want to do a twelve-lead ECG.’

Brian scowled. ‘Let me have another go at finding this report first. I’ll reboot the computer and see if that helps.’

Another loud crack outside made Jennifer flinch. The lights in the office flickered, went out for several seconds, then came on again with slightly diminished strength. The menu on the screen in front of Brian vanished.

‘Shut down,’ Jennifer advised firmly. ‘It looks like our emergency generator has kicked in and the less power we use, the better. The computer’s out of bounds.’

‘So’s the ECG machine, then.’

‘It’s battery-powered,’ Jennifer reminded her partner crisply. Her expression softened. ‘Please, Brian, let me check you over.’

The older doctor complied reluctantly and Jennifer’s smile was sympathetic as she led the way down the dark hallway towards the consulting room. Brian Wallace was well into his sixties and probably should have retired two years ago after suffering his first heart attack. Like herself, Brian had been born and raised on the peninsula but it had been his first choice of career to come back here to practise medicine and become an integral part of the small community.

Jennifer’s return hadn’t been entirely voluntary and her time here as a doctor couldn’t begin to compare with Brian’s years of service, yet she could already feel the strands of the web the ties created. And they weren’t unpleasant ties. The bond was protective as well as demanding. She was a part of so many people’s lives. A piece of the fabric of this old building and an equal partner of this GP who had been her friend and mentor for as long as she could remember.

The ECG was reassuring. ‘There’s no sign of any ST depression or other changes.’ Jennifer showed the trace to Brian. ‘How’s the chest pain at the moment?’

‘Gone.’

‘Did it feel the same as your previous angina?’

‘Pretty much.’

‘Any associated symptoms?’

‘No.’

‘Have you had your aspirin today?’

‘Yes, Doctor.’ Brian smiled at Jennifer. ‘Can I go now?’

‘No. I want to take your blood pressure and listen to your chest. If they’re OK then you can go. Home—for a rest.’

‘It’s only three p.m.’

‘It’s dark enough to be six p.m. and I want you safely home before this storm gets any worse.’ Jennifer wrapped the blood-pressure cuff around her colleague’s arm.

‘We might get extra work.’

‘If we do, Wendy and I will cope.’ Jennifer reached for the stethoscope hanging around her neck. ‘We’ve only got the two inpatients and Lizzie’s labour could well be another false alarm.’

‘Well, Wendy’s an excellent nurse and I have complete faith in you to cope with anything that needs a doctor.’ Brian looked thoughtful. ‘And I did promise to check on Jack Currie’s ulcer on the way home.’

Jennifer sighed. ‘And how many other house calls did you promise to make?’ She released the valve on the bulb. ‘Your blood pressure’s fine. One-forty over ninety.’ She placed the disc of the stethoscope on Brian’s chest. ‘Take a few deep breaths for me.’

The pot of tea was cold by the time Jennifer arrived in the hospital kitchen. She threw a teabag into a mug and waited for the kettle to boil again. Wendy came into the kitchen carrying a tray of empty cups and saucers.

‘Mrs D. says she wants another biscuit.’ Wendy reached for a tin on the shelf above the toaster. ‘And she’s already had two!’

‘The storm’s not bothering her, then?’

‘I don’t think she’s noticed.’

Jennifer grinned. Mrs Dobson had become a long-term inpatient. At ninety-seven, she required more medical attention than the local rest home was able to manage, and it had seemed cruel to send her out of the area she had lived in all her life even though she was now often unaware of her surroundings.

‘How’s Lester?’

‘Quiet. He was asleep so I didn’t disturb him.’

‘Pain relief must be working, then.’ Jennifer added a spoonful of sugar to her tea. Lester Booth was suffering from an extremely painful dose of shingles. ‘What about Liz?’

‘The contractions are following the same pattern. One strong one and then one really feeble one.’ Wendy was stacking cups and saucers into the dishwasher. ‘She’s really fed up and her back pain is getting worse.’

‘Have you checked the foetal heartbeat?’

Wendy nodded. ‘Nothing’s changed. There’s no sign of foetal distress.’ She grinned at Jennifer. ‘Only the maternal variety.’

Jennifer sipped her tea thoughtfully. ‘At this rate Liz is going to be worn out well before we get anywhere near the second stage. If I’d sent her into town yesterday she could have been managed more effectively. They could have speeded things up and done a Caesarean if a forceps delivery failed.’

‘Liz wanted to wait to give Peter a chance to get home,’ Wendy added. ‘She was quite pleased when things ground to a halt. Are we likely to run into trouble, do you think?’

‘I hope not. It’s been a while since I did a forceps rotation and delivery, though.’ Jennifer glanced towards the small kitchen window as a wave of hail assaulted the glass. ‘I’m worried about the road being cut off. Having that on top of a potential complication makes us feel rather isolated. Let’s just hope the baby decides to co-operate and turn itself around.’

Wendy followed her glance with a grimace. ‘It’s probably snowing on the hilltop by now.’ She looked at her watch. ‘I’d better go and check on Liz after I’ve given this to Mrs D.’ Wendy picked up the plate with the chocolate biscuit. ‘Then I’ll take Brian a cup of tea. He wasn’t in the office when I went past.’

‘I’ve sent him home.’ Jennifer caught Wendy’s surprised expression and smiled a trifle grimly. ‘He’s getting angina again.’

‘Oh, no!’ The biscuit was in danger of sliding off the plate. ‘How bad is it?’

‘Hard to know. I suspect Brian hasn’t lost his touch at hiding symptoms. I checked him out and I’ll do another ECG in the morning, but I didn’t want him here just in case things do get busy.’

A faint noise reached the women above the howl of the midwinter storm. A noise that rose and fell with an easily recognised urgency. The warning siren was used to call the local volunteer fire officers in to their station. It was unlikely that their fire-fighting skills would be required right now, however. Far more likely that their role as first responders for ambulance or rescue work was being summoned. Even while the noise was being registered in the kitchen, a much closer signal sounded.

‘That’s the surgery bell. Shall I go?’ Mrs D.’s biscuit was abandoned on the bench.

‘No, I’ll go.’ Jennifer tipped out the rest of her tea. ‘You stay with Liz.’ She looked over her shoulder as she moved to the door. ‘And could you ring home for me when you’ve got a minute? I still haven’t checked on the children.’

The large man standing in the tiny waiting room was wearing an oilskin parka that streamed water onto the linoleum floor. He held one hand clutched to his chest and well-diluted blood was staining the rapidly growing puddle. ‘John! What’s happened?’ Jennifer held open the door of the treatment room. ‘Come straight in here.’

‘It’s a bit of a mess, Doc.’ John Bellamy sat down heavily on a chair as Jennifer pulled gloves on and reached for a pack of sterile dressings. ‘I was just making sure the boat was secure and this wave rolled right over the deck. I landed in my tackle box.’ His face twisted as Jennifer moved his hand to place it on a towel on the bed beside him. She pulled the head of the angle lamp out from the wall and clicked on the light. ‘I got one of the damned hooks out but there’s another one that’s too deep.’

‘Sure is.’ Jennifer looked at the fish hook buried in the calloused pad below John’s thumb. ‘And you’ve got a nasty tear where you pulled the other one out. It’s going to need a stitch or two. Let’s get your coat off and make you a bit more comfortable first.’

‘No point in getting dry.’ John shook his head firmly. ‘I need to get back and keep an eye on the boat. The tide’s not full in yet and we’ve got waves breaking on the road already.’

Jennifer was drawing up local anaesthetic into a syringe. ‘It’s going to be too dangerous to be anywhere near the boats, then.’ She looked at her patient with concern. ‘You’re not thinking of getting back on board, I hope.’

John shook his head wearily, releasing more droplets of water from his grizzled hair. ‘I just need to watch,’ he said quietly. ‘That’s my livelihood out there.’

‘I know.’ Jennifer’s tone was sympathetic. ‘Let’s hope things don’t get any worse.’

The surgery bell rang again just as Jennifer eased the fish hook from the incision she had made with a scalpel. She pressed a sterile gauze pad over the wound. ‘Hold that on for a second, John. I’d better see who that is.’

Two women stood in the waiting room. The younger woman looked anxious. ‘Mum’s had a fall, Dr Tremaine.’

‘I couldn’t see a thing when the lights went out!’ The older woman sounded annoyed. ‘I tripped over the coffee-table.’

‘Were you knocked out?’

‘No, but I’ve cut my leg and you know what my skin’s like.’

Jennifer nodded. Edith Turner had been on steroids for years to treat her lung condition. Even a slight knock could tear her papery skin badly. Judging by the blood-soaked towel around her lower leg, this accident had been more than a slight knock. She touched the towel to find the stain almost dry.

‘It’s stopped bleeding, anyway. Take a seat in the consulting room and I’ll be with you in a couple of minutes. I’ve just got a few stitches and a dressing to take care of.’ Jennifer was debating whether to open the internal door from the waiting room to call for Wendy’s assistance when the outside door opened again.

‘The front driveway is completely blocked!’ a cheerful voice informed Jennifer. ‘So I had to come in this way.’

‘Margaret!’ Jennifer was delighted to see another of her senior nurses. The uniform the older woman was wearing was a surprise. ‘You’re on night duty. You’re not due in for hours yet.’

‘Thought you might need some extra help what with this weather.’ Margaret Coates pulled a clear plastic hood clear of her grey hair.

‘You’re an angel,’ Jennifer told her. ‘Can you take Edith in to the consulting room and have a look at her leg? You might need to soak that towel off. I’ve got a bit of stitching to finish in the treatment room.’

The last stitch in John’s palm was being tied when Wendy came into the room. ‘Contractions are back to ten minutes apart,’ she reported to Jennifer. ‘Liz is asking for some pain relief.’

‘I’ll go and see her. Could you dress John’s hand? Put a plastic bag over it all when you’ve finished so it doesn’t get wet. John wants to go and have another look at his boat.’ Jennifer stripped off her gloves and stood up. ‘Did you get hold of Saskia?’

‘Sorry, the phone lines seem to be out.’ Wendy was ripping the covering off a crêpe bandage. ‘I’ll try again later.’

Margaret signalled to Jennifer as she stepped into the hallway. ‘Edith’s got a nasty avulsion,’ she said. ‘And the skin flap’s all scrunched up and torn.’

‘Put a moist dressing on it,’ Jennifer directed. ‘I’ll come and sort it out in a few minutes.’ She moved quickly towards the door further down the hallway as the surgery bell sounded again. Jennifer paused for a second, not wanting to enter the maternity suite until she was able to focus completely on her patient. Her level of tension needed lowering.

If the phones were out there was no way of ringing home, but Saskia was far more responsible than most girls her age. If there had been any problem getting all the children home safely, she would have found some way to contact Jennifer on her mobile. She could reach Brian on his own cellphone if absolutely necessary but calling him in to help deal with a stressful influx of casualties was the last thing Jennifer wanted to do. Wendy and Margaret were both very capable nurses. Surely even this storm couldn’t throw anything at them more than the three medical staff could deal with. There was nothing life-threatening about the injuries arriving so far and as long as Liz’s labour was straightforward, they should be fine. Jennifer took a deep breath and entered the maternity suite.

‘Sorry to have been gone so long, Liz,’ she told her patient cheerfully. ‘Let’s have a look at you and see what’s happening.’

Ten minutes later, Jennifer headed back to the treatment room. Wendy and Margaret now had Edith on the bed.

‘I’ve had a go at straightening this flap.’ Wendy looked up, the tweezers poised in her gloved hand. ‘What do you think?’

Jennifer eyed the wound. ‘Couldn’t have done better myself. Could you dress that, please, Margaret?’ She waited until Wendy had dropped her gloves into the rubbish bin near the door. ‘Liz is about six centimetres dilated so she’s definitely in labour. I’ve set up the Entonox for her to use for pain relief but it’s better if she keeps moving at the moment. Can you stay with her?’

‘Sure.’ Wendy nodded. ‘Sam McIntosh is in the consulting room with his mother. He needs looking at.’

‘What happened?’

‘Apparently the wind caught the garage door and it hit him on the head. Possibly unconscious but only very briefly. He seemed fine but rather quiet. Jill got worried when he vomited about half an hour ago. Looks like concussion.’

Jennifer knew Sam well. Six years old, he was the same age as the twins. Sam lived just down the valley from Jennifer’s property and often came to play after school. He looked pale and unusually subdued at present.

‘I’m going to shine a bright light in your eyes,’ Jennifer told the small boy. ‘Try and keep them open for me.’

She managed to complete a full neurological check and reassure Sam’s mother before another interruption occurred. This time it was her cellphone. The flash of panic that something had happened at home intensified when the caller identified himself as Robert Manson, one of the local fire officers.

‘We’ve got an accident near Barry’s Bay.’ Robert’s voice was difficult to hear over the crackle of static and the background noise of the weather and people shouting. ‘We need you on scene, Jennifer.’

‘How bad is it?’ Barry’s Bay was well away from the route the children would have taken and they had probably been home for hours by now.

‘We’ve got one of the drivers trapped. He’s unconscious. He’s the worst but we’ve got a couple more patients.’

‘I’m on my way.’ Jennifer moved fast. She was donning over-trousers and her oilskin parka by the time Wendy found her.

‘What’s happened?’

‘Car accident. We’re going to need some help, Wendy. Do any of the other nursing staff have cell-phones?’

‘Not that I know of.’

‘Get hold of Tom Bartlett, then, if you can. Let him know what the situation is.’ If he wasn’t already on the accident scene, their local police officer should be able to use his four-wheel-drive vehicle to round up some extra staff.

‘Do you want Brian called back?’

‘Not yet.’ Jennifer was determined to keep her partner as a last resort. She picked up the large tackle box that contained her resuscitation kit. ‘We need a bed made up for Sam. I want to keep an eye on him overnight. Run a neurological check every twenty minutes or so for now.’ She gave her nurse an anxious glance. ‘I hope I won’t be too long.’

‘Don’t worry. We’ll hold the fort,’ Wendy assured her confidently. ‘Rather you than me out in that lot. It’s not going to be pleasant.’

Pleasant was an adjective almost as far removed as possible from anything that could describe the conditions Jennifer found herself in. It was now only 5.30 p.m. but it felt like the middle of the night. The wind was strong enough to rock the solid four-by-four vehicle she was driving and the rain heavy enough to virtually obliterate visibility, even with the windscreen wipers on full speed. Waves crashed against the sea wall as she crawled slowly along the foreshore on the far side of the road. The force of the sea was enough to send a river of foamy water across the tarmac. Jennifer tried to dampen her alarm but her thoughts tumbled wildly.

She could imagine a newspaper headline. LOCAL DOCTOR WASHED OUT TO SEA IN STORM. What would the article say? ‘Thirty-two-year-old Dr Jennifer Tremaine is missing, presumed drowned, having been swept from the road by a fatal combination of a southerly storm and a high tide.’

Jennifer changed gears as she reached the first hill past the township. The water level was well below her now but her imagination had been caught by the notion of the article. ‘Dr Tremaine had been practising in her home town of Akaroa for nearly six years and was well used to attending emergency call-outs in any type of weather.’ That would be true enough. They could even go to town on some of the more dramatic rescues she had been involved in. Like that one on the fishing trawler right out in the headwaters of the harbour. They could probably find the photographs that had been published on the front page of the newspaper a few years back, where the bus full of tourists had gone over the bank thanks to the snowdrifts which had obscured the side of the road. Jennifer had had her share of drama over the years but she had never encountered weather quite this vicious.

Her progress was slowed even more as she passed Duvauchelle by the hail that clogged the windscreen wipers and bounced off the bonnet of the vehicle. She smiled wryly. ‘Dr Tremaine had never intended to practise medicine in a small rural hospital,’ she invented aloud. ‘After a highly commendable record at medical school, she had every intention of moving overseas. She planned to become a specialist surgeon, attached to a world-renowned unit—probably in the United States—and become famous for her incredibly brilliant skills and the unparalleled depth of knowledge in her field.’

Jennifer snorted and abandoned the mental game. She could see the flashing lights of the rescue vehicles ahead of her as the hail changed to sleet. She was about to get very wet and very cold, working under miserable conditions to save a life that could well belong to someone that she had known since childhood. The battles she fought were often personal and victory gave a level of satisfaction she would never had found anywhere else. Certainly not in the States and probably not even as a specialist surgeon. The fates that had delivered her home were probably a lot wiser than she had been. This was where she belonged and exactly where she was needed.

Robert Manson was directing a small but dedicated team of volunteers. They were using heavy cutting equipment on a badly crumpled car jammed against the bank. Another car was further up the hill, its windscreen broken and one side badly dented. The doors hung open and Jennifer could see a woman sitting sideways on the front passenger seat, her head cradled in her hands. Another person, presumably the woman’s companion, stood motionless beside her, watching the activity down the hill. Jennifer left her own vehicle’s engine running, with the heater on a high setting and the headlights helping to illuminate the rescue scene. She pulled her resuscitation kit from the back and joined the group of men between the fire engine and the car.

‘Hi, Jenny!’ Robert had to shout over the noise of the cutting gear. ‘Sorry to drag you out in this. We shouldn’t be much longer.’

‘What’s the patient’s condition?’

‘Still not conscious but he’s got a good pulse and he’s breathing OK. There’s a doctor in there, stabilising his neck. We’re just putting a neck collar on him.’

‘A doctor?’ Jennifer was taken aback, her position as the first medic on scene removed. ‘Not Brian, is it?’

Robert shook his head. ‘Don’t know who he is. Said he was a doctor and he seems to know what he’s doing. He arrived a few minutes after we did. He’s got a camper van.’

Jennifer’s gaze followed the direction of Robert’s arm. The rain had eased to a steady downpour and she could see the shadowy outline of the large van in the intermittent glow of the flashing rescue lights. Someone on holiday, then. Jennifer would need some reassurance of their qualifications but if they checked out she would be only too glad to accept some assistance.

‘Has anyone checked the other victims?’

‘Not properly.’ Robert looked back towards the second vehicle. ‘Damn. I told them to stay inside the car, out of the rain. That chap’s not even wearing a coat. He’ll be frozen.’

‘Get them into my truck,’ Jennifer suggested. ‘The heater’s on.’ She stepped back as the noise of the cutting equipment slowed and the fire officers pulled the mangled car door clear.

‘We’re ready for the backboard,’ someone shouted. ‘And the oxygen.’

Jennifer moved forward. The wind caught her hood, pushing it back and driving heavy rain into her face. She pushed her fringe back from her eyes, able to see the accident victim clearly for the first time. A young man, his face was injured and bloody but not enough to disguise his features. Jennifer felt a familiar twist of her gut. She knew the patient. He was Liam Bellamy—the son of the fisherman who had just had the hook removed from his hand.

‘Liam?’ Jennifer leaned closer and raised her voice. ‘Liam? It’s Jenny Tremaine. Open your eyes for me.’

‘He’s not responsive.’ The deep male voice came from the back seat of the car. ‘Except to painful stimuli. I’d put his GCS at about 8.’

‘Airway clear?’

‘It is now.’

Jennifer nodded. Liam’s mouth was closed around the end of the plastic oropharyngeal airway.

‘Here’s the oxygen.’ A mask was passed in beside Jennifer. ‘It’s running on 15 litres.’

Jennifer fitted the mask to Liam’s face. As she pulled the elastic strap behind his head her hands brushed the arms of the man still supporting Liam’s head. She glanced up, registering the stranger’s appearance for the first time. She blinked and stared, her jaw dropping. The man smiled without amusement.

‘Hello, Jennifer. Fancy meeting you here.’

‘Andrew!’ The name came out as an astonished gasp.

‘Here’s the backboard.’ Robert’s voice was right beside Jennifer’s ear. ‘How do you want to do this, Doc?’

‘Slide the end of the board onto the seat. I’ll look after his head and you take the legs. Let’s keep him as straight as possible.’ Jennifer nodded at the man in the back seat as he let go of Liam’s head. She supported the weight on her shoulder, her arms around the young man’s body as they turned and lifted their patient onto the backboard. The other members of the local rescue team crowded in to help lift the board onto the waiting stretcher and transfer it to the back of the modified Land Rover that served as an ambulance. Jennifer had her kit open and IV equipment already out by the time she was joined by her unexpected colleague. She didn’t glance up until she had inserted the IV cannula and flicked the tourniquet open again.

‘Andrew Stephenson,’ she said softly. ‘I just don’t believe this.’ Her gaze shifted. ‘Is that saline ready to go, Mickey?’

The young fire officer nodded. He handed the end of the tubing to Jennifer who connected it to the line in Liam’s forearm. She checked the flow as the bag was suspended, then reached for her penlight torch.

‘Have you got a spare dressing?’ Andrew was still standing outside the back of the vehicle. ‘I’ve managed to cut my leg on some metal.’

Jennifer nodded. ‘Find one for him, Mickey.’ She was still focussed on her patient. She pulled Liam’s eyelids open and shone the torch on his pupils. ‘Liam, can you hear me?’

The response was an incoherent mumble of words but Liam’s arms moved. Jennifer caught the one with the IV line in.

‘Try and keep still, Liam,’ she said firmly. ‘You’ve been in a car accident.’

‘He’s lightening up a bit.’ Andrew took a package from Mickey. ‘Thanks, mate.’

‘Why don’t you get in out of the rain?’ Jennifer suggested. ‘I’ll have a look at your leg.’

‘I’m all right.’ Andrew had his foot on the first step of the Land Rover. He enlarged the rip on the leg of his jeans.

‘That’s one hell of a cut.’ Mickey sounded impressed. ‘I think you’d better let the doc take a look.’

Andrew had already folded a large gauze pad and pressed it to his leg as Jennifer looked up. ‘Andrew is a doctor, Mickey. We went through medical school together.’

Not precisely together, she amended silently, fitting her stethoscope to her ears. More like at the same time. Competing fiercely for the top spot of their intake. Alternating their positions at the head of the class and taking intense satisfaction in proving themselves superior to the other in whatever field they were competing. Academic, practical or even social—the struggle had blurred the boundaries of all aspects of those years. Looking back, the antagonism had provided a memorable background to Jennifer’s tertiary education. It had been a fight she had revelled in. And the enemy had been Andrew Stephenson.

‘You sound like an American tourist,’ Mickey told Andrew.

‘I’ve been living in the States for a few years,’ Andrew responded. His tone was weary. ‘I suppose I’ve picked up a bit of an accent.’

‘Liam’s got a flail chest but breath sounds are equal at present.’ Jennifer’s attention shifted briefly to Andrew. ‘You’re a general surgeon, aren’t you?’

‘Not any more.’

‘What?’ Jennifer’s brow furrowed. ‘Have you specialised in something, then?’

‘Not exactly.’ Jennifer’s stare at Andrew wasn’t productive. His head was bent, his attention on the dressing he was holding to his calf. A dressing that was already soaked with blood.

‘Is that an arterial bleed?’ Jennifer snapped.

A figure appeared beside Andrew before he had time to respond. Tom Bartlett glanced at Andrew’s leg, then towards Jennifer.

‘I’ve got one of the boys to take your truck back to the hospital with the two people from the other vehicle, Jenny. They don’t seem to be injured badly but they’ll need checking. How’s Liam?’

‘He’s pretty seriously injured. Under normal circumstances I’d be calling for a helicopter to get him to Christchurch. We’ll have to get an ambulance in by road.’

‘No go, sorry.’ Tom’s face was grim. ‘There’s been a massive slip on the other side of the hilltop. Our access is completely cut off.’

Jennifer marshalled her thoughts rapidly. ‘You’ll have to come with me,’ she told Andrew. ‘I’m going to need some help.’

‘I can’t.’ Andrew shook his head. ‘I’m on holiday. My camper van’s over there.’

‘I don’t give a damn about your holiday.’ Jennifer couldn’t believe Andrew’s casual attitude to this situation. ‘This is serious,’ she told him coldly. ‘Liam’s life might depend on you sacrificing a few hours of your precious leisure time.’

‘What I meant was, I don’t have a current practising certificate for New Zealand.’ Andrew met her furious glare without blinking. ‘I’m not licensed to treat patients here.’

‘I don’t give a damn about that either,’ Jennifer said briskly. ‘You’re qualified to help. And you need medical attention yourself. You’ve already lost quite enough blood.’

‘What about the camper van?’

‘Stop arguing and get in,’ Jennifer ordered. She looked at Tom. ‘Can you sort out the van?’

‘Sure. Where do you want it?’

‘The hospital car park is blocked. Have it taken up to my place.’

‘Hang on a minute—’

Jennifer ignored Andrew’s protest. ‘Did Wendy get hold of you, Tom?’

‘About extra staff? Yes.’ Tom nodded confirmation. ‘I got hold of Janey and she’s going to round up Michelle and Suzanne.’

‘Great.’ Jennifer’s head swivelled. ‘Let’s get going, then, Mickey.’

The fire officer climbed down the steps and looked at Andrew. ‘You’d better get in,’ he told him, ‘so I can fold these steps up and shut the doors.’

Andrew paused for another moment, shaking his head in disbelief. Then he climbed into the back of the vehicle, sitting heavily on the bench seat that ran parallel to the stretcher.

‘I knew this holiday was going to be a disaster,’ he informed Jennifer. ‘I’ve known it for nearly a year.’

‘Why did you come, then?’ Jennifer was fitting the electrodes from the lifepack to Liam’s chest and a pulse oximeter to his finger. Her tone was unsympathetic.

‘I couldn’t miss it.’ Andrew gave a snort of laughter that held no amusement. ‘After all, it is my honeymoon.’




CHAPTER TWO (#ulink_ccb7fa76-ef74-5325-a2e6-40d58d8fba42)


IT WAS not a moment to offer congratulations.

Jennifer Tremaine ignored Andrew Stephenson’s statement regarding his holiday and the odd implications it carried. Jennifer didn’t care about the reasons Andrew had returned to this side of the globe or why the trip might be proving less than satisfactory. If there was a new wife sulking in the back of the camper van because of some marital dispute, Tom could sort it out. Andrew certainly didn’t seem bothered but that was hardly surprising to Jennifer, given what she remembered about the man. She could put aside what she thought of his personality, however. The fact was, he was here, and Jennifer badly needed the professional skills he was capable of providing. When Mickey slammed the back doors of the Land Rover closed she almost smiled with satisfaction. She had Andrew Stephenson trapped for the moment and she was taking him in the direction she had chosen.

Despite the protective wet-weather clothing, Jennifer was soaked and cold. She took a moment away from her assessment of Liam Bellamy’s condition to reach for some towels in an overhead locker. The thick, dark blonde curls of her hair were plastered to her head and still dripping enough water to be a real nuisance.

‘Blood pressure’s 100 over 60,’ she informed Andrew as she roughly dried her face and hands. ‘Heart rate’s up to 130. He’s shocked, but his airway’s still clear and his breathing hasn’t deteriorated any further.’ She shoved a fresh towel towards her passenger. ‘Get yourself a bit drier,’ she ordered. ‘You must be frozen. Wrap yourself in a blanket as well.’

‘Thanks.’ Andrew took the towel with one hand. His other hand was still holding the dressing on his lower leg. The thick gauze wadding was saturated and a trickle of blood moved through the fingers holding the pad in place.

‘Put some pressure on that,’ Jennifer directed. ‘Thanks.’ Andrew’s tone was much less appreciative this time. ‘But I do remember the basics of haemorrhage control.’

‘Try to implement them effectively, then,’ Jennifer suggested. She turned back to Liam, her stethoscope in her ears again. The gap in time since she had last had any contact with Andrew Stephenson seemed to have evaporated effortlessly. A casual snipe at each other and they were back to communicating the way they always had. Time clearly hadn’t changed Andrew, but Jennifer was faintly ashamed that she could slip so easily into what she considered an immature and less than professional mode of interaction. She rose quickly, bracing herself against the stretcher as she pulled open another locker. She took out a bandage and one of the largest sterile dressings available, ripping open the packages as she turned back.

‘Fold this up,’ she directed Andrew, handing him the large gauze wadding. ‘I’ll put a pressure bandage on and maybe that will stop the bleeding.’ She tried to smile at Andrew as he looked up—a form of apology for her lapse in courtesy—but he didn’t return the gesture. As Jennifer stooped and began to bind the bulky dressing firmly to his leg, he picked up the towel and dried his face. Jennifer worked rapidly, taking only seconds to finish her task. It was long enough to gain a physical impression of the man, however. The muscle beneath her hands felt like iron. Andrew hadn’t gained an ounce of flab over the years. If anything, he was even leaner than he had been.

‘That saline’s almost run through. You’d better start another unit.’

‘OK.’ Jennifer reacted promptly. Perhaps Andrew was taking more notice of Liam’s condition than the impression he had given. Maybe he would be more inclined to offer his assistance when they had some better facilities available. If they ever got back to the hospital. Mickey seemed to have brought the Land Rover to a complete halt.

‘What’s going on, Mickey?’

‘I’m watching the waves,’ Mickey called back. ‘The wash is right over the road just here and I don’t want us stuck in the middle if we catch a big one.’

At least they were only minutes away from the hospital. They only had to head up the hill a little way and turn onto Napoleon Drive. There was a tense silence in the vehicle as they waited. Jennifer listened to the roar of the surf as it covered the sound of more hail on the roof above them. They moved with a jerk as Mickey accelerated to clear the patch of road between waves. Jennifer leaned closer to Liam.

‘We’re almost there,’ she told him. ‘Don’t worry, Liam. We’ll soon have you sorted out.’

Her patient moved convulsively, coughing and then retching. He was gagging on the plastic airway and the oxygen mask filled up with blood. Jennifer uttered a dismayed oath as she wrenched it clear of his face before he could inhale any of the contents. The airway tube fell to the floor and rolled beneath the stretcher.

‘Get him on his side,’ Andrew ordered crisply.

Jennifer was already doing her best but Liam was a well-built young man and hardly moved when she grasped his shoulders to pull him over. Suddenly it seemed as if Liam was rolling himself onto his side and Jennifer realised that Andrew was beside her, lifting and turning the heavy body with apparent ease.

‘Have you got a suction kit?’

‘On the wall behind you. There’s a clip underneath.’ Jennifer was holding Liam’s head, keeping his airway open. She hoped the rough manoeuvre hadn’t exacerbated any injury. ‘I hope he doesn’t have a pelvic fracture.’

‘I’d say his airway and breathing are more of a priority right now,’ Andrew responded coolly. ‘Here…’ He handed her the tube from the suction kit and switched the unit to full power.

‘You do it,’ Jennifer told him. ‘I need to find another OP airway and a bag mask.’

‘I’m not wearing gloves.’

‘Then put some on.’ Jennifer snatched the tube and cleared the blood from Liam’s mouth and nose. She noted the cut inside his lip, the broken teeth and the probable broken nose, but were they enough to explain the amount of blood in the mask?

‘I’ll find another airway for you.’ Andrew reached into the kit to extract one of the plastic devices. The abrupt halt of the Land Rover caused him to overreach.

‘There’s a bloody great tree blocking the driveway,’ Mickey shouted. ‘I nearly hit the damned thing.’

‘Sorry.’ Jennifer braced herself as the vehicle began reversing. ‘I should have warned you about that. We’ll have to go around the back by the kitchens.’

Andrew handed her the airway. He rapidly assembled the bag mask components and Jennifer plugged the tubing into the oxygen supply before fitting it over Liam’s mouth and nose. She glanced at Andrew.

‘GCS is dropping again. He’s lost his gag reflex and his breathing is getting worse. He’s going to need intubation as soon as we get him inside.’

‘He needs evacuation to the nearest major hospital. You can’t possibly have the facilities to deal with a patient in this condition here.’

‘We’ll have to,’ Jennifer said tersely. ‘We’re the only chance he’s got. There’s no hope of evacuation in this weather.’ She sent Andrew a warning glance. ‘And I’m including you in that ‘‘we’’.’

Andrew shook his head. ‘I told you—I’m no longer a doctor. I gave up medicine nearly a year ago.’

‘Why?’

‘That’s my business.’

The Land Rover had stopped moving again. The engine idled and Jennifer could hear rain on the vehicle’s roof in the silence that followed Andrew’s cool comment. She squeezed the bag she was holding again, turning her astonished stare back to her patient. ‘I don’t care what your reasons were,’ she announced. ‘And you don’t stop being a doctor just because you chucked your job in. Right now I need to assess and stabilise my patient. I need help and I’m going to use whatever resources I can find. Including you.’

The back doors opened and Jennifer moved swiftly, unhooking the end of the stretcher. ‘Bring the lifepack and the suction kit,’ she ordered Andrew. ‘And follow us.’

Wendy and Margaret were both waiting by the open door as Mickey and Jennifer raised the stretcher and wheeled it towards the back entrance of the hospital.

‘Tom Bartlett rang us,’ Wendy informed Jennifer in a rush. ‘Janey and Michelle are here, looking after the other patients. Sue’s coming in as soon as she’s dropped off her children. The treatment room’s clear.’ Wendy took a quick breath. ‘How’s Liam doing?’

‘Not great.’ It was Andrew who spoke as they moved past Wendy. ‘Sats are dropping fast. Probably a tension pneumothorax from the rib injuries.’

Jennifer let Margaret take her place pulling the stretcher. ‘I’ll get a chest-drain kit set up,’ she said, moving rapidly ahead and shedding her oilskin parka as she moved. The astonished stare directed at Andrew by both Margaret and Wendy had not been lost on Jennifer but she couldn’t afford to be distracted by introductions just yet. Within seconds they were all crowded into the treatment room. Mickey, Margaret and Wendy positioned themselves around the backboard as Andrew held the head end and directed the transfer of their patient to the bed.

‘On my count,’ he instructed. ‘One, two…three!’ Andrew reached for Jennifer’s stethoscope which had been left draped across Liam’s abdomen. He glanced up as he lifted the earpieces clear a short time later. ‘We’re going to need a drain on both sides,’ he informed Jennifer. His gaze raked Wendy. ‘You’re a nurse?’ he queried tersely. ‘I need some gloves.’

Jennifer could feel Wendy’s hesitation. She gave her nurse a reassuring glance as she reached for a second sterile chest drain package. ‘It’s OK, Wendy,’ she said calmly. ‘Andrew’s a doctor. A surgeon. He knows what he’s doing.’

The tension in the room wasn’t limited to the nurses’ wariness of the strange doctor. The situation was critical and both Andrew and Jennifer worked in a tense silence as they dealt with Liam’s respiratory collapse.

‘Got it!’

Jennifer had heard the characteristic hiss of air escaping from the side of the chest Andrew was working on. She concentrated grimly on inserting her own drain, dimly aware of a familiar frustration at Andrew achieving a successful result first. It lasted only seconds.

‘Haemothorax on this side.’ Jennifer attached the drain to the bottle that Margaret had prepared. She watched the flow of released blood. ‘Rather a large one.’

‘A single rib fracture can cause a loss of 150 mls into the pleural cavity.’ Andrew was picking up the stethoscope again. ‘And this lad’s fractured a fair few.’ He nodded as he shifted the disc on Liam’s chest. ‘We’ve got equal breath sounds.’ He glanced at Mickey who was ventilating Liam with the bag mask, then he looked at Jennifer. ‘Are you going to intubate? Have you got mechanical ventilation available?’

‘I’ll do it now.’ Jennifer was pleased to see that Wendy was already setting out the intubation kit. She stripped off her soiled gloves and reached for a new pair.

‘What about X-ray facilities?’ Andrew queried. ‘We need chest, C-spine and pelvis.’

‘No X-rays, sorry.’

‘Blood pressure’s dropping.’ Margaret sounded worried. ‘Ninety over fifty.’

Andrew’s attention flicked to Margaret. ‘Get the rest of his clothes cut off,’ he directed. ‘I’ll check his abdomen and pelvis. You get on and do the intubation, Jennifer.’

Margaret’s hesitation was only momentary. Jennifer could sense her rapid acceptance of directions from someone who was clearly in control of the situation. Turning to pick up the laryngoscope, she caught Wendy’s gaze. Her nurse was clearly questioning Jennifer’s apparent acceptance of being cast into the role of an assistant by someone who was, after all, a complete stranger despite the demonstration he was giving of his obvious abilities. Jennifer merely nodded at Wendy and Mickey, who had stayed to assist.

‘We’ll get the collar off and you can provide manual in-line stabilisation for us, Mickey. You can do the cricoid pressure when I’m ready, Wendy. This may not be easy with the facial injuries Liam has.’

Jennifer concentrated on her task of securing Liam’s airway, confident that Andrew and Margaret would be dealing with anything else that might need urgent attention. If Andrew’s involvement came with the price of giving up leadership of this small team, Jennifer was quite willing to pay. This was no time to even remember old battles but Wendy wouldn’t have questioned Andrew’s take-over if she’d known him like Jennifer did. Andrew had never been able to resist taking command of any situation he found himself in—particularly one that included her own presence. Jennifer was more than happy to let this one go. She had a professional colleague whose skills matched—probably exceeded—her own, and Jennifer was grateful for the shared responsibility as she registered the comments she overheard from further down the table.

‘Pelvis doesn’t feel unstable,’ Andrew was saying. ‘Any femoral fractures?’

‘Nothing obvious.’

‘We need some more fluids. Find me a 12-gauge angiocath.’ Andrew spoke to Margaret as though they were familiar colleagues. ‘I’ll go for the groin. He’s completely shut down peripherally. Do another blood pressure, too, would you, please?’

‘Sure.’

Jennifer had Liam’s head positioned now and stable. ‘Hyperventilate with the bag mask, Wendy. I’m ready to intubate.’

‘Blood pressure’s 80 on 55,’ Margaret told Andrew.

Jennifer tried to concentrate on visualising the larynx and vocal cords. Part of her brain registered Margaret’s comment with dismay. Liam was becoming progressively more shocked. He was losing more blood than could be accounted for by the injuries they had identified so far. If they were going to save Liam Bellamy’s life they needed to find the source of the blood loss and control it. Until then they had to maintain an adequate circulation.

‘We’ll push saline into this larger line,’ Andrew decided. ‘Have you got haemaccel as well?’

Jennifer eased her laryngoscope into its final position. ‘Pass me a 9-mm tube, thanks, Wendy, but don’t release pressure on the cricoid cartilage just yet.’

Andrew had instigated the rapid fluid replacement by the time Jennifer had inflated the cuff on the endotracheal tube and set up the ventilator. He was eyeing the chest-drain bottle on her side of the bed.

‘He could have a diaphragmatic rupture,’ he suggested to Jennifer. ‘It would explain a continued blood loss of that rate and a lack of abdominal distension if he’s injured his spleen. Given the rib fractures on that side, it seems quite likely as a source of major blood loss.’

‘Find another bottle, Margaret,’ Jennifer requested. She looked at Andrew. ‘What about a peritoneal lavage?’

‘What about it?’

Jennifer suppressed a flash of annoyance. The reminder of how often she and Andrew had disagreed over a diagnosis or method of treatment again wiped out the gap in time very effectively. They had always challenged each other, demanding justification for opinions or decisions. Trying to prove themselves more capable than the other.

‘It could be diagnostically useful.’ Despite the inappropriate setting to dredge up old battle skills, Jennifer couldn’t quite help the edge of sarcasm in her tone. ‘If we got lavage fluid coming from the chest drain, then we’d know for sure that there was a diaphragmatic rupture.’

‘And what then? Are you proposing a laparotomy if it’s indicated?’ Andrew’s eyebrow was raised sceptically. ‘Are you qualified to undertake a procedure like that?’ He glanced around the treatment room. ‘Here?’

‘No, I’m not qualified,’ Jennifer said quietly. ‘But you are.’

‘No, I’m not.’

Jennifer could feel the astonishment of both her nurses and Mickey. She ignored the rising tension. ‘You’re a specialist surgeon,’ she reminded Andrew. ‘The last I heard, you were so good you got poached from the Boston Memorial to join some very prestigious private outfit.’

‘That’s ancient history. I told you, I’m not practising any longer.’ Andrew’s tone suggested that either Jennifer’s memory or her ability to understand were well below par.

‘Why?’ Jennifer was blunt. She wasn’t about to let Andrew back out now. ‘Did you kill somebody?’

Andrew’s face darkened as his features froze for an instant. His eyes met Jennifer’s directly. ‘No.’ His tone was as cold and calm as the stare she was receiving. ‘And I’m not about to take the risk of doing precisely that by operating on someone in less than ideal circumstances.’

The alarm that sounded on the cardiac monitor was brief. The arrhythmia settled spontaneously after a few erratic heartbeats but it was enough to remind both doctors of their patient’s still critical condition. The tap on the door of the treatment room came in the short silence that followed the cessation of the alarm. A young nurse aide poked her head around the door.

‘Dr Tremaine? Could you come and check on Liz, please?’ Michelle’s face was anxious. ‘She’s in a lot of pain and the machine that’s doing the baby’s heart rate is beeping.’

Jennifer caught Andrew’s dark eyes again with a silent plea. He transferred his gaze to Liam, his expression resigned.

‘I’ll do the lavage,’ he said. ‘And we’ll take it from there.’

‘Thanks.’ Jennifer was suddenly aware of how pale and weary Andrew looked. Her own cold, damp clothing was clinging to her skin and Andrew must be a lot more uncomfortable than she was. He had been out in the storm far longer than she had and he was injured as well, yet he hadn’t voiced a word of complaint.

‘Tom Bartlett is here as well,’ Michelle said to Jennifer. ‘He wants to talk to the other people that were in the accident. Oh, and Mickey’s wanted back at the station.’

‘OK.’ Jennifer stripped off her gloves. She couldn’t afford to worry too much about Andrew Stephenson’s level of comfort just yet. ‘Wendy, you come with me. Margaret can stay and assist Andrew.’ Jennifer paused as she followed Mickey to the door. ‘Marg, find Andrew a set of scrubs when you get a minute. His clothes are soaked and he must be frozen.’

Wendy trotted behind Jennifer as they made their way towards the maternity suite. Jennifer grinned at her colleague.

‘I wonder if Andrew might fancy doing a Caesarean?’

‘Who is he, exactly?’ Wendy’s eyes were round. ‘And where the hell did he appear from?’

‘He’s on holiday and was involved in the accident somehow.’ Jennifer stopped beside a large cupboard. ‘I’ll get some dry scrubs for myself, I think.’ She reached for a set of the pale blue theatre clothing.

‘He’s amazing,’ Wendy continued in awed tones. ‘And he’s so…He’s…’ She gave a silent whistle.

‘You wouldn’t be the first woman to find Andrew Stephenson attractive,’ Jennifer told her nurse wryly. ‘And you won’t be the last.’ She was rapidly unbuttoning her shirt, screened by the open cupboard door.

‘How do you know that?’

‘I went through medical school with him.’ Jennifer stripped off the damp shirt and replaced it with the loose, thick cotton top. Then she peeled off the oilskin over-trousers she was still wearing.

‘Did you go out with him?’

‘Heavens, no! I couldn’t stand the man.’ Jennifer pulled scrub trousers over her jeans for extra warmth. ‘And he couldn’t stand me either.’ She shot Wendy a quick grin. ‘I’m quite pleased to have him around right now, though.’

‘You and me both. He’s real knight-in-shining-armour stuff, isn’t he?’

‘Don’t get your hopes up.’ Jennifer felt obliged to issue the warning, having noted the gleam in Wendy’s eye. She moved on briskly. ‘You’d be wasting your time,’ she added as Wendy caught up.

‘Why?’

‘He’s on his honeymoon.’ Jennifer didn’t see Wendy’s disappointed expression. She could see Tom waiting further down the hallway. ‘I’ll go and check Liz,’ she told Wendy. ‘You take Tom in to see those other patients. I think Janey might be with them. Find out whether she’s got an update on young Sam as well. I want to know how he’s getting on with that concussion.’

Elizabeth Bailey was miserable. ‘That stuff isn’t helping any more,’ she told Jennifer, waving dismissively at the Entonox cylinder. ‘My back is killing me.’

‘I’ll give you something stronger in a minute.’ Jennifer was watching the foetal monitor as she pulled on clean gloves. The heart rate had dropped a fraction but not enough to be a problem yet. She would reset the level for the alarm as soon as she had examined Liz.

Suzanne Smith arrived just as Jennifer administered a dose of pethidine to her patient.

‘Where do you need me most, Jen?’

‘Right here.’ Jennifer moved out of earshot to speak to the nurse. ‘Liz is definitely in labour this time but things are moving very slowly and it’s a classic ‘‘backache’’ labour. She’s been here since this morning and she’s still only six to seven centimetres dilated. She’s had enough and we might have a long way to go till the end of stage one.’ Jennifer shook her head. ‘Goodness knows how we’ll cope if the baby doesn’t turn. Under normal circumstances I’d evacuate her. What’s the weather like out there now?’

‘Awful. And the road’s still blocked. I heard it on the radio.’ Suzanne bit her lip. ‘I heard about Liam. How’s he doing?’

‘I’m about to find out.’ Jennifer managed to smile at Suzanne. ‘I’m so glad you’re here, Sue. At least I know I’ve got Liz in the hands of a very capable midwife. I may be busy for quite a while.’

‘I’ll know if I have to call you. Best of luck.’

They were going to need more than luck. Liam Bellamy’s condition had deteriorated further by the time Jennifer returned to the treatment room.

‘He needs an urgent laparotomy,’ Andrew declared. ‘He also needs a blood transfusion. Have you got any frozen, fresh plasma?’

‘No.’ Jennifer eyed the second chest-drain bottle which was nearly full. ‘Maybe we could do an autologous transfusion and reuse his own blood.’

‘We’d need to anticoagulate the blood. I don’t expect you’d have a cell-saver system available.’

‘No. We’ve got plenty of anticoagulation agents, though.’

‘Not much point pouring it back in unless the leak is fixed. My guess is a ruptured spleen. His liver could also be a likely candidate.’

‘Could you repair it?’

Andrew shook his head slowly. ‘You don’t know what you’re asking, Jennifer. We don’t have the facilities or the staff. Not even an anaesthetist.’

‘I can do an anaesthetic,’ Jennifer offered promptly. ‘It was my first rotation as a registrar. We’ve got the gear. The instruments are even sterilised on a regular basis. They used to do quite a bit of surgery here in the old days. And my nurses are great. Wendy and Margaret could both help.’

Andrew was still shaking his head. Jennifer caught hold of his arm. ‘I took a fish hook out of a man’s hand earlier today,’ she told him with quiet intensity. ‘He put himself in considerable danger trying to make sure his boat was going to be safe in this storm. His fishing boat is his living and the only way he can support his family. He’s desperate to hold things together since his wife died three years ago. His kids are all he has. Liam is his eldest son.’

Jennifer could feel the muscles in Andrew’s arm tense beneath her hand. She fixed her eyes on his face, willing him to agree. He still looked pale. The skin stretched across the strong lines of his features and deep lines around his dark eyes suggested that he was in pain…or unwell. Jennifer swallowed quickly. Was that the reason he’d given up his career? He’d just lost a significant amount of blood himself from the leg injury. He’d been exposed to the elements and put under stress. Had that exacerbated some underlying serious medical condition?

‘Are you all right?’ Jennifer queried urgently. ‘Are you able to operate?’ She almost reached up to touch his face. Her concern for Andrew’s state of health wasn’t purely for Liam’s sake. Andrew Stephenson needed medical attention that only she would be able to provide. She was in a position of crisis here and somebody had to lose at least in the short term. The question was, who could afford to wait?

‘I’m able.’ Andrew’s response fell into the tense silence. Jennifer felt her breath being released in a sigh of relief and unconsciously tightened her grip on Andrew’s arm with a grateful squeeze.

Andrew nodded down towards Jennifer’s upturned, eager face. ‘I’m able,’ he repeated with more emphasis. His solemn expression softened as his mouth twisted into a lopsided smile. ‘And I’m willing.’ The smile faded. ‘We’ll need a small miracle if we’re going to be successful, you realise.’

‘Miracles happen.’ Jennifer tugged Andrew’s arm gently as she turned him back towards their patient. ‘Sometimes they just need a bit of a push to get them started.’




CHAPTER THREE (#ulink_b2df128c-e386-56c2-a1ab-a269dad97b56)


‘I STILL can’t believe it.’ Jennifer’s hazel eyes were alight with triumph. ‘We did it!’

‘He’s not out of the woods yet.’

‘He’s relatively stable. He’s come through the surgery and the bleeding is controlled. His blood pressure’s up and he’s breathing well on ventilation.’ Jennifer was smiling as she leaned over a tray and selected a suture needle. Andrew’s eyelids drifted slowly closed again but Jennifer didn’t notice. ‘They’ve almost cleared that slip on the road and there’s a team coming from Christchurch to transfer Liam to the intensive care unit. They’ll be here within a couple of hours.’

‘He still needs blood.’ It seemed to be a major effort to open his eyes again. Andrew had never felt so tired in his entire life. Even the strain of nearly three hours of conducting major surgery under primitive conditions wasn’t enough to explain this weariness. ‘I’m O-negative,’ he informed Jennifer.

‘Mmm.’ The light above the couch in the consulting room was catching Jennifer’s bent head. Her hair had dried during its confinement under the cap she had worn in their makeshift operating theatre. Now Andrew could see it was still the colour he remembered so well. A rich honey blonde. And it was still just as curly, with soft waves that almost reached her shoulders. ‘Can you feel this at all?’ Jennifer asked.

‘No. You put in enough local to numb an elephant.’

‘I needed to. This cut was right down to the bone. It must have hurt like hell.’ Jennifer was concentrating on her task. Andrew watched in fascination as she caught the tip of her tongue between her teeth for a second. He could feel the tug deep in his calf muscle as another stitch was knotted into place. ‘No wonder you bled like a stuck pig,’ Jennifer commented.

‘I’m O-negative,’ Andrew repeated.

‘So you said.’ Jennifer glanced up. Her lips twitched as she reached for scissors. ‘I have to admit I couldn’t spot that. It looked just like ordinary blood to me.’

Andrew snorted. ‘You’re missing the point, Dr Tremaine. O-negative is a universal donor.’

‘Are you suggesting I’ve forgotten everything we learned at med school?’ Jennifer sounded cool. ‘I might point out that my marks in biochemistry were often better than yours.’

Andrew sighed inwardly. Jennifer hadn’t changed a bit. She still assumed that anything he said was in some way a criticism of her. She was still far too quick to defend herself by going into verbal attack mode. ‘What I’m suggesting is that I could donate some blood to young Liam Bellamy. A bit more haemoglobin circulating would do him a lot of good right now.’

‘You look like you could use a bit more yourself.’ Jennifer dropped the curved needle into a tray and picked up another. ‘We’re up to skin level now,’ she told Andrew. ‘I’ll try not to leave you with too much of a scar.’ She frowned at her patient. ‘You’re still looking rather pale. I think you probably lost more blood than I realised. I certainly wouldn’t even consider taking any more.’ Jennifer bent her head to her task again. ‘Besides,’ she added casually, ‘who knows what sort of condition your blood is in?’

‘What’s that supposed to mean?’ Andrew forced his weariness a little further away.

‘I’m talking about infectious diseases,’ Jennifer responded calmly. ‘Things like hepatitis or HIV.’

‘I wouldn’t have been licensed as a surgeon if I posed any threat of transmitting disease.’

‘How would they know?’

‘Try regular blood tests.’ Andrew felt a flush of annoyance. ‘I’ve been vaccinated for hepatitis and have documented proof that I’m clear of HIV.’

‘And when was your last test? Before or after you gave up your position as a surgeon?’

Andrew pushed aside the blanket covering his body. He felt distinctly overheated now. ‘Does it matter?’ he snapped. ‘Are you really interested in my sex life?’

‘No. Of course not.’ Andrew could see a faint flush of colour staining Jennifer’s cheeks.

‘Good. Because I would have nothing of interest to tell you. My sex life would bore anyone. Including me.’

Andrew felt a trickle of perspiration on his face. Was the heat responsible for giving him this wave of dizziness and nausea? Or was the stress of the last few hours catching up? Jennifer hadn’t been wrong about that cut hurting like hell. The pain hadn’t gone until she’d pumped local anaesthetic into his leg. And he had lost a lot of blood. He’d pushed himself to the limit after agreeing to operate on Liam Bellamy. While the assistance he’d had had exceeded expectations, it had still been a major achievement on his part to remove Liam’s spleen and control the massive abdominal blood loss. He was beginning to feel distinctly spaced out now. He gave up the effort of keeping his eyes open.

‘My sex life is non-existent,’ he heard himself saying. ‘How’s that for boring?’

The silence was odd. Andrew wondered whether he’d actually said the words aloud. Surely not! He opened his eyes to find Jennifer staring at him. Her expression was more peculiar than the silence.

‘You said you were on your honeymoon.’

‘I am.’ A silly grin plucked at the corners of Andrew’s mouth.

‘So where’s your wife?’ Jennifer was still staring. Lord, her eyes were gorgeous. Huge and round with the shade of hazel an exact match for the darker tones in her hair. Andrew blinked.

‘I didn’t bring her,’ he told Jennifer cheerfully. What was wrong with him? He was actually enjoying confessing his failure. ‘I’m starting a new trend,’ he added. ‘Solo honeymoons.’

‘Are you feeling all right?’ Jennifer was standing up. She appeared to be swaying slightly. ‘You look a bit hot.’

‘It is hot. This place is like an oven.’

‘It is warmer than it was,’ Jennifer conceded. ‘Jimmy came in to stoke up the old boiler because the emergency generator doesn’t cover the central heating. I’m not hot, though. I think I’ll take your temperature.’

‘Who’s Jimmy?’

‘Our caretaker. He’s married to Ruby.’

‘Who’s Ruby?’

‘Our cook.’ Jennifer was rummaging in a drawer. ‘Where is that thermometer?’ She glanced over her shoulder at Andrew. ‘Ruby came in as well. She’s making sandwiches for everybody. Are you hungry?’

‘No. Have you finished with my leg?’

‘I just need to put a dressing on it.’ Jennifer abandoned her search for the thermometer. She picked up a sterile pad and a crêpe bandage instead. The knock at the door of the consulting room halted her return to Andrew’s side.

‘Hi, Tom. Come in. I’m nearly finished here.’

Tom nodded at Andrew. ‘I just dropped by to let Mr Stephenson here know that his camper van’s been delivered to your place.’

‘Thanks, Tom. How are things looking out there?’

‘We’re over the worst. The weather’s starting to clear and there’s been no more accidents reported. The kids are all fine, by the way. Saskia wanted to know when you’ll get home.’

‘Not for a while yet, I’m afraid.’

Tom nodded again. ‘I’ll let her know. Is there anything you need here?’

‘We’re fine,’ Jennifer told the police officer. ‘Thanks to Andrew here, we’ve managed to cope with a fairly large crisis.’

‘So I heard.’ The glance Andrew received was one of respect. ‘John Bellamy’s here. Margaret’s taken him in to sit with Liam. He’d like a word.’

‘Of course. Tell him I’ll be there in a minute.’ Jennifer turned quickly back to Andrew as Tom left the room. She peeled the backing off the clear, sticky dressing. Now it was Andrew’s turn to stare at Jennifer.

‘Kids?’ he queried softly. ‘How many have you got?’

Jennifer was beginning to wind the crêpe bandage around his leg. ‘Let’s see.’ She smiled. ‘There’s Angus. He’s three. The twins, Jess and Sophie, are six and Michael’s the oldest at eight.’ She glanced up with a quick grin. ‘I suppose I’d better count Vanessa as well. She’s still a baby at six months old.’ Jennifer reached for a roll of tape.

Andrew was stunned. Five children? And the oldest was eight years old? His weary brain didn’t want to do the calculations. His chest felt tight. No wonder he’d never stood a chance. Jennifer must have been pregnant for the first time before she’d even married Hamish. Well before she’d left medical school. No wonder she’d given up her ambitions to be a surgeon herself. It was amazing she found time even to be a country GP.

‘There.’ Jennifer smoothed the tape holding the bandage in place and stripped off the gloves she was wearing. ‘Why don’t you have a rest while I go and check on Liam? Ruby’s getting your clothes dry so you’ll be able to get out of those scrubs soon. I’ll get her to bring you a cup of tea.’

Andrew wasn’t listening. So many questions were forming themselves in his fuzzy brain. Like why wasn’t Jennifer wearing a wedding ring? And where was Hamish? Surely the man voted most likely to succeed in their year hadn’t lowered his sights to a career in a small, rural hospital? But if he wasn’t around, how come Jennifer was still producing babies? And how could she possibly still look as young and attractive as ever when she was the mother of five? The tightness in his chest changed to a tickle and then a major irritation.

‘That’s a nasty cough.’ Jennifer frowned. ‘Are you sure you’re feeling all right?’

‘I’m fine.’ Andrew forced himself to a sitting position. ‘I had a viral illness a couple of weeks ago. Left me with a touch of bronchitis.’

Jennifer was still frowning. She fiddled with the end of her stethoscope. ‘Maybe I should give you a proper check-up.’

‘Forget it. You’ve got real patients to see to. Like Liam.’

‘Wendy’s quite capable of monitoring things. She’ll come and get us if we’re needed.’

The second knock on the door made them both expect an instant summons to Liam, who still lay in the treatment room, but it was Suzanne who appeared in the doorway.

‘We need you, Jen. Liz has been in second stage labour for over an hour. The baby hasn’t turned and I’m not happy. Liz is exhausted and the foetal heart rate is dropping slightly during contractions.’

Wendy’s face appeared beside Suzanne’s. ‘Liam’s ECG is showing a few irregularities,’ she informed Jennifer. ‘Can you come?’

Andrew watched as Jennifer straightened her back. He could see the determination to cope in her face as it settled into a look of grim focus. She must be as tired as he was. She’d worked a full day before being called out to that accident site and she’d coped brilliantly with the unusual stress of major surgery being conducted in her treatment room. It must be years since she’d worked as an anaesthetist and it hadn’t been easy, dealing with a patient in Liam’s critical condition. She had two patients needing urgent attention now and he suspected that others were waiting. That middle-aged couple from the accident for starters. He swung his legs over the edge of the couch. His loose scrub-suit trousers unfolded to cover the bandage on his leg.

‘You see to the baby,’ he told Jennifer. ‘I’ll look after Liam.’

Gratitude for Andrew’s unexpected offer of assistance stayed with Jennifer until she stepped into the maternity suite. Then everything else was forgotten. Elizabeth looked awful. Her face was puffy and her eyes swollen and red. A considerable number of tears had clearly been shed since Jennifer had last seen her patient. She picked up the damp cloth lying on the bedside locker and sponged her patient’s face gently as she absorbed her impression of the young woman’s condition and watched the trace of the foetal monitor.

‘You’ve been coping so well, Liz. You’re not having an easy time of it, are you?’





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