Temporary Doctor, Surprise Father

Jan prayed that thirteen years, a name change, and an extreme make-over might throw Beck off her trail. No longer January Stewart, the popular high-school prom queen, now she was a once-divorced, radically toned-down version of her former self. Everything about her was different, from her last name to bobbed dark blond hair instead of long brash platinum waves cupping her waist. She wore glasses now instead of contacts, and had gained a handful of strategically placed pounds. He really shouldn’t recognize her. Should he?

“Got it,” she mumbled, wiping her nose with a tissue to disguise her face, her voice sounding gravelly from her tickling throat.

“Thanks,” Beck said. “And it’s nice to meet you.” Something flickered in his eyes when he reached for and shook her other hand. Recalling how his eye color could change from day to day depending on what he wore, she quickly looked away before her warming cheeks became too obvious, but not before she’d already noticed they were gray-blue today. His hand felt calloused, as if he was no stranger to hard work. That made sense for the street tough kid who’d always longed for adventure. Legions of awakening nerve endings marched up from her hand to her arm and fanned out across her shoulders.

A fond memory of how secure she’d once felt holding his hand flashed into her mind. She loosened her grip and let her hand slip free, anything to stop the reaction, but her mind refused to shut down.

Never in a million years would she ever have guessed he’d become a police officer. He’d done everything in his power to act like an outlaw in his teens, always getting into fights and not caring what anyone, including teachers, had to say.

Her lips tickled at the edges with the absurdity. But he’d never have dreamed she’d become a nurse, either. “Most likely to be a movie star.” Wasn’t that what her high-school annual had predicted for her? Heck, they’d even inserted a pair of sunglasses over one of her rare candid pictures with the caption, “Bright future. Must wear shades.”

Carmen strode around the ER desk and plopped a clipboard in Gavin’s hand. “Full moon’s apparently already rising. We’ve got a level-one trauma in transit. A gunshot wound. ETA five minutes,” she said with her usual aplomb.

Grateful for the distraction, Jan went on alert.

“Is this gang related?” Dr. Riordan asked.

“Not sure, but he fits the age range and the neighborhood.”

“Notify Security and lock down the ED waiting room just in case.”

“Already have,” Carmen retorted.

Gavin lifted his brows, tilted his head and trained his dark eyes on Beck. “Are you off duty yet?”

“Just about.”

“Then you’d better get changed.”

* * *

Adrenaline pumped through every vein in Beck’s body in the men’s locker room. Wasn’t that what he lived for? The mention of a gunshot wound sent his mind spiraling back to his last tour of duty. Though gunshot wounds had been common, they had been the least of his worries then. What still haunted him were IEDs—improvised explosive devices—and lost body parts and burns, plus the fact you could never easily identify the difference between the enemy and the local allies. To this day he tensed whenever he passed an abandoned car at the side of the road.

Beck forced himself to focus on the job at hand. He’d learned that was all he could ever do. Think of it as another adventure. One more for the file.

Something else butted into his thinking. Why did that nurse seem so familiar? She wasn’t exactly his type, but an odd current had traveled up his arm when they’d shaken hands. She hadn’t looked him in the eyes, and with lightly tinted glasses like those, it had been hard to read her expression. She’d seemed to squirm, and it surprised him. Usually, women reacted much more welcomingly to his touch. He shook his head. He should be focusing on the incoming GSW, yet…there was something very familiar about her.

After stripping and throwing on a pair of thread-worn scrubs, he realized he only had his work boots for shoes. Looking around the room, he spotted some extra-large OR shoe covers and slipped them on over his boots. Tucking in and tying the waistband on his scrubs, he rushed toward Gavin Riordan, the man offering his ER and saving him three weeks’ intensive training in North Carolina. Along with everyone else, he waited at the ambulance entrance for hell to break loose as they all applied personal protective gear.

And there she was again, the nurse, waiting beside Gavin. Her height and oval-shaped face definitely reminded him of his high-school sweetheart. Some sweetheart she’d turned out to be. No sooner had he left for bootcamp then she’d torn his heart out of his chest and stomped on it. Focus, Braxton, focus.

One thing struck him about the ER: it was so much quieter here than in the field. Then, boom, the ambulance entrance doors flew open, and Gavin and the trauma team jumped into action around the gurney.

“Got the call a half hour ago,” the first EMT said.

“It’s a penetrating injury. Gunshot wound to right chest wall with possible pneumothorax,” the second EMT said, while assisting the semi-conscious young patient’s breathing with an ambubag as the team rolled the stretcher down the hall.

Beck remembered the term “the golden hour”, the most important sixty minutes in any trauma patient’s life if he was to survive. Though things might look chaotic, there was, in fact, a planned system by the attending doctor and his team for checking the ABCs—airway, breathing, circulation—and making primary and secondary surveys of the patient.

“No other obvious injuries noted.” The EMT gave them the run-down of vital signs and initial assessment while they made their way down the corridor. “A 16-gauge IV placed in left forearm, infusing normal saline at 150 cc per hr. Pressure dressing applied to point of entry wound.”

Bright motion-activated lighting snapped on the moment they crossed the threshold of the trauma room, illuminating all the gory details. Wine-colored blood covered most of the victim’s clothes. A C-collar had been applied at the scene as he’d fallen out of a truck. They’d attempted to relieve the apparent tension pneumothorax with a needle at the second rib below the collarbone. It may have saved the guy’s life.

On the count of three the team transferred the patient to the larger procedure room bed.

The familiar-looking nurse with the boxy glasses and shy attitude went right to work cutting off the patient’s clothes, using surprising force to rip the shirtsleeves open to speed up the process. Even her mannerisms reminded him of January. But she’d had so much more style than this woman. She had been bubbly and full of life. This woman seemed subdued and almost beaten down. But they called her Jan. Hmm. Could thirteen years change someone that much?

A chaotic dance ensued among two doctors and three nurses. Their hands and bodies worked together, stepping aside, sliding under, reaching over, around, and through to get an airway placed, the patient hooked up to monitors, and a second IV started.

Beck wasn’t sure whether to hold off or jump right in with the team, but followed his gut and helped Jan remove every last stitch of clothing and toss it to the floor. He kicked the wad of clothes at his feet toward the wall to prevent anyone from tripping on it.

Gavin gave instruction that the OR be notified then called out a list of orders, including labs, blood gases, X-rays and two units of blood, while he did what Beck remembered as the primary survey. It was a methodical approach to checking the airway, breathing and circulation. Gavin auscultated the patient’s lungs and mumbled, “Crepitus” then studied the wound more closely. “Luckily for him this bullet nicked a vein and not an artery,” he said, palpating the femoral artery on the same side before he uncovered another gunshot wound lower down the leg.

The patient’s cold, clammy skin made Beck suspect shock.

“Get me a chest tube drain with autotransfusion,” Gavin told the nurse beside him.

Beck knew that meant Gavin suspected hemothorax—blood surrounding the lung instead of air. Beneath the first-aid bandages applied at the scene, a quarter-sized crater erupting with thick dark blood was located in the right upper quadrant and became the center of attention. Until the lungs were stabilized, the second, less threatening gunshot wound could wait.

The overhead monitor alarm beeped rapidly as the initial vital signs registered. The oxygen sats had tanked, BP was 80/40 and the pulse 130. The youth’s heart was working like crazy in an attempt to maintain his body’s circulation, and with a pneumothorax his lungs weren’t getting nearly enough oxygen. If not stopped, it would be a deadly cycle.

“Let’s get that chest tube in now,” Gavin said, searching for and finding Beck. Their eyes met in wordless communication, and Gavin stepped back, allowing Beck to approach the man. Baptism by fire.

Jan magically reappeared and rolled over a tray with all the equipment he’d need. He flashed back to his training, then several tours of duty, and recalled each step of the process of inserting a chest tube. He’d done his share of them in the field. Feeling under a microscope here, with the world watching, he donned sterile gloves and, driven by adrenaline, hoped his hands didn’t shake too noticeably.

After prepping the skin with antiseptic, he draped it with a sterile towel. He palpated the space between the fifth and sixth ribs and reached for the large syringe Jan handed him. He inserted the needle into the bottle of lidocaine she held for him, and administered the local anesthetic, waited briefly then accepted the proffered scalpel and made an incision in the mid-axillary line. She dutifully handed him a sterile package she’d begun to open from the outside, which gave easy access to the inside tubing without contaminating it.

Beck glanced briefly into her eyes just before he took it. For one beat their gazes locked. At close range, her eyes were blue, just like January’s. Damn.

A mini-jolt of adrenaline helped him refocus. Using the rigid guide, he inserted the tube into the pleural cavity and aimed upwards as he slowly advanced it until he felt resistance. He pulled back a tiny bit and clamped the tube. With no sign of blood, the wounded young man had been lucky. Jan connected the tube to an underwater seal before he undid the clamp. A reassuring bubbling sound gave him the confidence to begin suturing the tube in place. Soon, with the trapped air removed and no longer pressing against the lung, the lung could reinflate and the man would be breathing a lot easier.

“OK, let’s get a chest X-ray to check positioning,” Gavin said as he clamped a hand on Beck’s shoulder. “Good job.”

To say Beck wasn’t relieved would be lying, but the knowledge of a job well done admittedly felt good. “Thanks. It’s been a while.”

Jan wrapped adhesive tape around the tube and affixed it to the patient’s chest wall, then Beck looped the chest tube and taped it snugly to the patient’s abdomen before applying the final dressing.

Once Beck stepped back after his part was finished, Gavin took over. He’d located the superficially lodged bullet and removed it, then plopped it into a plastic specimen container held by Jan.

“Fantastical,” she mumbled as she studied the bloody ball of metal while Gavin stabilized the patient and readied him for surgery.

Had she just said fantastical? That was it. The missing link. In the midst of chaos and saving a life, quick memories popped into his mind of the only other person he’d ever heard say “fantastic” that way. If he hadn’t been sure before, he definitely was now.

But this person was nothing like that girl.

Still reeling from the notion that he’d stumbled on his first love, he watched Gavin proceed with a secondary survey head-to-toe assessment for more subtle injuries.

While consciously avoiding any thoughts about his ex-girlfriend, he waited for the chest X-ray films. Beck leaned against the wall and observed the team hovering over the patient, whose vital signs were already improving. He lifted the protective goggles from his eyes where perspiration had started to bead and steam them up, resting the glasses on his forehead. He glanced around the gurney from person to person, with everyone intent on what they were doing. Excellent teamwork.