Doctor...to Duchess? (5 page)

Seeing her in a tiny nightie... Talk about a near short circuit. Just the flick of a finger on one of those silky little shoulder straps and...

He cleared his throat roughly. This was going to have to be one of those “keep your friends close and enemies closer” situations. Regardless of the effect Dr. MacKenzie was having on his composure, she wasn’t in the same camp. And things needed to stay that way.

“Start the car!”

Oliver’s senses shot to high alert as a fully clothed Julia pulled open the back passenger door of his four-by-four and threw in what looked like a military medical trauma kit.

“What’s going on?”

“Reggie Pryce. Do you know him?” She didn’t wait for an answer. “He’s trapped under his tractor in Shaw Field on the other side of the estate. They’ve called for an ambulance—but it could take well over an hour on these roads.”

Oliver scowled as she spoke. Just like old times. No matter how many fun runs were held, you couldn’t avoid the truth. This place was a deathtrap. Never enough time to get proper help.

He glanced at Julia, fully expecting her to give him a pointed look—a look that blamed him for their lack of resources. No. Quite the opposite.

“Let’s get going, yeah?” Her tone wasn’t accusatory. Just pragmatic. Wasted time cost lives. He cranked the engine.

“Do you know what the injuries are?”

“His son said he’s conscious but not looking good. Complaining of chest pain, and apparently he’s had quite a whack to the head. It’s one of those open cabs with a metal roof hood. Like most farmers, he wasn’t wearing his seat belt.” Oliver gave her a nod to continue as he pulled away from the clinic. “He was muck-spreading the field, hit a fresh rabbit warren and the whole thing tipped.”

“Right. I know a shortcut.” Oliver sharply turned the four-by-four onto a woody track. “Should cut about ten minutes off of the journey.”

“So there
are
advantages to being an insider.”

Oliver glanced at Julia, looking for signs of sarcasm or malice, but simply saw a deeply focused woman, visibly on point for whatever awaited them.

“Done much field work before?”

“Not really, but an injury’s an injury wherever it is. You know that more than most, I expect.” Her left hand automatically flew forward onto the dash as they rounded a sharp curve. She cried out in pain then gave a quick laugh as if to cover it up.

“You all right?”

“Yes. Still not used to keeping the old left hand out of action.”

“Trying to make me feel guilty?” It was a stab at light humor, but from the look on her face she was clearly unimpressed. A nice change from the sycophantic responses he usually received to his poor cocktail party banter.

Oliver stole another sidelong glance. He was fairly certain she didn’t know pushing her red lips into a thoughtful pucker was the opposite of off-putting. Quite the reverse, in fact.

“Hardly. Just getting used to your rather, uh, dynamic driving.”

Oliver gave an appreciative laugh. “This is my childhood turf! I know these woodland roads better than anything.”

“And yet the rumor mill is saying you would rather be in a war zone than here.”

There it was.
The biting comment. He’d known it was coming and had to raise an impressed eyebrow. The woman didn’t mince words.

“You didn’t strike me as someone who took idle gossip for fact.”

“Looks like we have bigger fish to fry at the moment.” Julia ignored his parry as they drove through an open field gate. She was right to have blanked him. It wasn’t her fault he hadn’t been around to set the record straight.

The upturned tractor appeared beyond the gateway. Oliver felt his pulse steady, relieved to be back on safer turf. Medicine. It was his mast—the thing that had kept him strong throughout the years away from Bryar Hall.

* * *

Julia grabbed her medical kit from the backseat and flew out of the four-by-four as they reached the tipped tractor. Her eyes scanned the site as she approached, relieved to see the body of the tractor didn’t appear to be bearing its full weight on Mr. Pryce’s torso. The curve of the landscape bore some of the weight but, even so, his chest appeared to be trapped by the tractor’s metal seat frame, while his torso had contorted so that his feet were lodged under the tractor’s mainframe. She knelt on the ground, immediately checking his airways and pulse rate. There was air, only just, and an unsteady pulse.

As Mr. Pryce’s son, Mike, hovered over her, Julia began to paw through the utility pouch of her trauma kit, well aware the field was covered in freshly spread manure. It was a minefield of bacteria—septicemia central. She had to get the seeping gash on Reg’s forehead cleaned and fast. No point in adding a blood infection to the list of injuries he’d have to battle.

“He lost consciousness a couple of minutes ago. I tried everything I could think of to keep him awake.”

“It’s all right, Mike.” Oliver appeared by her side, his voice full of reassuring calm. “We’ve got you covered. Julia?”

“I’m just going to clean up the blood and get some gauze on this head wound. It’s bleeding heavily but isn’t too deep.” She chanced a glance up at Oliver. “He’s not breathing as well as he should. Looks like flail chest.” Julia kept her voice low. They both knew what that meant. A fifty percent survival rate. They had to work fast and hope there wasn’t any internal bleeding to fight, as well.

“Good call.” Oliver placed his fingers on Mr. Pryce’s neck, trying to feel for a pulse as he spoke. “Rapid, shallow breathing. I’m guessing he passed out because of the pain, Mike. It’s the body’s way of coping.” He put a hand on the young man’s shoulder. “I’m going to need your help. We’ve got to lift the tractor. Who knows what’s going on under there that we can’t see?”

Oliver looked at Julia intently. Were his green eyes seeking trust or answers? He continued before she could respond.

“Looks like you have an oxygen kit in that pack of yours, yes? As soon as that tractor is lifted, we can deal with the full picture.”

Julia shook her head. She knew Oliver was an experienced trauma doctor, and rapid response would be something that came naturally, but something told her they were better off waiting. “We should change that ambulance to a helicopter and wait for it to arrive before doing anything beyond stabilization.”

“There are only two choppers for this entire region,” Oliver snapped. “Who’s to say one’s available?”

“We’re hardly going to know if we don’t try. I didn’t take you for a no-hoper.”

Oliver quirked an eyebrow in response.

He was willing to listen.
Good.
Maybe some good old-fashioned logic would get through that thick skull of his.

She continued, “If any rib cage shards pierce his lungs when the tractor moves, we won’t have the equipment to deal with it. Opening him up here would be as good as killing him.”

“Good point.” Oliver pushed an arm under the portion of the cab pinning Reg to the ground and felt his extremities. “Nothing seems to be blocking blood flow. His legs are still warm. Let’s see what we can do.”

She nodded and continued to swab away the blood on Reg’s forehead, hoping Oliver didn’t see the slight shake in her hand. He might be used to traumas like this in Africa, but it was Julia’s first. Volunteering at military family clinics hadn’t prepped her for this. The fact there was even a semblance of calm steadying her heart rate made her feel proud. And she was not a little relieved Oliver was there. The man exuded control. He was definitely in his element.

“Mike.” Julia turned to Reg’s son. “I don’t want you to worry, but we may need to help your father breathe. We think he’s fractured some ribs and it makes it very difficult for him to breathe on his own.”
Or near impossible.
Flail chests led to a decrease in oxygen exchange at the site of the trauma and affected both lungs. Pendulum respiration was no joke. With the same air moving from one lung to the other, hypoxia or respiratory failure weren’t far behind.

“Can you make a call to emergency services and say we need a helicopter right away? Tell them it’s a flail chest. Got that?” He nodded, pupils wide with stress. She had to keep him focused. “Then can you help Oliver with the ropes, please? You’re going to have to help pull the tractor off when the helicopter arrives.”

“He’s going to be all right, isn’t he?”

“We’re going to do everything we can. Maybe you could start by unhitching the muck spreader?” She knew better than most you couldn’t make promises. Matt had never promised he’d come home safe—he’d only told her that his heart was always with her. She pulled a fresh swab out of her kit and got to work.

“You’ve got all the bells and whistles.” Oliver nodded toward her kit, rising as he spoke. “You all right on your own for a bit?”

“Yeah. You two go ahead. I’ll do what I can here.”

Julia fine-tuned her focus and quickly went to work cleaning the wound on Reg’s head before applying a bandage. Next, she lowered her cheek to his mouth to check on his breathing.

It was still strained, and Reg remained unresponsive.

She needed to stabilize his chest wall before they moved him. If it wasn’t secured now, just one misstep and he could die. It was as simple as that.

She popped her stethoscope on and forced a slow breath through her lips as she established his respiratory rate and pattern. The full minute she timed felt like a century. She checked for neck swelling, swollen veins along his cervical collar and hyper-expansion in his lungs. There didn’t appear to be a pneumothorax but, from the cooling of his skin, things weren’t looking good.

“Mike, how are we doing on the helicopter?

Mike appeared around the corner. “They say one can be here in ten minutes.”

“Brilliant, thanks.” It could’ve been an “I told you so” moment, but Oliver was nowhere to be seen, and smugness wasn’t her style. “How are you holding up?”

“Muck spreader’s unhitched. Just attaching the tow lines now.”

Right.
Focus, focus, focus
. The number of things that could go wrong in ten minutes was mind-numbing: cardiac tamponade; pericardiocentesis; to chest drain or not to chest drain? Not to mention all the things they should be considering now that Reg was going to fly to hospital.

“Right, we’re all hitched up. What do you need me to do?” Oliver’s voice wrapped round her like a warm blanket. Oliver the doctor was a much nicer person to spend time with. He made her believe she could do this.

“We need to splint up his rib cage before the tractor is raised. Any ideas?”

“Obs?”

Julia rattled off what she knew while reaching into her kit for a trauma blanket.

“Maybe we could use this for splinting. If we can turn him round to the flail side as we wrap him in the blanket, it should hold him steady and give him extra warmth while we wait.” She pulled off her coat and bundled it up. “Use this as a support cushion to help.”

He took the coat and placed it on the ground where they would roll Reg. “Do you have any morphine?”

“Some.”

“Let’s make use of it, shall we?” Oliver gave her a gentle smile before returning to his exacting placement of the blanket around Reg’s ribs.

Julia handed over the vial and prepared a needle for him. She liked how he worked—steady. In control. Doing what he could in a bad situation. It was easy to picture him working in a conflict zone. Shame. As each moment passed, it was getting easier to picture him here. Julia shook her head. Not the time or place to daydream!

Ever so carefully, they managed to shift Reg’s upper torso onto the left side, the high-flow oxygen mask attached to his mouth.

“How long is it before the helicopter arrives?”

Julia glanced at her watch, surprised to see five of the ten minutes had passed. It had felt like the blink of an eye. “About five more minutes.”

“Why don’t you hold Reg in place, and Mike and I will go ahead and pull the tractor off? It will take a couple of minutes and that way when the chopper arrives we won’t be in the way. They can land in the center of the field no problem, put Reg on a board and get him to hospital.”

“Are you sure the tow ropes can handle it?”

Oliver locked eyes with her, his voice rock solid. “I wouldn’t try it—particularly with you looking after Reg—if I wasn’t sure.”

“Oh.” She blinked away the desire to stay there, searching the depths of his eyes, exploring what he meant by “particularly with you.” Was it a slight or was he looking after her as well as Reg? She blinked again and saw he needed a decision. “No, of course not. Let’s get going.”

* * *

Oliver double-checked the gears and eased his vehicle forward. It had a three-and-a-half-ton towing capacity. A quick check on the old-fashioned tractor had said it was just over two tons. This should be a no-brainer. He began to feel the strain of the tractor tug on his vehicle. Lifting it against the pull of the slope was going to make it tough. Tough—but not impossible. Slowly, he inched forward. With his eyes darting between the rear-view mirror and the field in front of him he began to feel his vehicle take on the full weight of the tractor. This would go well. The familiar sensation of success kicked in. This was the Oliver he knew. The one who made decisions and stuck with them. As the tractor came upright with a comfortable thud, Oliver gave himself a grin in the rear-view mirror.
See? Nothing to it
.

The familiar sound of a helicopter’s rotors snapped him back into action. Mike was already untying the tow leads so Oliver could move the Land Rover out of the helicopter’s way.

Within moments, the crew was on the ground, and Reg Pryce was boarded and on the way to hospital. He didn’t know if the poor man would survive his injuries—they were serious—but at least they had done all they could. He looked over as Julia signed some paperwork before the flight took off. Scrubbing at his chin, he silently acknowledged that Reg stood a much higher chance because of her. He wouldn’t even have tried to get a helicopter in and that bored straight through to his soul.

Had this place really made him that cold—that lacking in drive? He certainly wasn’t like that anywhere else he worked. His brain worked well outside the box in the stark environs of a combat zone and it didn’t feel good that he was as likely to fall into old patterns here at Bryar Estate as the next person. A smile crept onto his lips despite himself. Maybe Julia’s arrival was a reminder of all that
was
possible in this hideaway hamlet. Just maybe.