Chapter Eight
C al slipped two uncharacteristically shaking fingers in the rings of the clamp on the femoral artery above his repair and slowly released pressure. Please work , he prayed. Worse came to worst, he could re-clamp everything and hope they could get Tuli to Fairbanks in under twenty-four hours. They’d be racing the clock against permanent tissue damage and an entire blizzard, but at least he had a plan B, even if it semi-sucked.
The artery below the clamp filled with blood, even with the tourniquet still applied on Tuli’s upper thigh.
Then a pulse became visible. Each jump of the vessel sent a jolt of adrenaline through his own circulation.
Hold. Hold.
Three more pulsations. He expected to see blood squirting from between the sutures.
He gritted his teeth. Hold, goddammit.
“Can you dab that area, please?” His voice came out shaky. Hopefully no one noticed or thought poorly of him for it.
“To be honest, I don’t want to touch it,” Deirdre said.
Despite the situation, he chuckled. She didn’t realize how much her quiet confidence grounded him in this situation.
“Hey, I don’t blame you one bit.” He met her bright blue stare, and the tension between his shoulder blades eased. “But we have to.”
She dabbed the suture line and surrounding tissue. No bleeding from the vessel. Only a small amount of oozing came from damaged but now re-perfused muscle. His heart lodged in his throat. Had they really done it? “I think it’s good.”
“Way to go. You might make a solid surgery intern before you’re all done.” Dr. Yang laughed. As everyone in the room took a deep breath, Dr. Yang intoned, “You’re not quite done. The location of injury has a high risk of tearing the nearby femoral vein and femoral nerve. See if you can isolate and check those structures.”
He and Deirdre both sucked in twin deep breaths and bent their heads in unison, studying the exposed tissue. The vein was lateral to the artery and—he carefully dissected around it enough to visualize it and gingerly move it with vascular forceps—patent. The nerve? He found a remnant of the off-white millimeter thick nerve below the injury site. Torn.
“Where’s the other part?” he muttered.
Deirdre dabbed and gently pushed tissue back. “Is that it?”
He blinked, willing himself not to anchor his conclusion in the first structure he saw that looked like a nerve. He forced himself to go through the process of looking around and considering what else this could represent. It did look like a nerve. Tracing it proximally a few centimeters, he identified the muscular branches of the nerve. Likely above that, it would come together into the thick main femoral nerve.
Okay. He had both ends of the severed nerve. “Found it, Dr. Yang.”
“If you can reapproximate the endings of that nerve with a stitch, that will reduce the chance of long-term neurological damage to the limb.”
He lifted his hand, wanting to brush sweat from his forehead, but caught himself. There really should be a surgeon here in Yukon Valley twenty-four seven for times like this.
Bending to the task, he placed two sutures into the ends of the severed nerve and snugged them together. “Done.”
“Give the area some good irrigation to make sure you remove any foreign material.”
Deirdre dabbed as he drew up sterile saline in a large syringe and flushed the area several times. The fluid soaked the sterile towels and the bed. A mixture of blood and saline dripped off the vinyl mattress and onto the floor.
“This room looks like a disaster, but the wound, I think, is cleaned out,” he said.
Deirdre’s eyes lit up. “I’ll run interference for complaints from environmental services staff when they try to clean this mess.”
Everyone chuckled. The air in the room seemed less heavy.
Dr. Yang said, “Only thing left to do is release the tourniquet.”
Cal locked onto Deirdre’s wide-eyed stare. “I am one hundred percent certain none of us want to do that, Dr. Yang.”
“I know. But do it.”
“All right. Moment of truth. Clyde, can you reach under the sterile towel and loosen the tourniquet?”
Clyde slowly released the pressure. As blood flowed, completely unimpeded, through the leg, the femoral pulse bounded more vigorously, and the surrounding tissue and distal limb went from pallor to pink in a matter of a few minutes.
“I’ll be darned.” Cal said, then caught himself. “Um, not that I had any doubt whatsoever this would totally work.” He whipped his head around to shoot daggers at the snickering staff.
Deirdre said, “You did it!” Her smile was hidden by the mask, but he could see the happy crinkles next to her eyes.
Dr. Yang interrupted the celebrations. “Great job and all that jazz. All right, friends. Some of us have work to do,” she said dryly. “Irrigate a few more times, then close the defect. Don’t worry about layered closure. Place a pressure dressing over the site. Ship him as soon as you are able, and we’ll be ready for him whenever he arrives. We’ll do follow-up management up here.”
“Dr. Yang. Fantastic assist from hundreds of miles away. We can’t thank you enough.” Cal blew out a huge breath. “Now I know why I’m getting gray hair.”
“You earned every strand.” Deirdre’s confident tone of voice warmed him.
The staff disconnected the telehealth unit and rolled it out of the room. Tuli’s vitals were stable. The second unit of blood dripped through the IV.
After another ten minutes of irrigation and additional repair, Calvin stood up straight, every muscle and joint protesting the upright position.
Sure, he managed plenty of life-threatening situations on a regular basis at Harborview.
Never without a safety net.
Yukon Valley Hospital might be small, but the staff and their ability to improvise was next level.
After taking off his gown, gloves, eye shields, and mask, he said, “Everyone did an impressive job saving Tuli’s life. Way to go. Let’s do a team debrief before shift change.” He took a moment to meet everyone’s eyes. “But bottom line for me is that I couldn’t have done this without every one of you here today.” He stopped rotating when he got to Deirdre. Her steady encouragement made him feel like he could save any patient, regardless of how few resources were available.
He could get used to unwavering support like that. A dangerous thought.
Deirdre smiled at Cal and the team, faint red lines marking her cheeks and the bridge of her nose where the mask had rested. “I’d give everyone a hug, but I’m a total disaster.” She paused, her gaze raking over him. “And Dr. Garrett looks like he committed a crime!”
“My only crime is doing surgery without an actual license.” The laugh that came up from the depths of his belly released the past hour of tension like a popped balloon. “I’m counting on the fact that no one is going to report me to the state medical board.” Of course, he was covered by the fact that he was working within his scope as an ED physician, but everyone seemed to appreciate the levity of the moment.
Ducking out to the call room, he quickly rinsed off in the shower, grabbed a fresh pair of underwear and socks and a T-shirt, and threw on clean scrubs. In a matter of minutes, he had holding orders placed and a plan for transfer to Fairbanks as soon as the weather would allow.
Staff cleaned up the mess in the room and began restocking supplies, their companionable murmurs wrapping around him. Deirdre had stuck around to help Amberlyn and Clyde.
Deirdre was something else. Cool under pressure. Confident. A perfect partner.
For someone else. He scrubbed his eyelids, as if that would get the image of her wide blue eyes out of his memory.
Fifteen minutes later, Tom stuck his head out of the trauma bay. “Tuli’s awake now, Doc.”
As Cal stepped into the room, Tuli gave a groggy smile. “Hey, Doc. I made it. Either that or heaven is not as advertised.” He glanced toward the door, then down at his bloody bed linens and clothes. “Hi, Lou. Sorry my artery attacked you and made the inside of the ambulance look like an exorcism occurred. Any chance I can get cleaned up?”
Mav snorted as he rolled the gurney away toward the ambulance bay.
Louise smiled, brows furrowed. “We’ll be cleaning the rig for a week. You, too, from the looks of it. Ah, Clyde’s got you a fresh gown and sheets.” With another long look, she pushed off the open sliding doorway and followed Maverick out.
“Hey, someone give me my phone. I’m going live before I put that pastel blue gown on.” Tuli snorted. “Bet this story will go viral.”
Everyone in the room eye-rolled or groaned. No one handed him his phone.
Cal squeezed Tuli’s upper arm, turned around, and spied Deirdre gingerly picking up her clean blazer from the countertop. The front of her blouse had a dark stain on it from Tuli’s blood. Tendrils of sweaty hair had matted on her neck and cheeks. Her face was still flushed, probably from the heat of wearing the impermeable gown while working under the bright exam light.
Hardworking. Determined. Endearing.
Beautiful.
“I’m heading out, unless anybody needs anything else.” Deirdre shoved hair behind an ear.
When she paused a few feet from Cal, everything else in the room faded away. Dimly, he noted that the staff had made themselves very busy or very scarce.
“Thanks again, Deirdre.”
“I’d say anytime , but no offense—I’m calling it a day and hoping no one needs me for the next twelve hours.” She wrinkled her nose, smiled at everyone, then turned on her heel and exited.
For an extra few seconds, Cal stared at the sliding glass door.
“There’s a problem, Doc,” Tuli said.
He immediately leaned over him, lifting the fresh gown to check the dry dressing on his leg. “What? Are you in pain? Any breathing issues?”
“No. You have it bad.” Maybe the blood loss caused confusion.
“What?”
“Look, I might have been under anesthesia, but I have enough brain cells left to tell me what saw.” He pursed his lips. “You in denial about Deirdre Steen?”
His neck prickled as his stomach took a dive. “First of all, there’s nothing going on. Second of all”—he glanced toward the door where Louise hovered, ostensibly finishing up paperwork—“you have zero room to talk. Do you want me to go into detail with my lucid observations about you making eyes at a certain EMT?”
Tuli started to cross his arms but winced at the IVs and straightened his limbs out again. His eyes went wide, then shuttered. “Yep, must be the drugs making me see and say silly things. Forget I said anything. Never mind.”
Two could play this game. “That’s what I thought.”
Exiting the trauma bay, Cal settled in front of a computer in the work area to finish his documentation and add any other orders. On his phone resting next to the monitor, he glanced at a red notification. His shoulders tightened. He had been expecting an email that could disrupt everything, whether he wanted it to or not.
As the message popped up, he blew out a breath and sank down in the seat. It was from his department chair at Harborview, checking in on his timeline for returning. Of course they needed him there, covering shifts. He knew his absence had created a hardship for the team.
What of his absence from the team here?
What about his absence from the person who made the best team with Cal? Who always had.
Scrubbing his hands over his face for what had to be the thousandth time today, Cal turned the phone facedown. He had an entire career waiting for him back in Seattle.
He had… appearances to maintain in Yukon Valley.
This work, these friends, playing pretend with Deirdre—all of it was temporary. A foundation built on melting ice.
For some reason, Calvin wasn’t prepared to sink or drown.