“A CHEST TUBE won’t work, will it?” Jenna asked. She knew a chest tube could reinflate a collapsed lung, but she suspected bleeding inside the lung was a whole different scenario.
“No.” Zach’s tense gaze met hers. “Let’s go. We can suction the blood out of her lungs in the chopper. The quicker we get her to Trinity, the quicker they can take her to surgery.”
She wasn’t about to argue, knowing Sherry’s chances of survival hung on a very thin thread. Between the two of them, they hoisted their young patient onto the gurney. Jenna strapped her in as Zach gave breaths with the ambu-bag. Then he handed the bag to Jenna, and pushed the gurney as she ran alongside.
Zach must have given Nate the high sign, or the pilot had eagle eyes, because he had the chopper revved up and ready to go when they reached the back of the helicopter.
Jenna crawled in through the back hatch after they’d hoisted their patient inside. Zach closed the door behind her, then ran around to climb in the side door. He took the seat at the head of the patient, but Jenna was already suctioning blood from the endotracheal tube. She stared in horror as the blood came out in copious amounts, filling a good portion of the suction canister. The contents portended the patient’s chance of survival. How would they manage to keep up enough to control the bleeding?
Zach took the suction supplies from her hands and shoved her helmet into her stomach. She’d completely forgotten to put it on. Quickly, she donned the headgear, then connected the communication link.
“We’ll take turns with suctioning. Dial her up to 100 percent,” Zach directed.
She nodded. “How many more units of blood should I give?”
“How many O-neg units do we have left?” Good point. She glanced into the small cooler. “Three. I’ll give them all.”
He nodded his agreement and cued his microphone. “Nate, radio in to warn them we’ll need a hot unload. The cardiothoracic team needs to be on standby. We’re taking her straight to the OR.”
“Will do.” Nate proceeded to call in to the dispatcher.
Jenna hung another two units of blood, then took a turn with suctioning. The amount and thickness of the blood coming from Sherry’s lungs was just as bad this time around.
“The bleeding hasn’t slowed. We’re not gaining any ground with her.” She couldn’t hide her frustration.
“Maybe, but we’re not losing any, either. Her blood pressure is hanging in there at 85 over 40.”
Okay, she could take lessons from Zach and try to see the glass as half-full. She battered down the feeling of doom. “Should we start a vasopressor?”
“Yeah, add some dopamine, but use it sparingly. I don’t want her heart rate to go much higher.”
Jenna hung the medication in one IV, leaving the other for the last unit of blood. In spite of the near constant suctioning and the blood transfusions, Sherry’s heart rate spiked to 178 and her oxygen saturation dropped to the low 80s.
They were losing her. Jenna struggled to remain calm. Nate’s voice over the microphone gave a little relief. “ETA two minutes. The cardiothoracic team is waiting on the helipad.”
Come on, Sherry, hang in there. Jenna gave additional IV fluids once she ran out of blood. Zach finished suctioning the moment Nate landed the chopper and killed the engine.
Jenna stayed with the patient as Zach jumped down, then went around to the back. She pushed the gurney out toward him, then hopped out.
Dozens of medical personnel swarmed Sherry’s gurney. Jenna knew her help wasn’t needed at this juncture, but she followed the group as they wheeled Sherry into an elevator and rode down to the trauma OR suite. At the doorway to the OR, she hesitated, not wanting to break the sterile field. As she watched, the tone among the caregivers became more urgent.
“She’s in full-blown arrest. Start CPR.”
Jenna recognized Zach’s voice and her fingers itched to jump in and help. But even Zach stepped back as the entire cardiothoracic team took over the code blue.
“Put her under,” the surgeon yelled. “I need to open her chest, or we’ll lose her.”
She couldn’t tear her gaze away as the anesthesiologist connected Sherry to the anesthesia machine. They barely took the time to prep her before cutting into the left side of her chest. Blood spurted and the OR nurses hurried to connect the suction.
Jenna had never seen any surgical procedure like this before. Certainly not under these circumstances. She could only watch in morbid fascination.
“Her blood pressure is non-existent.” Now the anesthesiologist shouted over the din. “I’ve already started a second and a third vasopressor. Hurry up, or we’ll have to start CPR again.”
“Dammit.” Two surgeons worked as fast as they could, but when blood pooled on the floor at their feet, and Sherry’s heartbeat went from too fast to a rate that was far too slow, Jenna feared their efforts would be in vain.
“We’ve lost her pulse,” the anesthesiologist said abruptly. “She’s gone.”
The surgeons glanced up at the monitor and the activity in the room ceased.
“No.” Jenna hadn’t realized she’d spoken out loud until the attending surgeon turned to look at her. She clamped her mouth shut and bit down hard on her lip to keep from crying.
Zach rubbed the back of his neck as he crossed over to her. “We did our best, Jenna.”
“Why didn’t they do CPR? Why didn’t they keep going?” She couldn’t hold back her accusing tone.
“Because they couldn’t do CPR and operate on her chest at the same time. The only way to fix the problem was surgery.” Zach didn’t take offense.
She took several deep breaths to ward off the sudden nausea. Maybe Zach was right and there was nothing more they could have done. Sherry had lost her young life as a result of needless violence.
And the young girl could have been Rae.
“Come on, you’d better sit before you fall.” She was only vaguely aware of Zach steering her away from the blood-filled OR suite. He held on to her arm with a firm grip. Outside, in the OR lounge, he shoved her into a seat.
“I’m fine.” Her voice lacked conviction, and it was a struggle to stay upright even in the chair.
“You’re not fine.” The sharp edge of his tone cut her like a razor. “Do you think I don’t know what you’re going through? Do you think I don’t see the resemblance between this patient and your sister? Cripes, Jenna, you have every right to feel ill.”
“I can’t believe she died.” Jenna couldn’t remain strong, not anymore. She buried her face in her hands. “Why couldn’t we have gotten there a little earlier?”
“Shh.” Zach sat in a chair next to her and pulled her into his arms. Grateful for his strength, his support, she hung on. He stroked a hand down her back. “It’s all right, sweetheart. It’s all right.”
Jenna closed her eyes, but the scene at the mall was etched in her mind. For a moment she soaked up some of Zach’s strength. His arms wrapped around her felt so right. At the same time she knew it was wrong. They were flight partners, nothing more. She took a deep breath and gently pushed away from the addictive comfort of Zach’s chest. She was a paramedic, had seen many deaths. Why had she let this one get to her?
“Sorry. Didn’t mean to lose it like that.” She avoided Zach’s gaze.
“Don’t apologize, Jenna.” Zach reached up and slowly wiped the tears from her cheeks with his thumb. “I understand.”
His touch made her feel cherished. Special. An emotion as alien to her as driving a Lexus. She hardened her heart. Zach didn’t know anything about her life.
“Do you?” She looked him directly in the eye. “This incident is awful, but it’s hardly the first of its kind. Especially not where I live. Don’t you see? This is exactly why I’ve been working so hard to get Rae into college. At least with a solid education she has a fighting chance to avoid ending up another victim in the circle of violence.”
Zach nodded his gaze thoughtful. “Yeah, I guess I can see that.” His smile was crooked. “You are an amazing woman, Jenna. One of the few who actually takes action rather than sitting around and complaining how life isn’t fair.”
His comment was so unexpected she was momentarily speechless. Her brain short-circuited. “Uh…thanks.”
“Are you looking for any more volunteers to help out at the MECT center?” he asked.
She stared at him for a moment. Maybe this was his way of trying to be nice. But, really, he was taking things a little too far. “I’m not going to lie. We’re always looking for help, Zach, but you’re a doctor, I know how many hours you’re expected to work. I appreciate your thoughtfulness, but I know you don’t really have any time to spare.”
“And you do?” Zach rolled his eyes in exasperation. “I like basketball, I happened to play in college. I could offer a basketball camp, give the kids a few pointers. Can you really afford to turn down my help?”
As much as she wanted to, she couldn’t turn him down. He was right, he would be able to reach the kids in a way she couldn’t even begin to do. Zach disturbed her on a personal level, but that was her problem and shouldn’t affect the kids struggling to make sense in a violent world.
“No, I can’t,” she agreed with a weary smile. As much as she’d wanted to avoid Zach, she couldn’t deny the tiny thrill at the thought of seeing him again. Often. At work and outside work. What was she thinking? This didn’t mean anything. Except maybe that they were friends. Yeah, Zach was a nice guy with a killer smile. She wouldn’t mind being his friend.
“Then, yes. If you’re sure, we’d be glad to take whatever time you have to give.”
* * *
Zach wanted to kiss her. Right there. Right then. He fought the internal battle with his conscience because this was neither the time nor the place. Friends—remember? Yeah, he was supposed to be her friend, not kiss the heck out of her. With an effort, he forced himself to pull away. “Good. I’m glad.” His voice sounded odd and he cleared his throat. “I’d like to help.”
“We’d better get back. Nate is probably wondering what happened to us.” Jenna sighed as she stood.
“Take a few more minutes,” Zach advised. He could have used the time, even if she didn’t need it. But Jenna shook her head.
“No. What if another call comes in? Besides, there may be more victims back at the mall. We should go back, just to make sure they don’t still need our help.”
He guessed Jenna needed to see a victim who was still alive, one who’d managed to make it. He understood and rose to his feet. “Let’s go.”
Zach retrieved the gurney they’d used for Sherry. Jenna helped him change the bloody linens and wipe the metal frame with bleach cloths. When they’d finished, they rode the trauma elevator to the helipad, where Nate was indeed waiting.
“Take us back to the mall,” Zach directed, once they’d stored the gurney and belted themselves into their respective seats. “There may be more victims.”
Nate banked the chopper in a steep curve and headed back to the mall parking lot, explaining to the dispatcher their plan and making sure there were no other calls waiting.
Several ambulances still stood outside the mall entrance. Zach and Jenna split up to cover the scene better, each looking for anyone in need of more urgent medical assistance.
Most of the patients he saw had only minor injuries. Jenna caught his attention and waved him over.
“What’s up?”
“I think this victim is suffering from a pretty severe head injury,” Jenna informed him. “Apparently he hit the floor hard. Although there is no outward sign of any injury, he had a large lump on his head. The crew planned to transport him via ambulance, but now his neuro status is getting worse.”
Bending down to assess the patient, Zach had to agree. The patient’s name was Jim and he didn’t open his eyes or respond in any way to light stimuli. “I think you’re right. Do we know anything about Jim’s medical history? If he’s on blood thinners for some reason, he could be prone to bleeding into his head.”
“Not sure, but he’s not carrying any blood-thinner information on him,” the medic responded. “We didn’t find anything helpful in his wallet.”
People who took blood thinners were told to carry a wallet-sized card or a medical alert bracelet, letting medical staff know about their condition, but the only thing Zach could do was to treat the patient as if he weren’t on any medication. “Jenna, bring the gurney. I’m going to intubate him. We need to transport him to Trinity as soon as possible.”
She didn’t need to be asked twice, running off for the supplies and then returning a few moments later with everything needed. He was grateful to note the color was back in her cheeks as she dropped the flight bag at his feet.
The medics on the scene had already gotten IV access. “Let’s start a mannitol drip.” He went through the process of intubating the patient then, once Jenna had the tube secure, he began to hyperventilate the man. “I want you to give frequent, large breaths to help prevent any further brain swelling.”
She nodded to signify she understood. Once they had everything under control, they prepared to transfer the patient to the helicopter.
Zach fell into step beside Jenna as they made their way back to the chopper. Every television station had a camera out and while the reporters couldn’t get close to the helicopter, he could see the cameras were trained on the two of them as they stowed the patient in the back, then climbed aboard.
“Cleared for take-off,” Nate drawled.
“Try not to hit any of the television cameras on the way,” Zach joked, tightening his helmet. Jenna put the headphones on the patient even though Jim was unconscious and couldn’t communicate. He noticed she always took care of the little things, worrying about the comfort of her patient above anything else.
“Aw, shucks, why not? I should get extra points for knocking them off,” Nate protested.
“Yeah, don’t we wish.” Zach met Jenna’s gaze. “Would you hand me a penlight from the flight bag? I want to check his pupils again.”
“Sure.” She handed him the light, then leaned closer to see for herself. “The right one looks larger than the left.”
“You’re right, he definitely has a pretty serious head injury. The pupil on the right reacts only sluggishly. According to the medic on the scene, the pupils were closer in size right after the injury.”
“Will he make it?” Jenna asked, her gaze troubled.
“I hope so.” Zach didn’t want to lose another victim so close to the first one any more than she did. “Nate, get us to Trinity as soon as possible.”
“Will do.” All hint of humor had vanished from Nate’s tone.
As Zach watched over the patient, Jenna took notes and made sure all the equipment was properly connected and working. In some ways she had the harder job; his was simply to keep focused on the patient while everything else was her problem. Zach was amazed at how well she managed to multitask.
He could admit, at least to himself, how much he liked having Jenna as a flight partner. Mostly because of her skill, although, if he was honest, that wasn’t the only reason. No matter how hard he tried to talk himself out of it, he still wanted to kiss her. Those few minutes in the OR break room had reminded him how long it had been since he’d been out with a woman. Almost a year. He hadn’t been interested in anyone since his broken engagement.
And he shouldn’t be interested in Jenna now. For one thing, they worked together. If he could just convince his body to ignore her on a physical level, he’d be better off.
“With all this mannitol, shouldn’t I place a Foley catheter?” Jenna wanted to know.
Zach hid a mental wince, glad Jim was out of it and wouldn’t know the catheter was going in. “Yeah, good idea.”
“ETA five minutes.” Nate’s familiar drawl came through the helmet.
Jenna quickly placed the catheter, then went back to her documentation. “Vitals are stable at least. But he’s putting out a lot of urine. I hope his blood pressure holds up.”
Zach forced himself to concentrate on patient care. “If his blood pressure starts to rise, that’s a bad sign. Once he gets to Trinity, they’ll put an intracranial monitor in place to keep track of his intracranial pressure.”
“I’ve heard of them, but have never seen one.”
He didn’t sense any wistfulness in Jenna’s tone, but he was reminded again at how she was determined to put her sister’s education before her own.
Which was too bad, because he thought Jenna would make an excellent doctor or nurse.
* * *
The calls were steady as the night wore on. Zach was grateful. At least the time passed quickly. Not until about five in the morning did they have time to sit and relax again.
“Only two more hours to go.” Jenna stretched her feet out and rested her head on the back of the sofa with a sigh. “I’m exhausted.”
He wondered if her toes were still painted pink beneath those steel-toed boots. “Didn’t get much sleep yesterday?”
“No.” She yawned and blinked.
“Do you mind if I ask you a question?”
Her eyes snapped open as she straightened as if on instant alert. “I guess not,” she responded cautiously.
“If I lend you the money, would you get your car fixed?”
“No.” Her instant refusal was no more than he’d expected, but he’d felt the need to try.
“Why not?”
“Because I don’t spend money I don’t have.” She looked at him for a long moment. “And besides that, there’s no reason to go into debt for car repairs. I’ve been riding the bus alone since I was ten.”
He sucked in a quick breath. Ten? Heck, all the kids he’d known at that age had been driven to events in the comfort of car pools made up of the neighborhood parents. He tried not to show his reaction. “I guess you’ve been on your own for a while, then.”
“Yes.” She declined to say anything more and Zach realized she didn’t want to talk about her past. He couldn’t help himself from asking, even though he knew he was prying.
“What happened to your parents?”
“My mom died a few years ago, my dad was never in the picture.” The closed expression on her face didn’t invite further questions.
He suspected there was more to the story than she was telling him. But he didn’t know how to make her confide in him.
Heck, he didn’t even know why he wanted her to confide in him. All he knew was that he had this deep urge to help.
And he suspected his concern didn’t stem from feelings as simple as friendship.