Prognosis Christmas Baby Read online

  He grinned back at her. ‘I don’t want to risk it.’

  Maggie sobered. Wow. He really, really, really didn’t want kids. But then his right hand wandered from her breast, down her stomach and totally distracted her. She bit her lip and arched her back again. ‘Are two going to be enough?’

  Nash chuckled, his erection straining as he gazed down at her, her nipples taut, her stomach quivering beneath his touch. ‘I’ll get creative,’ he murmured.

  And he was. Very, very creative. All night long.

  Two weeks later both Nash and Maggie found themselves on a run of nights together, the first time their shifts had coincided since their one-off night of passion allowing them to easily avoid any awkwardness on the unit. Sure, she’d seen him around since but had managed to avoid working with him too closely.

  There wasn’t that kind of luxury on night duty with only one registrar manning the ship.

  Maggie was nervous about finally working with him but she needn’t have been. He just smiled at her in all his jeans-clad glory, a secretive I’ve-seen-you-naked-but-it’s-okay smile when their gazes first met and she knew it was going to be all right.

  Okay, yes, she’d spent two weeks reliving that night and all its wonder over and over in her head. She dreamt about it – fantasised about it. About him. About his hands and what he’d done with them. His mouth and where he’d put it. And the pleasure he’d rained down on her in a frenzy of desire.

  But they’d made a deal. One night only. And she had no intention of welshing. Even if sleeping in her bed with his smell embedded in her sheets and his touch - his taste - embedded in her memories, was driving her crazy. What she had was a prime case of lust and she was fairly certain she wouldn’t die from denial.

  And anyway, the night didn’t allow time for either of them to psychoanalyse their night of hot sweaty sex. They hit the ground running and didn’t stop. Maggie was in charge of the shift and a retrieval arrived as soon as handover finished.

  Billy Sugdeon was a five-year-old immersion, pulled from a back-yard fishpond with a ten-minute downtime. The little boy was barely visible beneath the metallic space blanket as the paramedics pushed the gurney into one of the side rooms. Maggie and Gwen, Billy’s assigned nurse, worked with Nash to get the blond-haired, blue-eyed darling unhooked from all the transport monitors, one ear on the handover.

  They transferred him to the bed and began hooking him up to their monitors. ‘Are the parents here?’ Maggie asked as the retrieval crew prepared to depart.

  ‘Mum is. She’s waiting in the parents’ lounge. We told her you’d need half an hour to get the little tyke settled but you’d go and get her when you were done.’

  ‘Thanks.’ Maggie nodded as she adjusted the ventilator settings.

  Nash inspected the intra-osseous needle site. It had had been screwed into the patient’s tibia when no other venous access could be found. The boy was pale and cold despite the space blanket, his heart rate a little too slow for his liking.

  ‘Let’s warm him up and get some lines in,’ he said, flicking on the overhead warmer switch. ‘We’ll take him to CT after that.’

  ‘You want some sedation running?’ Maggie asked as Gwen went to get some blankets from the warmer.

  ‘No. We’ll let the retrieval stuff wear off and see what he does.’

  Maggie and Nash worked together like they’d been doing it for years. Like they were professional colleagues only and their night of rapture had never happened. She assisted with several intravenous line placements, an-endotracheal tube change and a chest X-ray.

  Billy’s limbs started to twitch as soon as the X-ray plate was removed from behind him.

  ‘Midazalom,’ Nash ordered.

  Maggie administered the pre-prepared solution into Billy’s central line and watched as the seizure stopped. It wasn’t an unexpected development. Often times an injury to the brain, be it traumatic or hypoxic, could result in some sort of seizure activity. She just hoped it was as the result of initial brain swelling and not a sign of more permanent damage.

  ‘I’ll write him up for a loading dose of phenytoin,’ Nash said, accessing the computerised medication chart at the bedside console and ordering the anti-convulsant therapy.

  Maggie checked the drug with Gwen. ‘Why don’t we get Mum in now? It’ll give her some time before the CT scan.’

  Nash nodded. ‘I’ll get her.’

  Maggie watched surreptitiously a few minutes later as Nash approached the bedside with Billy’s mother. He was talking in a low voice, his voice soothing to the obviously emotional woman. Her eyes were red-rimmed and her hands were visibly shaking.

  As she got closer and saw her son looking small and helpless amidst all the medical equipment she pressed her hand to her mouth and fresh tears welled in her eyes. Maggie could see her hesitate, falter and then crumple.

  ‘Whoa, there,’ Nash said as the sobbing woman collapsed against him. He put his arm around her shoulders, holding her upright. ‘Chair, Maggie.’

  Maggie, well used to the emotional shock parents felt on seeing their children in a critical care environment, was two steps ahead of him and had the mobile stool behind the mother in an instant, allowing Nash to lower her gently. He knelt beside Billy’s mother and shot a grateful smile at Maggie.

  ‘Thanks,’ he murmured.

  Maggie nodded admiring his way with the devastated woman reminding herself of their one-night-only deal. ‘No problems.’

  Gwen and Nash accompanied their patient to CT twenty minutes later and Maggie watched them go with a heavy heart. She shook her head and wondered how many blond-haired, blue-eyed immersions she’d looked after.

  She’d lost count over the years.

  Glancing through the glass window separating the two side rooms she took in the red-headed burns boy next door. Why were they always red-headed? She wondered if anyone had done a study on hair colour and its correlation to specific types of accidents?

  Maggie laughed out loud, the sound echoing in the empty room strewn with discarded packaging, used linen and multiple bits of medical plastic that had wound up on the floor. It seemed like such a trivial thought but anything that kept her mind off the horrifying prospect that Billy might be severely brain damaged was more than welcome.

  He and his mother had managed to touch her heart.

  Checking the wall clock, Maggie couldn’t believe it was nudging midnight and she’d only just managed to get around to all the patients. Thankfully Linda and another experienced nurse were helping to run the shift tonight so Maggie knew everything was being taken care of including the staff breaks.

  There were two patients of concern.

  Toby, who had been extubated yesterday after a few weeks of ventilation, appeared to be struggling again. And Ruby Wallace, a nine-year-old with a closed head injury thirty-six hours post-MVA, had a grumbling temp.

  Billy had returned from CT. He’d warmed up, his heart rate had improved and he was reasonably stable. The CT showed global swelling but no specific areas of concern. Hopefully he was going to be one of the lucky ones.

  No sooner had they got Billy settled back in when Linda entered the side room. ‘Nash, Ray needs you. Toby’s just not coping.’

  Linda stayed to help Gwen get Billy sorted and Maggie went with Nash. The situation at bed three didn’t look good at all and one look at Toby had Maggie pulling the Resus trolley closer.

  Toby, who usually beamed at anyone who came close to the bed, even with an endotracheal tube sticking out his nose, was looking exhausted, using all his accessory muscles in his chest again to help him breathe. He certainly had no energy left to smile. His oxygen sats were eighty-five on a hundred per cent rebreather mask and his arterial blood gas was abysmal.

  ‘Shall we trial him on mask c-pap?’ Maggie queried.

  Nash nodded. ‘I think so.’ He popped his stethoscope in his ears and listened, not liking the decreased air sounds over his right chest. ‘Let’s get an X-ray too.’


  Toby’s father, Brett, was staying overnight and seemed very relieved when Nash explained to him that Toby would need to go back on non-invasive ventilation. Maggie could tell that watching his son struggle to breathe was increasingly distressing for the father too.

  Toby wasn’t having any of it, though, fighting the claustrophobic confines of the mask. The harder he fought, the more he taxed his respiratory system. He was also in a lather of sweat, which made maintaining a good seal on the mask very difficult.

  The X-ray showed a marked deterioration from the morning’s picture but no pnemothorax, as Nash had suspected. It took several doses of sedation to finally settle the boy with another blood gas finally showing an improvement in his gaseous exchange.

  With the imminent crisis averted at bed three Maggie was able to grab her first cup of coffee. Considering it was almost three a.m. she was hanging for one. She made one for Nash too and brought it out to the central nurses’ station, plonking it down beside him where he sat at the doctor’s computer, making an electronic entry into Toby’s chart.

  Nash glanced up. He hadn’t had a chance tonight to think about their tryst but the smoulder in her fudge-brownie gaze put him straight back in her bed. ‘Thanks,’ he murmured.

  Maggie’s breath stuttered to a halt at the heat in his loaded gaze. Watching him in action tonight should have helped to put him firmly in the colleague category, but his calm capability, his decisive authority, his dedication to his job made him even more desirable.

  She nodded and turned away. The night had been crazy and there was much to catch up on. She didn’t have time to moon over his blond good looks. She sat at the computer console furthest away from him, planning to review all the patients’ charts. She’d just clicked on the first one when Linda called her over to bed eight, where she was doing a meal relief.

  ‘I don’t like the look of her, Maggie.’

  One look at Ruby Wallace and Maggie could understand Linda’s concern. She was tachycardic, hypotensive and febrile.

  The little girl had been in a high-speed car accident two days ago. She’d been restrained but her head had still smashed sideways into the window, resulting in a large subdural haemorrhage. She’d had emergency neurosurgery to evacuate the blood but was still in a coma requiring ventilatory support.

  ‘She’s been grumbling along most of the day with this fever but just in the last twenty minutes she’s spiked her temp and her heart rate. Her oxygen requirement has increased. Her lactate on her blood gas is rising and her blood pressure’s bottoming out. I think she may be septic.’

  Maggie nodded. ‘Nash?’ she called as she grabbed the Resus trolley again.

  Nash wasn’t sure if it was because he was so attuned to her or whether it was the note of concern in Maggie’s voice but he stood immediately, joining her and Linda at bed eight. He listened to their concerns, more than a little alarmed at the deterioration in Ruby’s condition and the rising lactate.

  ‘Yes. I think she may be septic too. Let’s get some blood cultures and give her a ten per kilo bolus of colloid for her blood pressure to start with.’

  Maggie accessed the arterial line for the blood while Linda hooked up the extra fluid.

  ‘Her abdo’s quite distended,’ Nash mused, palpating the tense dome. They’d been treating Ruby for an illeus since admission due to her lack of bowel sounds and bruising from the seat belt. Abdominal ultrasounds had shown no acute trauma but they’d kept her nil by mouth while her gut recovered from the impact.

  ‘Yes,’ Linda agreed, ‘I reckon it’s blown up just in the last hour.’

  Maggie added the blood to the culture bottles, a heavy foreboding settling in her bones. She reached up to the monitor to adjust the alarm settings as Ruby’s heart rate climbed to one hundred and eighty. The little girl started to gag and cough and then vomited. Bilious liquid spilled from her mouth and nose, streaming down her face and over the sheets.

  Maggie quickly whipped out the yankeur sucker and, turning Ruby’s head to the side to try to prevent aspiration, she suctioned the girl’s airway while Linda aspirated the nasogastric tube. Alarms trilled all around them as Ruby’s heart rate again breached the set limits.

  ‘I’ll call the surgical reg for a consult,’ Nash said, walking briskly to the nearest phone.

  Maggie wiped Ruby’s face with a towel and used a couple more to sop up the excess stomach contents around her. Dr Hannah Oakland arrived fifteen minutes later as the second ten per kilo bolus was almost finished. Nash could see it was having no impact on the flagging blood pressure. ‘Let’s start some inotropes,’ he ordered.

  Maggie and Kylie, Ruby’s nurse who had returned from her tea break, drew up some dopamine while Hannah and Nash consulted.

  ‘You want an ultrasound?’ Nash asked her

  Hannah shook her head. ‘I think we need to go in and have a look. I’ll organise it. Where are her parents?’

  ‘Mother’s asleep in the parents’ lounge,’ Kylie volunteered.

  Maggie, Nash, Linda and Kylie worked to stabilise Ruby for Theatre while Hannah talked to her tearful mother and gained consent for exploratory abdominal surgery. Maggie averted her eyes as Ruby’s mother stroked her daughter’s hair, tears trekking down her face.

  ‘It’s okay, Rube,’ she whispered, ‘you’re going to be okay.’

  Even after fifteen years Maggie found it impossible not to become involved and she hoped desperately that Ruby’s mother was right and her gut feeling was wrong.

  The sky was lightening when they finally wheeled Ruby into the operating theatre at the end of the corridor. Maggie and Linda, who hadn’t had a break yet, left Kylie to clean up the bed area confident that Ruby wouldn’t be back until the end of their shift, maybe even after that.

  Nash joined them in the tearoom and they all sat round staring into their coffees still a little dazed by rapid-fire events of the night. Sure, these nights happened every now and then but they were both physically and emotionally draining.

  Linda drained her mug and stood. ‘I’ll go check on Kylie,’ she said.

  ‘You haven’t finished your break yet,’ Maggie protested.

  Linda shrugged. ‘I’m too wired to sit still.’

  Maggie nodded. That happened sometimes. Adrenaline was vital to cope with the emergencies they’d had to face tonight but it did have its jittery side effects.

  Linda departed and Nash was grateful to be left alone with Maggie. ‘Are you okay?’ he asked. She looked weary. Good, but tired around the eyes and tense around the shoulders.

  ‘Sure,’ she answered automatically, staring into the milky depths of her coffee. ‘What about you?’ she asked, remembering that Nash’s sister had been about Ruby’s age when she’d died.

  ‘I’m okay.’ He nodded. ‘It’s been a hell of a night.’

  Maggie nodded, swirling the muddy liquid in the mug. That it had.

  ‘I thought we’d pulled our last all-nighter,’ he murmured.

  Maggie flicked her gaze up from the drink. A small smile lifted the corners of his beautiful mouth and he looked sexy and inviting and she wanted to crawl onto his lap and snuggle her head into his neck.

  She returned his smile, her heart light for the first time this shift. Opening her mouth for a sexy rejoinder, it was abruptly cut off by a rattling noise up the corridor and the trilling of an alarm had her frowning instead. ‘That can’t be Ruby already?’ She looked at her watch. ‘It hasn’t even been half an hour.’

  But it was. Which could only mean two things. The problem had been trivial and easily remedied. Or the problem was so big it just couldn’t be fixed. Unfortunately for Ruby, it was the latter. She’d thrown a clot into her mesenteric vasculature, infarcting her entire bowel. Toxins were flooding her system.

  She was dying and there was nothing anyone could do.

  To say they were all shocked was an understatement. The nine-year-old had survived a horrific car smash but had been expected to make a full recovery from her head injury.
>
  Unfortunately, her conscious level had masked what was going on in her belly and she wasn’t expected to see out the day.

  Maggie sat in with Nash and the surgeon and the social worker as they broke the news to Ruby’s family. Their reaction was heart-wrenching and Maggie blinked rapidly to clear the mist of tears from her eyes as the family broke down.

  Whatever sadness she felt was insignificant to what the family were experiencing, and they needed her to be strong and do her job.

  They limped through the next couple of hours, getting Ruby out of bed for cuddles with her parents — no easy feat still ventilated with all the associated tubes — and just trying to be there for the distraught family. When the first day-shift person arrived Maggie almost kissed their feet.

  All the staff on the night shift were affected by what was going on in bed eight and there wasn’t one of them that didn’t want to go home to hug their kids or their loved ones and escape the unfolding tragedy.

  It was well after eight by the time Maggie finished handing over and catching up on her charting. She was tired but edgy and the prospect of going home to an empty house with no distractions from the image of Ruby stubbornly implanted in her head was depressing as hell. She knew she wasn’t going to sleep, even though her body craved respite.

  She got into the lift, too tired to take the stairs. It dinged open on the top floor and she headed for the fire exit that led out to the rooftop car park. Nash was halfway through it when she rounded the corner.

  They looked at each other for a few moments, both a little battered from the long night with no rest stops and the emotional whammy of Ruby. ‘Here you are,’ he said. ‘I went looking for you.’

  ‘Here I am.’

  Nash stepped out into the car park and she followed him. The early sunshine had been usurped by heavy clouds and a cool breeze blew across the rooftop. It looked bleak, matching their mood perfectly. He turned back and opened his mouth to tell her how sorry he was about Ruby but she spoke first.

  ‘Do you want to come back to my place?’

  Nash blinked. He understood where the request was coming from. He’d seen how gutted she’d been when the surgeons had imparted their tragic news. Had felt it cut deep into his soul too, remembering Tammy. ‘I thought we were a one-night-only deal,’ he asked cautiously.