and as she bent over the man she could see the patient’s neck veins were bulging as he struggled, or rather as his heart struggled to beat. Only it was drowning.
She’d seen it countless times when she was a resident surgeon, before she’d chosen her specialty. Before she’d become a surgeon to the stars. First she had to confirm the rest of Beck’s Triad, before she even thought about trying to right it.
She didn’t want to freeze up. Not here. Not in her new start.
“Dave, you’re going to be fine,” Carson said, trying to soothe the patient. Only Dave Jenkins couldn’t hear him. “It doesn’t look like he’s lost a lot of blood.”
“He’s lost blood,” she said, trying not to let her voice shake.
Just not externally.
Carson took off his jacket, rolling up his sleeves to inspect the gash on Dave’s right arm. “It’s deep, but hasn’t severed any arteries.”
The wound had been put in a tourniquet, standard first aid from those trained at the mill. It wasn’t bleeding profusely. It would need cleaning and a few stitches to set it right.
“That’s not the problem.” Esme pulled out her stethoscope.
Carson cocked an eyebrow. “Really?”
“Really.” She peered down at Dave. His faceplate, his eyes rolling back into his head. He was in obstructive shock. “Who saw what happened? There’s more than a gash to the arm going on here.”
“A piece of timber snapped back and hit Dave here.” Esme glanced up as the man pointed to his sternum.
“The gash came after?” she asked.
“No, before, but Dave didn’t get out of the way and he didn’t shut off the machine after the first malfunction. He was overtired—”
“Got it.” Esme cut him off. She bent over and listened. The muffled heart sounds were evident. A wall of blood drowning out the rhythmic diastole and systole of the heart. Drowning it. Cursing under her breath, she quickly took his blood pressure, but she knew when the man pointed to his sternum what was wrong.
Cardiac tamponade.
Dave wouldn’t survive the helicopter coming. He probably wouldn’t have survived the trip to the hospital.
“What’s his blood pressure?” Carson asked.
“Ninety over seventy. He’s showing signs of Beck’s Triad.”
“Cardiac tamponade?”
Esme nodded and rifled through her rucksack, finding the syringe she needed and alcohol to sterilize. “I have to aspirate the fluid from around his heart.”
“Without an ultrasound?” Carson asked. “How can …? Only trained trauma surgeons can do that.”
Esme didn’t say anything. She wasn’t a trauma surgeon, though she worked in an ER during her residency. She’d done this procedure countless times. She was, after all, the cardio God. She knew the heart. It was her passion, her reason for living. She loved everything about the heart. She loved its complexities, its mysteries.
She knew the heart. She loved the heart.
Or at least she had.
“It’s okay. I’ve done this before. Once.”
She was lying. She’d done this countless times. She’d learned the procedure from Dr. Draven. It was a signature move of his that he taught only a select few, but they didn’t need to know that. How many general practitioners performed this procedure multiple times? Not many.
“Once?”
“I really don’t have time to explain. It’s preferable to have an ultrasound, but we don’t have one. I need to do this or he’ll die. Open his shirt.”
Carson cut the shirt open, exposing Dave’s chest where a bruise was forming on the sternum.
You can do this.
“I need two men to hold him in case he jerks, and he can’t. Not when I’m guiding a needle into the sac around his heart.”
There were a couple of gasps, but men stepped forward, holding the unconscious Dave down.
Esme took a deep breath, swabbed the skin and then guided the needle into his chest. She visualized the pericardial sac in her head, remembering from the countless times she’d done this every nuance of the heart and knowing when to stop so she didn’t penetrate the heart muscle. She pulled back on the syringe and it filled with blood, the blood that was crushing the man’s heart. The blood that the heart should’ve been pumping through with ease, but instead was working against him, to kill him.
Carson watched Esme in amazement. He’d never encountered Beck’s Triad before. Well, not since his fleeting days as an intern. It was just something he didn’t look for as a family practitioner. Cardiac tamponade was usually something a trauma surgeon saw because a cardiac tamponade was usually caused by an injury to the heart, by blunt force, gunshot or stab wound.
Those critical cases in Crater Lake, not that there were many, were flown out to the hospital. How did Esme know how to do that? It became clear to Carson that she hadn’t been a family practitioner for very long. She was a surgeon before, but why was she hiding it?
Why would she hide such a talent?
It baffled him.
Because as he watched her work, that was what he saw. Utter talent as she drained the pericardial sac with ease. She then smiled as she listened with her stethoscope.
“Well?” Carson asked, feeling absolutely useless.
“He’ll make it to the hospital, but he’ll need a CT and possibly surgery depending on the extent of his injuries.”
There was a whir of helicopter blades outside and Harry came running in. “The medics are here to fly him to the hospital.”
Esme nodded. “I’ll go talk to them. Pack the wound on his arm.”
Carson just nodded and watched her as she disappeared outside with Harry. She was so confident and sure of herself. She had been when he’d first met her, but this was something different. It reminded him of Danielle. Whenever she was on the surgical floor Danielle was a totally different person.
Actually, Carson found most surgeons to be arrogant and so sure of everything they did, but then they’d have to be. Lives were in their hands. Not that lives weren’t in his hands, but it was a different scale.
Carson rarely dealt with the traumatic.
He turned to Dave’s wound and cleansed it, packing it with gauze to protect it on his journey to the nearest hospital.
Esme rounded the corner and behind her were two paramedics. He could still hear the chopper blades rotating; they were going to pack him and get out fast, before smoke from the forest fires blew back in this direction and inhibited their takeoff.
Esme
