successful investments.
Despite being born into privilege, Matt became a self-made man, and with that came insight into the family dynamic that had dominated his life. He loved his family, but that feeling was marred by the sense of responsibility he felt toward them and disdain for their way of life. They judged and treated people entirely according to wealth and background with no regard for true character. They would have eaten the old Katie alive, and Matt knew that, despite his best efforts to protect her, his family’s resentment of who she was and her position of importance in Matt’s life would have slowly eroded her spirit and the small amount of self-confidence she had.
But now things were different. New money was no longer vulgar, not when Matt had accumulated more wealth than the rest of his family combined. He had also learned to draw some hard lines surrounding his personal life and they no longer dared to interfere in his relationships or other choices.
If his ability to control his family was the reason he was back in Kate’s life, he would have found her years ago. He could more easily explain why he’d stayed away than why he’d returned. He’d stayed away out of guilt. No matter how noble his reasons had been for ending their relationship, he had done it horribly, his mind reacting instead of thinking.
To avoid her sacrificing who she was and wanted to be for him, he had sacrificed his own character. He had stayed away because after all these years He knew he couldn’t offer her what they had once had—trust. If she asked him again why he was back, he would be honest. He was back because she needed him and after nine years apart he finally had something to offer her, and he wasn’t going to let her refuse.
KATE REACHED THE emergency department within minutes of hearing the overhead call for help. A code orange was one of the most rare codes and in her entire career she had never heard one called. A code blue was called when a patient stopped breathing. A code red when there was a fire in the hospital. A code orange was reserved for when some sort of disaster occurred and the emergency department was overwhelmed and unable to cope with the patient load.
She wasn’t working, she wasn’t even supposed to be in the building, but that didn’t matter. She had been trained to care for the sick and no office hours applied to that duty.
She threw her bag into the locker room, exchanging her shirt for a scrub top, not so much to protect herself but more to identify her in the sea of people that would be filling the department.
She walked to the trauma bay, coming alongside Chloe and her attending physician, Dr. Ryan Callum. They showed no surprise at her arrival.
“What’s going on?” she asked, her eyes darting around the department, evaluating.
“Multiple vehicle collision in the tunnel, including a city bus, with an unknown number of casualties. The Boston fire department and medics have been on scene for at least fifteen minutes but they are having trouble extracting some of the passengers. We are the closest and the first-response site for all trauma cases, with County and other surrounding hospitals as overflow.”
“What would you like me to do?”
“The operating room has been notified and all nonurgent cases are on hold until we evaluate how much surgical trauma there is. Chloe and the other emergency residents are going to triage the victims according to their injury severity score. If you could be on hand for the critical and severe patients and work with the trauma team to decide who goes to the operating room and in what order, that would help immensely.” He didn’t elaborate further as the team poured into the ambulance bay to meet the first arriving victims.
Within an hour, fifteen patients had been classified with severe and critical codes. Kate mentally ordered the surgical cases for the operating room, taking into account both the severity of their injuries and their readiness for the operating room. She picked up the phone and asked to be put through to the attending surgeon responsible for the trauma team.
“Jonathan Carter,” the surgeon answered, obviously waiting for this call.
“It’s Kate Spence. I have seen the critical and severe tracked patients from the tunnel accident. Nine are presenting as clear surgical cases and four need to go immediately. There is an obstructed airway, a rib fracture with flail chest, a compound femur fracture, and a penetrating trauma to the abdomen.”
“The operating room has four rooms available with nursing and anesthesia. Orthopedics has a team in place and can start with the femur and work through the orthopedics cases. I’m here and so is Dr. Reed, but we don’t have a third surgeon in-house on a Saturday and the nearest person is one hour away because of the tunnel closure.”
“Are you asking me which two of the three non-orthopedic cases we should take first?” she asked, knowing the wrong choice could lead to a patient’s death.
“No, I’m telling you that you are taking the penetrating abdominal wound to the OR without an attending surgeon.”
Her train of thought changed from patient triage to shock. She didn’t need him to repeat himself; he had been clear and his words were echoing in her mind.
“Dr. Spence, you are three months away from being a board qualified surgeon. I’ve worked with you, Dr. Reed has worked with you, and we both agree that you are more than capable of acting alone. The patient is better served with you now than waiting around for someone else.”
“Thank you.” She felt humbled and terrified and neither emotion was she going to allow to show in her voice.
“Don’t thank me. You’ve earned this. I’ve already notified the operating room that you will be doing the case solo. They are just waiting for the patient details and then will send for the patient immediately.”
The team moved quickly. She made the necessary call and then went upstairs to change into her surgical attire. Within ten minutes the patient was on the table, being anesthetized. She moved to the left-hand side of the table and waited for the signal from the anesthetist to start. She could hear the monitors firing, her patient’s heart rate racing, just as hers was. She knew she could do it. Knew they wouldn’t have let her if she couldn’t. But there was something about being the most qualified person in the room, with no one to help her if she got in over her head, that was terrifying.
She needed to set the tone. Everyone in the room was on edge because of the severity of the situation. The only way to bring people down was to lead by example, to stay calm. She could do that. She held out her gloved hand. “Knife.”
She worked meticulously, creating an incision extending from either side of the metal shard that was plunged into the center of the man’s abdomen. She couldn’t just pull it out, she needed the shard in place to act as a tamponade for the bleeding until she could identify which organs and vessels had been damaged. She worked through the layers of the abdominal wall until she was able to place a retractor to hold open the wound and give her the complete visualization she needed.
Damn, she thought to herself. The metal was extending into the transverse colon and the abdomen was completely contaminated, placing the patient at high risk for postoperative infection. Thankfully, the shard had stopped before reaching the aorta, which lay two centimeters below the tip.
Typically this was when her attending would ask her what she wanted to do. Did she want to repair the bowel or remove a segment of the damaged bowel, and if
