that Abbie couldn’t. Thanks to his experience as a general paediatric surgeon before he’d specialised first in oncology and then in reconstructive surgery, there was nothing that could happen in an operating theatre that he couldn’t manage, at least in an emergency situation.
Knowing that had always made her feel safe.
Confident.
All she needed to do now was to tap back into that background confidence. And remind herself of just what she’d achieved with Ella’s treatment without that umbrella Rafael could provide.
She could do this. Even if Rafael didn’t really want her in there.
Taking a deep breath and pressing her lips together in a grimly determined line, Abbie crossed her arms in front of her body and turned so that she could use her back to bump open the swinging doors that led into the brightly lit operating room.
* * *
Rafael saw Abbie enter the theatre from the scrub room, holding her gloved hands crossed in front of her body, with only her eyes visible between the bottom of her hat and the top of her mask. He watched only until her gaze met his. He held the eye contact for a heartbeat and then nodded once, turning back to the task ahead. It was a simple gesture but one that had become significant to them both in the past. It conveyed satisfaction. Gratitude. Confidence. There was a difficult job to be done. He needed her to be here. She had arrived.
Things were as good as they could be for the moment.
Had he really thought it would be better if they tried to keep their professional lives as separate as their personal lives had become? At least until things had settled down? Thank goodness Ethan and Leo had taken them both to task and made it a professional duty to start working closely together again or it could have been a very long time before he’d had the bonus of having Abbie by his side like this again.
And he did need her. Rafael had been shocked when he’d met the helicopter crew in the emergency department as they’d transferred the care of little Lucy to his team. She’d been stabilised as far as possible in the rural area where the accident had occurred but there were bigger challenges ahead. The first had been dealt with in the emergency department with the help of a specialist paediatric anaesthetist. Securing a definitive airway had been extremely difficult due to the level of facial trauma but at least it had given him time to get used to the horrific injuries. He just wished he’d had more time to warn Abbie before she arrived in Theatre.
‘Oh, my God...’ He could hear the way Abbie’s breath caught in her throat as she whispered her first reaction.
‘It’s actually not as bad as it looks,’ he told her quietly. ‘The jaw’s broken in three places and she’s lost several teeth. Cheekbones are both fractured and displaced. As is the nose. One ear has been partially amputated but there’s no skull fracture or brain haemorrhage. And I think her eyes are okay. It will be easier to see what other damage there is when we get these parts of her face back where they should be. It’s the soft-tissue damage that’s making things look so bad. The scans are up over there if you want to have a look.’
‘Is there a photograph available?’ Abbie’s initial shock had worn off commendably fast. ‘Of what she used to look like?’
‘Yes. The grandmother emailed one through. It’s been printed out and is beside the viewing screens.’
‘Thanks.’ Still holding her crossed arms carefully in front of her to avoid any potential contamination and need to rescrub, Abbie moved to examine the images of both the damage and what the little girl’s face should look like. It was several minutes before she came back to the table but that was fine. Rafael had a lot of work to do before there would be an area ready for Abbie’s delicate touch in repairing delicate vessels and skin tears.
And he needed to concentrate. It wasn’t easy, trying to manoeuvre tiny titanium rings into position to try and fix fractured bones back together.
‘What’s been said about her arms?’
‘Colles’ fracture on the left. Spiral fracture of the radius and ulna on the right. Looks like she put her arms out to break the fall and then hit the ground face first. Not pretty but it may have saved her from a bad head injury or internal damage.’
‘What’s been done for them?’
‘The arms?’ Rafael didn’t need this distraction. ‘Just support with back slabs until orthopaedics can come in. It’s well down the list of priorities.’
‘Do we have the X-rays?’
‘They’re on digital file. Why?’ Rafael needed Abbie to focus on what was more of a concern right now—putting this little’s girl’s face back together.
‘Look at this.’
‘I can’t.’ Rafael was waiting for his senior theatre nurse to suck blood away so that he could see where to place the ring he was holding in his forceps. ‘I could use some help here, Abbie.’
But Abbie ignored him. ‘Scalpel, thanks,’ she ordered a registrar. ‘And someone throw some antiseptic on this arm.’
Rafael gave up on the ring and looked up, incredulous. ‘What are you doing?’
‘Opening this arm.’ Sure enough, Abbie waited only until a nurse had hurriedly swabbed the skin of a small forearm and then she was slicing into it with her scalpel. Rafael’s jaw dropped. He’d never seen her act like this.
Ever.
Seconds later, Abbie dropped the scalpel, having left a long, deep incision in the small arm. She reached for the hand still lying on the table and pressed one of the small fingernails.
‘Capillary refill’s slow but at least it’s there now.’
‘It wasn’t there before?’ Rafael was frowning now. This was the child’s right hand, which many might consider even more important to her future quality of life than how her face looked. Had there been a major problem with circulation that had been missed due to his focus on her face? Yes. He could see the unhealthy dark colour the fingers still had. How puffy they were.
‘You can still see the swelling in her arm. The fingers were cold and blue. There was no radial pulse.’
‘Compartment syndrome...’ Rafael took a deep breath. That was why Abbie had incised the muscle casing so decisively. If she hadn’t, the result could have been catastrophic. Lucy might have lost her whole hand, let alone the efficient use of it. ‘Thank goodness you noticed.’
‘If it had started when she was conscious, the pain level would have alerted someone.’ Abbie’s gaze was in no way accusing. ‘It’s just lucky I came in late and wanted an overall picture before getting focussed.’
Rafael could only nod. This was not the time or place to tell Abbie that he was proud of her picking up on the complication. And taking control without waiting for his opinion.
Getting that overall impression was a characteristic that Abbie had much more noticeably than he did these days. She was always fastidious in gathering every piece of information she could about a case. Looking at a bigger picture that included things like family circumstances and relationships. A way of looking at a case that invariably led to the kind of emotional involvement in a patient that he preferred to avoid when possible.
