had presence, Liv admitted to herself, as each person around the trolley quietly busied themselves with their allotted tasks, while listening to the paramedic’s handover. He was confident, but he didn’t swagger like Greg Hampton, one of the more junior doctors. But neither was he as approachable like Phil, the other casualty officer who was currently looking for a vein in the patient’s arm.
Working on automatic, Liv attached BP, cardiac and oximetry monitors to the patient and the paramedic collected his own equipment and left the room.
Stefano glanced at the monitor, a frown on his handsome face as he swiftly assessed the readings. ‘Phil, put in two lines and send blood for immediate cross-matching. I want all clothes covering the front and sides of the chest removed.’ He had an unmistakable air of authority that communicated itself to all the staff in the room and Liv cut through the man’s clothing and reached for warm blankets to prevent him developing hypothermia.
‘His respiratory rate is thirty-eight and it’s very shallow.’
‘He’s in respiratory distress.’ Stefano examined the man’s chest and Liv noticed that Phil was watching out of the corner of his eye. Although he’d only been working in the emergency department for a few months, Phil soaked up information and never missed an opportunity to learn.
And there would be plenty to learn from Stefano, Liv thought, watching the way he examined the patient.
‘There’s a great deal of bruising,’ she murmured, looking at the purplish marks on the man’s ribs and Stefano looped the stethoscope round his neck.
‘He has diminished breath sounds and decreased chest expansion.’ Working with a cool, calm sense of purpose, he finished examining the man’s chest. ‘He has a clinically significant haemothorax. Call the trauma surgeon and ring the operating theatre co-ordinator and warn them. He might need a thoracotomy to drain it. Let’s do a chest X-ray.’
The radiographer responded immediately. Like a carefully choreographed ballet, everyone worked simultaneously, carrying out his or her own clearly delineated roles.
‘I need a hand here, Liv.’ Phil was struggling to find a vein and Liv stepped forward to help. The more junior doctor slid the cannula into the vein and breathed an audible sigh of relief. ‘OK, I’m in. Let’s tape this, before we lose it.’ Beads of sweat had formed on his forehead and his gaze flickered to Stefano. ‘Wouldn’t he have distension of the neck veins or raised jugular venous pressure if he had a haemothorax?’
‘He’s hypovolaemic.’ Stefano’s eyes stayed on the monitor. ‘If you look closely at the patient, you’ll see that there is a degree of tracheal deviation. Do we have two lines in, yet?’
‘One. I’m just sending blood for cross-matching.’
‘Get that second line in now. I need two lines before I put in a chest drain.’
Phil handed the bottle to Liv and then turned back to the patient to deal with the second IV.
‘His veins are terrible,’ he muttered after a few minutes. ‘The first one was fine, but I’ve failed twice so far on this side. Do you want to have a go?’
Stefano stepped towards him. ‘Turn his arm over. Bene. Cannula.’ He held out a lean, strong hand and Liv passed him the equipment he needed, watching in silent admiration as the consultant slid the needle into the vein with no apparent effort.
He made the seemingly impossible look easy, she thought wistfully and clearly Phil thought the same thing because he shot her a rueful glance.
‘The X-ray is up,’ the radiographer said and they all turned to study the screen.
‘There’s no visible fluid level,’ Phil murmured and Stefano’s eyes narrowed, his gaze fixed intently on the screen.
‘Because with the patient in the supine position the blood collects under the affected lung. If you look, you can see blurring of the hemidiaphragm contour. I’m ready to put in the chest drain.’ He turned towards her. ‘Liv?’
He knew her name?
Liv taped the cannula to make sure they didn’t lose the second line. Did he also know that she hadn’t had sex for four years? ‘Sue will assist you with the drain.’ Her hands occupied, she glanced towards her colleague. ‘There’s a sterile pack behind you. I got it out earlier.’ Then she turned back to Phil. ‘That blood needs to be given through the rapid infuser,’ she reminded him. ‘It needs to be warmed.’
‘Sue can help Phil. I want you to assist me.’ The sudden bite in his tone left no room for argument so Liv simply stepped aside so that Sue could take her place, quietly instructed her to call the operating theatre and the trauma consultant and then opened the sterile pack herself.
Suddenly she found that her hands were shaking and she shook her head, exasperated with herself. All right, so he’d already demolished Rachel—he obviously had high standards, but so did she! She had no reason to be nervous.
Working quickly, Liv opened the cannula that she knew he’d need, but he was already one step ahead, his movements so swift that it required all her concentration to keep up.
For a terrifying moment she almost lost her nerve. She’d never worked with anyone quite as talented as him before and the sheer speed and skill of his fingers left her dragging behind. Fortunately her own natural ability asserted itself.
Don’t think about him, she told herself firmly. Think about the job.
She kept her gaze fixed on those long, bronzed fingers, every nerve and muscle in her body tense as she focused on what he was doing.
Not once did he hesitate or pause. His fingers were precise and steady as he cleaned the skin, injected local anaesthetic and then aspirated the syringe to confirm the presence of blood.
It was no wonder he demanded the best from those around him, Liv thought as she handed him the scalpel and watched him incise the skin down to the rib with astonishing speed and precision. He was a master, and it was obvious that he wasn’t satisfied with anything less than accuracy.
His handsome face blank of expression, he slid a gloved finger into the pleural cavity, checking the position of the incision. ‘I’ll want a 36F tube. Have it ready.’
‘Roberts forceps.’ Without being asked, Liv handed him the instrument she knew he’d need next and watched as he slid the drain into position through the track he’d made. Then he attached the tube to an underwater seal drainage system.
‘That’s a large tube he’s used,’ Phil muttered and Liv glanced at him briefly.
‘It has to be of sufficient calibre to drain the haemothorax without clotting. And if the haemothorax doesn’t drain, there’s a risk of infection.’ Her attention back on Stefano, she reached for the suture. ‘Zero gauge suture.’ She held it out to him and he took it immediately, their movements smooth and synchronised even though they’d never worked together in Resus before.
He inserted a purse-string suture to secure the drain and then glanced at the monitors again.
‘I want another chest X-ray so that I can check the position of the drain.’
The
