LITMIR.BIZ

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      ‘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 radiographer hurried over and as they shifted the patient and took the X-ray, Phil glanced at the drain.

      ‘He’s losing a lot of blood. Should we clamp the tube?’

      Stefano shook his head. ‘Clamping the tube has no effect on the amount of haemorrhage—the blood just collects in the chest and further compromises respiratory function.’

      ‘Mr Lucarelli? The X-ray is up on the screen,’ the radiographer said and Liv glanced up as the door suddenly opened and Anna walked into the room.

      ‘His wife’s arrived. I’ve put her in the relatives’ room,’ she said. ‘Can someone find a moment to talk to her?’

      Liv glanced towards Stefano Lucarelli but the consultant was staring at the X-ray, his handsome face unsmiling and his concentration absolute. He’s young, she thought, looking at his masculine profile and dark glossy hair. Young to be in such a responsible position. His strong legs were planted firmly apart, the thin cotton of the scrub suit skimming wide, muscular shoulders, his dark head tilted slightly as he studied the screen. He was staggeringly good-looking, confident and very much in control.

      Realising that she was staring, Liv looked away quickly and caught Anna’s speculative glance.

      Her friend gave her a wide smile. ‘I can see everything is going well in here.’

      Liv glared at her. ‘We’ll talk to his wife in a minute, Anna.’

      Stefano turned. ‘We’re waiting for the trauma surgeon. When the patient is stable and they’ve decided on the next step, I’ll talk to his wife.’

      Phil studied the drain again. ‘He’s drained 1000 mils.’

      ‘The initial volume of blood drained is not as important as ongoing bleeding.’ Stefano looked up as the trauma surgeon strode into the room.

      The two men conferred although Liv could see that the entire conversation was driven by Stefano Lucarelli.

      Clearly his reputation was as formidable as his clinical skills because the senior trauma surgeon seemed only too happy to listen to his advice.

      ‘I don’t want to perform a thoracotomy unnecessarily.’

      ‘I’ve used a large enough tube and it’s positioned well.’ Stefano glanced at the drain as if daring it to misbehave. ‘It will drain the haemothorax. Admit him for observation, monitor the drainage output over the next four to five hours. If he loses more than 200 to 250 mils of blood per hour, take him to Theatre. I’m going to talk to his wife. Liv, come with me.’

      Liv blinked. ‘I— Yes, of course.’

      She was about to make a mild comment about his dictatorial style when he looked at her, his gaze frank and direct. ‘You’re an excellent nurse. When I’m in Resus, I want you with me.’

      ‘Oh…’ The compliment was so unexpected that hot colour flooded her cheeks but she was saved the bother of replying because they’d reached the door of the relatives’ room.

      Without pausing, Stefano opened the door and strode into the room, leaving Liv to follow. She closed the door behind her, braced for him to open his mouth, put his foot in it and then walk out leaving the patient’s relative distraught, a scenario she’d witnessed on all too many occasions with other doctors.

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