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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. That was why they’d always made such a good team. Two halves of an amazing whole. The ‘dream team,’ as Ethan had reminded them only today.
But hadn’t he always been the unspoken leader of that team?
No longer, by the look of things. Abbie had changed since the last time they’d worked like this together. She’d become more decisive. More authoritative. More...independent? In here, that was a good thing. It would give him a partner he would enjoy working with even more. Out of here? That was another matter entirely. Persuading Abbie to forgive him and give their marriage another chance might be an uphill battle.
‘Call Orthopaedics,’ she was instructing a nurse. ‘We’ll need them here sooner rather than later. And someone find a dressing to cover this wound in the meantime, please.’ She stepped around the table to stand beside Rafael.
So close that their shoulders were touching.
‘Now...’ Abbie was peering into the area Rafael was working on to align the small jaw again. ‘Can I start debriding the cheek tissue? I’d like to get an idea of how much skin we’ve got left to work with. I suspect we’re going to need some grafts.’
Rafael absorbed the feeling of having her this close. He could hear the calm confidence with which she was now assessing the work she had come here to do. Suddenly it was easy to push anything personal and negative into a space that had no relevance in here. He knew without any doubt that within minutes he and Abbie would be working together seamlessly. The way they always had. His own confidence soared. They could do this. Between them they would get the foundation work done that would end up with little Lucy looking as close to the way she’d looked before the accident as was humanly possible.
He hadn’t felt this inspired—this happy in his work—since...well, since Abbie had left.
How had he not realised how much he’d missed this?
Because he had isolated himself emotionally from his work so effectively?
The way he’d isolated himself from his wife and daughter?
That was in the past. He’d learned his lesson. With the resolution that things were going to change from now on, Rafael didn’t dismiss the pleasure of having Abbie working beside him. Instead, he channelled it into making sure he did the best work he was capable of.
* * *
Talk about diving into the deep end.
Six hours later, Abbie all but staggered into the changing room where she’d stored her clothes in her old locker. The one beside Rafe’s.
She headed for the closest shower, which offered a private area that included a slatted wooden bench seat beneath a hook on which to hang her dry clothes. Having hung what she would change back into on the hook, however, Abbie didn’t immediately close the door or turn on the shower to let the water get hot. Instead, she sank down on the wooden seat and closed her eyes for a moment.
Everything ached. Her back and feet seemed to have totally forgotten their ability to stand in one spot for so long without major discomfort. She had cramp in her fingers from the fierce control she had exerted to