She nodded to transport attendants pushing patients in wheelchairs and gurneys toward the service elevators on their way to the operating room or patient floors or radiology. She followed the noise, the conversation level rising as she approached the ER waiting room where a few patients waited in the rows of plastic chairs, the sight the same the world over. Entering the ER proper through the double doors announcing Hospital Personnel Only in big red letters, she approached the nurses’ station just inside. A dark-haired woman about her age in navy blue scrubs sat at the counter organizing charts. She looked up and smiled. Her name tag read Susan O’Connell, RN.

“Can I help you?” Susan said in a welcoming tone.

“Yes,” Abby said, extending her hand over the counter. “I’m Dr. Remy.”

“New hire?”

Abby half laughed. “Yes, I’m—”

A red phone on the counter rang and Susan said, “Hold on,” and picked it up. She stood quickly. “I’m sorry, got an ambulance coming into the bay right now. If you want to get started, we could probably use a hand. The PA on duty just headed up to the ICU to see someone with ARDS.”

“Of course.” Abby slid her briefcase over the top of the counter onto a shelf and tossed her blazer after it. “What is it?”

“Tractor versus motorcycle. One patient—the motorcyclist.” Susan dialed the phone and spoke as she waited. “Head trauma, probable internal injuries…Mary Kate, it’s Susan. We’ve got incoming.”

A second later the overhead blared.

Code Blue, STAT, ER. Code Blue, STAT, ER.

Abby frowned. “No trauma alert?”

“No trauma team.” Susan came out from behind the counter and motioned to Abby. “Follow me, Doc.”

No trauma team. Welcome to small-town medicine, USA. Abby hurried after her, passing cubicles along both sides of the hall, most standing open, a few with the curtains pulled closed, presumably with patients inside. Susan pointed to a metal rack next to two swinging double doors, and Abby paused to pull on booties, a green cover gown, and a paper cap. Beyond the doors, the trauma bay was twice the size of the cubicles they’d passed, with a treatment table akin to an OR table occupying the center. Equipment cabinets filled two walls, and a long counter for charting and paperwork filled a third. The shelves were piled high with stacks of IV bags, dressings, cutdown trays, and the usual paraphernalia of a mini operating room. A red crash cart with drawers resembling a carpenter’s tool chest, only this one filled with drugs, stood ready. At least this looked like they might be equipped to handle an emergency.

Susan quickly spread a clean sheet over the thick gel mattress pad on the table and checked that the adjustable foot- and headrests were locked. Abby spied a wall switch and flicked on the big round light hanging down from the ceiling on a flexible arm.

“Respiratory?” Abby checked the drawers on the crash cart to familiarize herself with the equipment. All neat and orderly and well-stocked. She pulled out a laryngoscope and several sizes of breathing tubes.

“They’ll respond to the code,” Susan said, briskly and efficiently checking the IV bags that hung ready from the poles on either side of the bed. Normal saline and Ringers lactate, already attached to sterile tubing.

“Right.” Abby hadn’t been in the position of not knowing the routine since she’d been a first-year resident. She was used to being in charge. When Presley had called to say she needed someone to take over and expand their emergency services department, she’d jumped at the job. She’d had offers to stay in the city, but many of the other parents advised that Blake would do best if he could start fresh. She’d hoped to have a little more time to settle in, but here she was. “Surgery?”

“I saw Flann’s car in the lot. She’ll be here.”

Susan’s casual assurance didn’t quell Abby’s rising anxiety. Where she had trained, the surgeons were always available 24/7, and by now the trauma bay would be teeming with nurses, residents, trauma fellows, and technicians. And here she stood with a nurse and no idea where to find anything. She’d spent the last year as the senior fellow in a level one trauma unit. This hospital was far from that. She braced herself for the coming chaos. Hopefully, they’d have the personnel to handle a serious trauma.

“What have you got, beautiful,” a husky female voice called from the doorway.

Abby stepped aside as a sandy-haired woman in green scrubs barreled into the room. Even though she was average height and size, she seemed to fill the space. Maybe it was the energy pouring off her that electrified the air.

Susan responded. “Motorcycle versus tractor. Motorcycle lost.”

“Don’t they always?” The woman shook her head and pulled on booties. “ETA?”

“Ought to be pulling in right about now.”

“Perfect. I’ll be able to get my eight o’clock started on time, then.”

The woman glanced in Abby’s direction and shot her a cocky smile. “New nurse?”

Abigail forced a smile. And so it began. Surgeons never changed. Always swaggering, often condescending, and, unfortunately, necessary. She held out her hand. “Doctor. Abigail Remy.”

A smooth, firm hand enclosed hers. The dark gaze slid over her face, and a slow smile formed on a broad, shapely mouth. Good-looking and she knew it. Abby suspected this was the point where most women surrendered their panties. She tried not to swoon.

“Flannery Rivers. I guess the new residency program is starting a little bit early.”

Abigail kept her smile in place with effort and withdrew her hand. “Actually, no. I would be the ER chief.”

The playful warmth in the brown eyes chilled. “Really. And here I thought that was my job. I guess I missed the memo.”

Abby hesitated, considering whether to take up the gauntlet. Susan appeared to be watching them with the avid interest of a spectator at the US Open, her head swinging back and forth between them. Abby had no desire to be the talk of the entire hospital by lunchtime, although she probably couldn’t change anything at this point. Still, this was no place and no time to butt heads over who was going to be in charge. She planned to be, but she’d just have to update Dr. Rivers on the details later. “I’m sorry if communications have gotten twisted. I gather a lot has been happening pretty quickly here.”

“You might say that.” Flannery reached for her cap, as if to pull it off. “I guess you don’t need me here, then.”

“Actually,” Abby said, “I don’t know the code team. You should lead it.”

Flannery looked surprised and maybe a little chagrined. “Right, sorry. Sometimes I trip over my ego.”

Abby was just as surprised at the admission. Points to Rivers for good sportsmanship. Not many surgeons had the confidence to laugh at themselves, or admit their egos often outweighed their body mass. “Comes with the territory, doesn’t it?”

Flannery laughed and the cocky light returned to her eyes. “Absolutely.”

“Here they come,” Susan announced at the same time as a heavyset redhead pushed a portable X-ray machine into the room.

“Thought you might need me,” the X-ray technician said, puffing slightly.

“Thanks, Kevin,” Flannery said.

On his heels, two paramedics steered a stretcher through the open bay doors. A thin blonde in her forties balanced on the side of the gurney, bagging the patient, while a wiry Hispanic man guided them up to the bed, calling out, “Twenty-year-old white female. Unresponsive at the scene, vital signs erratic. Present BP 80/40, heart rate 130, Glasgow 10. Second liter of saline running in now, fractured right leg, right temporal contusion, breath sounds decreased on the right.”

“Meds in the field?” Susan called, jotting notes on a chart.

“Two milligrams of IV morphine.”

“I’ll get bloods for type and cross and labs,” Susan said, tying a tourniquet around the patient’s right arm.

Abby edged up to the left side of the gurney across from Flannery, who had a stethoscope pressed to the girl’s chest. She felt the trachea—midline—and visually assessed her torso and limbs. Her left arm was angled unnaturally in the midforearm, and her hand was gray and blue.

“Get ortho,” Abby directed, and then stopped herself. She glanced at Flannery. “Fractured left humerus, possible compression syndrome. We need an ortho guy and possibly a vascular surgeon.”

Flann nodded. “That would be me.”

“Which?”

“Both for now.”

Abby pressed her lips together. No orthopedist in-house. No vascular surgeon. Probably no specialists of any kind in-house. One surgeon to rule them all. God, what had she stepped into?

CHAPTER TWO

Flann ran through the routine of assessing the patient, the steps so familiar she could do them in her sleep. There had been a few times during her residency when she had. All the same, in the back of her mind, her father’s voice reminded her to always expect the unexpected. Every case was unique, no matter how many times she had seen the battered bodies, the traumatized tissues, the unforgiving march of disease. Routine was her biggest ally and her most dangerous enemy, the sword with two edges she wielded in her daily battles. She checked pupils, reflexes, breathing, and heart rate. She palpated the abdomen, percussed for fluid, searched for signs of rupture and internal bleeding. Ran her hands down the extremities, over the pulses in the groin and behind the knees and feet. As she worked, so did the others, monitoring vital signs, throwing X-ray films up on the light box, regulating the respirator, and monitoring blood gases. Everyone did their part, that’s what made them a team. Her team. Her domain.