DESTINED AFFECTION

ONE

 "Never mind," Camila snapped to the resident as she grabbed sterile gloves and a mask from a cart just inside the procedure room. She tied on the mask, ripped open the package of gloves, and pulled them on. "Just find me a thoracotomy set and open it."

Two nurses and a wild-eyed medical student ran into the room, pulling on gloves, and instantly began the choreographed trauma routine without need of instruction. One nurse immediately cut off the patient's clothing, the other hung a fresh bag of normal saline and ran it wide open, and the student collected blood specimens in multicolor, rubber-topped vials.

"Can you handle tubing this guy?" Camila asked, sparing the other doctor a quick glance as she poured Betadine directly from the bottle onto the patient's chest. "Or do you want me to? You need to be quick."

"I've got it," Lauren replied evenly. She picked up the curved laryngoscope, which resembled a thin flashlight with a right-angle extension, from a cart beside the stretcher, slid it deftly into the unconscious man's throat, and followed with a plastic endotracheal tube that she passed between the vocal cords and into the trachea. It took her less than ten seconds to complete the maneuver and attach the breathing tube to a ventilator.

"Nice," Camila grunted.

"Ally," Lauren said to the nurse beside her, "get me some morphine and succinylcholine, will you?"

"Sure." The nurse, a small trim blond, cast a curious look in Camila's direction and raised an eyebrow.

Lauren muttered, "New attending."

"Ah," was all the nurse said as she drew up the drugs and passed the syringes to Lauren, who then injected them into the IV line.

"Pressure?" Camila asked as she reached for the number-ten scalpel.

"Nothing," one of the other nurses replied.

"Okay, then. Somebody call and get some blood down here stat." As she spoke, Camia placed her left hand on the chest with her fingers palpating the fourth and fifth ribs just below the man's nipple and cut a long incision in the space between them directly into the chest cavity. She was about to ask for the rib spreaders when they appeared in her field of vision. "Thanks." Smart resident.

"No problem," Lauren murmured as she peered over Camila's shoulder. "Ally, hand me the suction, please."

Lauren cleared the clots from around the heart and watched as Camila used scissors to open the pericardium, the dense fibrous covering around the heart. She'd seen a lot of surgeons do the same maneuver and had done it herself, but she couldn't remember ever seeing anyone's hands move so quickly or so well. "Tamponade?"

Cardiac tamponade was a condition in which the heart was unable to pump effectively because it was being compressed by a collection of blood or fluid inside its own containing cover.

"Looks like it," Camila replied, gratified to see the heart start to beat. She slid her fingers underneath the left ventricle and carefully turned the heart. "And a big mother of a hole back here, too."

"Pressure's coming up," a voice announced.

"Not for long, not unless we get this bullet hole closed up." Camila never took her eyes off the beating organ in her hand. She never looked away from the field when she was operating, because it broke her concentration and cost her several seconds of precious time to refocus on the wound. She held out her right hand and hoped to hell that someone there knew something about surgery. "I need a three-0 silk on a taper needle. That's a—"

Miraculously, it appeared in her hand. Very smart resident. As she placed a purse-string suture in the muscle around the hole in the left ventricle, she heard the mellifluous alto voice behind her tell the nurses to call the OR and alert the chest surgeons that there was a patient coming up who might need bypass.

"Did it hit the hilum?" Lauren asked, referring to the vessels behind the heart that supplied blood to the lungs. She noted the perfect placement of the sutures and the slick, economical way that Lauren handled the instruments. She's an incredible surgeon.

"Don't think so." Carefully, Camila tied down the suture, hoping as she always did at this point that the muscle would hold and not shred as the knot was tightened. "Can you get a chest tube in and hooked up to suction?"

 "It's ready to go as soon as you get that bleeding stopped."

Camila straightened and met the appraising green eyes. Behind her mask, she grinned, flushed with success. "My part's all taken care of, Doctor. Now let's see how you do."

Lauren chose a spot one interspace above and just lateral to Camila's incision and made a one-inch incision of her own. She guided a blunt hemostat between the ribs and into the chest cavity, then pushed a thick, rigid rube through the opening she had made. The chest tube would create suction inside the thoracic cavity, allowing the lung to re-expand. While Lauren worked, Ally hung the first unit of blood.

"He's ready to transport," Lauren said as she connected the tube to the Pleur-evac, a canister designed to collect blood and fluid while removing unwanted air from around the lung.

The entire resuscitation had taken fifteen minutes. Camila and Lauren pulled off their gloves, lowered their masks, and walked out into the hall, while the nurses and the medical student prepared the patient and his various monitoring devices, lines, and intravenous bags for the trip up to the operating room.

"Well, now I really feel right at home," Camila said, rolling her shoulders to ease some of the tension. Just like old times. Almost.

But it wasn't—not really—and might never be again.

She glanced down with a grimace, realizing that her jeans were soaked with blood. "I need to shower and change. Can you get me some scrubs?"

"Come this way." Lauren strode toward a connecting corridor. "I'll show you where the locker room is. There are plenty in there."

"Thanks."

As they walked, Lauren took the opportunity to study the newcomer. She'd already seen her work, and the new attending was exactly as she had been advertised. Camila Cabello, aged twenty-eight, was a fully trained general surgeon who had just completed a trauma fellowship in New York City. Her resume had been impressive, and her performance just now matched her reputation. But of course, there hadn't been anything in her academic profile to suggest that she was, in addition to being an accomplished surgeon, a strikingly attractive woman—gorgeous brown, chocolate brown eyes, slightly above average height, lean and tight and boldly too beautiful. Cocky, too, as Lauren had anticipated. Begrudgingly, she admitted that Cabello just might have reason to be. She has magic hands.

"Here it is," Lauren announced, pushing open a door marked Staff. "Take any open locker, and check with Marty, the ward clerk, when you're ready. He'll give you a key."

"Thanks again." Camila leaned her shoulder against the door frame and regarded Lauren appreciatively. Beautiful, smart, and skilled. Things are looking up. "What year are you? You did a really nice job in there just now."

"So did you, Dr. Cabello." Lauren extended her hand. "We haven't been properly introduced. I'm Lauren Jauregui, the chief of emergency services."

"Oops." One dark eyebrow lifted and the corner of Camila's mouth quirked into a grin again even as she realized that she'd just spent her first half-hour on the job treating her new boss like an underling. "Not a great way to start, I guess."

She shook Lauren's hand, instantly struck by the warm strength in the long tapered fingers. The contact felt good, and she wondered if she was the only one to feel the slight spark of attraction. When she searched the green eyes flecked with gold, she saw nothing but a polite greeting, and, reluctantly, she released Lauren's hand. "I didn't recognize you. Sorry."

"No need to be," Lauren said neutrally, ignoring the speculative look in Camila's deep brown eyes. "What better way to get acquainted?"

I could think of any number of ways. Camila tried hard not to stare at the soft swell of breasts beneath the dark blue scrub shirt or at any other part of Lauren Jauregui's very attractive physique. She did take note, however, of the thin gold band on Lauren's left hand with a brief twinge of disappointment. Well, that takes care of that.

"Trial by fire, I guess. At least now I understand why you're so good...for a resident." Camila tried for a bit of humor, but the ER chief merely nodded faintly, her expression impossible to decipher.