An Inescapable Temptation

CHAPTER THREE

FRANCESCA’S fingers thumped furiously on the keyboard.

Hey babe!

You’ll never believe who I’m working with right now—Gabriel Russo. Yes, the very one. And he’s every bit the conceited billionaire boy that he was six years ago. It took me a few minutes to work out who he was—probably because I had to resuscitate him first—but needless to say, once I’d reminded him I was your flatmate you could cut the atmosphere in here with a knife.

Cruise ships might look huge in real life but the reality is, when you can’t stand to be around someone, they seem very small.

Haven’t seen you in a while, so hope you’re doing well.

In the meantime living in hope he’ll fall overboard,

Fran xx

‘Busy?’

The voice, cutting through the dark medical centre in the dead of night, made her jump. Couldn’t she get any peace from this man?

She could barely tolerate being in the same room as him. What’s more, he constantly appeared at her shoulder, checking over what she’d done. And for someone whose confidence was already at rock bottom it was more than a little irritating.

There were always two crew members on call at night—one for the passengers and one for the crew. One week had passed and this was Gabriel’s first official night on call and Francesca had drawn the short straw of babysitting him.

She spun around in her chair to face him. He had his black medical bag in his hand. ‘I’m waiting for one of the crew members to meet me,’ she said. ‘She’s complaining of abdominal pain.’

‘Need a hand?’

Francesca bit her tongue to stop her saying the words that were dancing around her head right now. Over my dead body probably wouldn’t go down that well with her boss.

‘No, I’m fine, thanks.’ She pasted a smile on her face and gestured towards his bag. ‘You look busy enough anyway. Lots of passenger callouts?’

He nodded, rubbing his hand across his eyes. ‘Three in the last hour. All for really ridiculous things. Please tell me this isn’t a normal night.’

Francesca smiled. If it had been anyone else she would have told him about the ‘cougar list’ currently taped inside one of the cupboard doors in the treatment room.

The list of well-known passengers—mainly women in their forties and fifties—who developed symptoms requiring a cabin call whenever a new, young doctor came on board. She could bet in the last hour Gabriel had seen a lot of skin and satin negligees.

Not all the passengers changed every week or every fortnight. A certain select group seemed to spend a large part of their life cruising. It was not unusual to have the same passengers on board for four to six weeks at a time. Sometimes they swapped to another ship for a month and then came back to the Silver Whisper again.

The ‘cougar list’ had been started by Kevin, one of the nurses, after he’d noticed a sharp rise in callouts whenever a new doctor started. It was really just a warning list to give the person on call the opportunity to decide if they wanted to take the other crew member on duty with them. She would tell him about the list—really, she would—just not yet.

Francesca was sure that Gabriel could handle a few coy looks. After all, hadn’t he spent his life chasing women, collecting them like trophies and then unceremoniously dumping them? This should be a breeze for him.

‘Here, have a look at this.’ She handed him the communiqué she’d been given requesting details about the rescue at Venezia Passegeri. Apparently the media were keen to run a story. ‘They’re a little late but maybe they were short of news.’

A dark shadow passed over his face as his eyes flew over the page. ‘Absolutely not. No names. I don’t want to talk about last week. Make sure the communications officer understands.’

She shrugged, a little surprised by his reaction. ‘The cruise line probably wants the publicity,’ she suggested. ‘What’s the problem? You’re used to being in the news.’

‘No!’ He looked furious. He crumpled the piece of paper in his hand and threw it deftly into the wastepaper bin. She smirked. Message received, loud and clear.

Was this man temperamental? Maybe his snappiness after his head injury hadn’t been the result of the accident. His questions to her had been a little blunt. He certainly wasn’t exhibiting all the traits Jill had told her about of the flirtatious, playboy doctor. Gabriel Russo seemed to be a wolf in doctor’s clothing. And the thought intrigued her.

Katherine had complained bitterly last week that Gabriel wasn’t the best of patients—apparently she’d had to practically pin him to the bed to monitor his neuro obs overnight after his head injury. He’d been furious when Dr Marsh had insisted he be monitored overnight and it had been a relief to them all when he’d been given a clean bill of health the following morning and allowed to take on normal duties.

His pager sounded again and he sighed, picking up his medical bag and heading for the door. ‘If I’m not back in an hour page me.’ He hesitated for a second, his brown eyes connecting with hers. ‘Please.’

Francesca couldn’t help but smile. Maybe he was finally catching onto the cougar brigade.

She turned back to the computer and pulled up the file for the crew member she was about to meet.

The notes were limited. Elena Portiss, twenty-seven, from Spain, working on board as a bartender, with a declared past medical history of endometriosis.

She’d phoned ten minutes earlier saying her abdominal pain was worse than usual—bad abdominal pain was not uncommon in a woman with a history of endometriosis.

There was a noise behind her and Francesca stood up and flicked the switch, lighting up the medical unit.

‘Elena?’

The young woman nodded.

Francesca was immediately struck by how pale the girl was. Her pale blue eyes were dull and lifeless, her normally tanned skin pallid and slightly waxy.

‘Come in here.’ Francesca walked into the nearby room and gestured Elena towards one of the examination trolleys. She worked quickly, checking her temperature, blood pressure and pulse. ‘You have endometriosis?’ Francesca spoke slowly, taking care in case there was any difficulty in language.

Elena nodded. Francesca noted that her hands were positioned carefully over her stomach, obviously trying to keep her pain in check. ‘It was diagnosed last year after I had very painful periods.’ She lifted her shirt and pointed to a little scar next to her belly button. ‘I had a camera in there.’

Francesca nodded. If Elena had had a laparoscopy done and the diagnosis confirmed then it was likely that her symptoms were related to her endometriosis.

‘Do you normally use painkillers?’ Elena nodded and fumbled in her bag, pulling out a battered box with the name written in Spanish. Francesca took the box, looking at it and writing the name down in the notes. It was a commonly used non-steroidal anti-inflammatory drug that was effective in treating endometriosis.

‘We will be able to give you something similar,’ she reassured Elena, ‘but the box may look a little different. Have you tried anything else?’

Elena pulled a second, slightly more battered cardboard box from her bag. ‘I stopped taking these,’ she said, ‘as they made me feel unwell.’ As she didn’t recognise the name on the box Francesca opened it and pulled out the foil strip with the twenty-eight tablets enclosed. Around half were missing and she realised immediately what they were. Oral contraceptives were commonly used to treat endometriosis in women who weren’t trying to start a family. They worked by regulating the hormone levels to stop the production of oestrogen in the body. Without exposure to oestrogen, the endometrial tissue could be reduced and this helped to ease symptoms.

‘Do you remember when your last period was?’ Francesca asked.

‘I’m not sure. I had some bleeding yesterday and a little this morning, but it wasn’t much.’

‘I’m so sorry, but I’m going to have to get a urine specimen from you. Do you think you can manage to go to the toilet for me?’

Elena grimaced as Francesca helped her to the toilet. It only took a few minutes before she was back on the couch and Francesca reattached her to the blood-pressure cuff. BP was ninety over sixty. Hypotensive. Colour poor. Alarm bells started to go off inside Francesca’s head.

The amount of pain that Elena was exhibiting was more than would be expected. Elena nodded, still clutching her stomach.

Francesca’s spider sense was tingling. Her instinct—the thing she’d thought she’d lost.

This wasn’t right. This didn’t feel right. Elena’s pain seemed too severe and too localised to be endometriosis. Francesca knew that endometriosis was a painful condition in which the endometrial cells that would normally be present within the lining of the womb could be deposited in other areas around the body. These cells were still influenced by the female hormones and could cause pain in various areas, particularly around the pelvis.

And she knew how painful it could be—one of her friends spent a few days every month doubled up in bed. But this just didn’t add up.

She checked the urine sample for infection and it was clear. Francesca opened the nearby cupboard and pulled out another test. It was only a hunch and she could be wrong. Using a little pipette she dropped a few drops of urine onto the test and checked her watch. A little line appeared.

Her heart gave a flutter in her chest. She hadn’t been wrong and for a second she felt almost elated. Then common sense pulled her back to reality.

She needed help. And no matter how much he irritated her, she knew who to call.

The pager sounded again.

Gabriel was annoyed. What would be the reason for this ridiculous callout? A stubbed toe? A grazed elbow? He was going to have serious words with the team in the morning if this was what they normally dealt with.

He glanced at the number on the pager. The medical centre. Francesca. Now, that was a surprise. She’d looked as if she’d rather set her hair on fire than ask him for help earlier.

And as for the media request…

It made his blood boil. His family were constantly in the paper—particularly in Italy. With the words ‘tragic’ usually appearing in the second sentence. Twenty-five years ago the media had been all over them and their ‘tragic’ loss. Every time they were mentioned in the press it was all raked over again.

The last thing they needed was more painful reminders.

Didn’t they get that the loss of Dante was imprinted on them for life, seared on their very souls?

Gabriel had never once given an interview to a journalist.

Correction. Gabriel had never knowingly given an interview to a journalist. The ugly remnants of a faked past relationship by an aspiring reporter burned hard. That, and his experience with Jill and a few others like her, told him that women weren’t to be trusted. Under any circumstances.

It only took him a few moments to reach the medical centre.

‘What’s wrong?’

Francesca was waiting at the door for him, some notes in her hands and a worried expression on her face.

She thrust the notes towards him. ‘Elena Portiss, twenty-seven, severe abdominal pain, past history of endometriosis.’

‘Have you given her some analgesics?’

‘Not yet.’

‘Why not?’

She hesitated just for a second. ‘Because she’s pregnant and she doesn’t know it. I think it may be an ectopic pregnancy,’ she said tentatively.

Gabriel’s eyes skimmed over the notes in front of him. He’d no idea why she looked like a deer currently caught in the headlights. She’d done everything he would have expected. ‘Let’s find out.’

Francesca caught his arm as he walked past her. ‘I haven’t given her any indication about what I think may be wrong.’ Gabriel caught the worried expression in her eyes. He understood completely. Endometriosis was frequently associated with infertility. To tell the patient that she was pregnant but that the pregnancy was ectopic would be a devastating blow. He strode through to the treatment room and spoke to Elena, who was lying on the examination couch, her face still racked in pain.

‘Hello, Elena,’ he said confidently, ‘my name is Dr Russo. I’m one of the ship’s doctors. Nurse Cruz has asked that I take a little look at you.’ He shook Elena’s trembling hand. As he placed his hands very gently on her stomach he noticed her visibly flinching. ‘I promise you, I will be very gentle.’

He moved lightly across her abdomen, pressing gently with his fingertips from one side to the other. ‘Where is the pain worse? Here? Here?’

Elena shook her head tensely, and then grimaced again in pain as his fingers reached her right side. The clinical signs were all present. She was pale, hypotensive, with lower abdominal tenderness and distension. That, together with a positive pregnancy test, gave an almost conclusive picture.

Francesca watched him from the corner of the room. Had she been wrong to mention her tentative diagnosis? Other doctors might have thought she was stepping on their toes to make such a suggestion.

But Gabriel hadn’t even blinked. He didn’t seem offended or annoyed with her suggestion. His only concern seemed to be for the patient.

Given the hostility between them it could have been a perfect opportunity for him to take her to task.

But apparently not. This man wasn’t exactly how she’d imagined him to be.

‘Okay, that’s me finished.’ He took his hands from Elena’s abdomen and stood next to her.

‘Do you know the date of your last period, Elena?’

She shook her head miserably. ‘I have been bleeding on and off for several months. I can’t say for sure. I was taking the Pill, too, but it made me feel unwell, so I stopped. Then I had some light bleeding yesterday. I’m not sure when my last period was.’

Gabriel nodded, ‘That’s okay’. He turned to Francesca. ‘Can you check her BP and pulse again for me, please, and draw some bloods? I’ll need her urea and electrolytes, but more importantly a full blood count, please.’

Francesca nodded and set the monitor to retake Elena’s blood pressure while she opened the nearby drawer to find the blood bottles. Once the blood pressure had been recorded she removed the cuff and replaced it with a tourniquet to facilite taking some blood. It only took her a matter of seconds to locate a vein. ‘Just a little prick,’ she said to Elena as she gently slid the needle into the vein and attached the bottle to collect the blood samples. Francesca released the clip on the tourniquet, letting it spring apart, relieving the pressure on Elena’s arm. She placed the needle in the nearby sharps box and gave Gabriel a quick glance as she left the room. ‘I’ll phone Kevin and get him to do the blood results for us.’

She wondered if he realised how quickly her heart was beating in her chest. Elena’s blood count would be a good indicator of whether her diagnosis was correct or not.

It could also prove that her instincts were still completely off.

The medical centre was equipped with a wide range of laboratory equipment that allowed the staff to carry out many diagnostic tests that were essential to diagnosing and treating patients. Kevin arrived a few minutes later, hair mussed, took the blood samples and prepared them for testing. When she returned to the room Gabriel was sitting next to the examination trolley, talking to Elena. Francesca could see the serious expression on his face and watched as he gently took Elena’s hand to explain her condition. Gabriel was surprising her. He was taking time to talk to Elena, to hold her hand and explain clearly what was happening. For some reason she found it almost the opposite of what she’d expected. This was a man who’d flung her friend out on the street at three o’clock in the morning yet here he was as a doctor, doing everything he should and showing empathy for his patient. In her head that just didn’t fit. Her curiosity was piqued.

She listened quietly in the background.

‘Elena,’ he said gently, ‘I think it is likely that you’re having an ectopic pregnancy.’ He noticed the complete confusion on her face, and realised she hadn’t really understood. ‘Your urine test shows that you are pregnant—but this is not a normal pregnancy.’

‘But I can’t be pregnant—I have endometriosis—it’s not possible for me to be pregnant.’ Her face was filled with shock.

‘It is possible,’ Gabriel continued carefully. ‘Have you had sex in the last six weeks?’

Elena nodded numbly.

‘Although your condition makes it difficult to conceive, it is not impossible. It is likely that because you were taking the contraceptive pill you’ve become unclear about when your next period was due. Your urine test is definitely positive. However, the pain and discomfort that you are feeling makes it likely that, instead of implanting in the womb, the fertilised egg has implanted in your Fallopian tube.’ He picked up a nearby book with pictures of the female reproductive system and pointed to the various areas, showing her where the fertilised ovum had likely reached.

The medical staff often used these clear diagrammatic books to explain conditions to crew members of different nationalities. ‘The embryo can’t develop within this confined space and causes bleeding and pain. Sometimes the tube can rupture and that can be very serious. But in all cases the pregnancy can’t continue.’

He waited for a moment, until he could tell that Elena had processed the information he had given her. Elena started sobbing uncontrollably. Gabriel had been right. The news of a pregnancy, followed by the news that it was ectopic and couldn’t produce a baby, had devastated her.

‘What happens now?’ she asked.

Gabriel stood up from the chair. ‘We have to watch you very closely so we are going to admit you to our intensive care unit. I’ll put up some fluids and give you some pain relief. One of our nurses will come and take some more bloods from you in the next few hours. I will have to arrange for you to go to hospital at the next port.’

Kevin appeared and handed Gabriel the blood results. Haemoglobin eight point seven. Gabriel glanced in Francesca’s direction. No words were needed. They both knew that was much lower than normal for a woman of her age and more than likely an indicator of some internal bleeding.

Francesca felt the flush of relief rush through her system. She’d been right. For once her instincts had been good. If things weren’t so serious for their patient right now she would run outside and breathe a big sigh of relief.

When had been the last time she’d felt like this? The last time she’d had real confidence in her abilities as a nurse?

After her initial meeting with Gabriel, she couldn’t have blamed him if he’d ignored her instincts at all. But he hadn’t.

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