Dear Reader,

For the last two books I’ve written I’ve had the good fortune of working with other talented authors to build a more complex world than you can normally cram into a short category-length book, and I have to say it’s positively addictive. Not just the group brainstorming—which is terribly fun—but even better the knowing that I can send a half-coherent email in the middle of the night to double-check something without worrying the recipient will think me crazy.

Before this year I would never have guessed how much fun it would be to drag other author’s characters into my book, and I must say I might have been spoiled by the experience…

I hope you enjoy Enzo and Kimberlyn’s story, and I hope you will grab the other three in the New York City Docs quartet and follow the rest of the brownstone gang through their last year of surgical residency.

Wishing you health, love and happiness

Amalie

There’s never been a day when there haven’t been stories in AMALIE BERLIN’s head. When she was a child they were called daydreams, and she was supposed to stop having them and pay attention. Now when someone interrupts her daydreams to ask, ‘What are you doing?’ she delights in answering, ‘I’m working!’

Amalie lives in Southern Ohio with her family and a passel of critters. When not working she reads, watches movies, geeks out over documentaries and randomly decides to learn antiquated skills. In case of zombie apocalypse she’ll still have bread, lacy underthings, granulated sugar, and always something new to read.

Surgeons, Rivals…Lovers
Amalie Berlin

www.millsandboon.co.uk

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Dedication

To my real Cousin Karen:

1. Sorry about the spelling change…

2. Thank you for all your support and enthusiasm for my books!

3. Childhood would not have been the same without you in it. Xoxo, Duh

Table of Contents

Cover

Dear Reader

About the Author

Title Page

Dedication

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

CHAPTER ELEVEN

CHAPTER TWELVE

EPILOGUE

Copyright

CHAPTER ONE

THE SOUND OF screeching tires stabbed Dr. Kimberlyn Davis’s ear. One by one every one of her major muscle groups seized, stopping her cold on the Manhattan sidewalk, tensed for impact. One burst of sound, then another and another—rubber on asphalt, metal on metal—her every heartbeat shuddering in time with each bone-rattling sound.

Teeth gritted, she twisted toward the street in time to see a body arcing through the air, arms and legs flailing for purchase in the already warm morning sun. A man. A motorcyclist. He tumbled, rolled and came down chest first on the grille’s edge of a still-moving black SUV. The second impact tossed him back—a human pinball thrown and battered far more than flesh and bones could stand.

Her clamped jaw held back sounds she couldn’t control enough to stop, a whimper that burned like a roar—searing her throat and blazing a trail down her chest to the still-bothersome scar that would forever mar her cleavage.

She should’ve run when she’d heard the first sound of squealing tires. Away from the danger. But she had taken an oath.

Before the cascade of car horns died off, before the vehicle he’d flown into had even managed to stop moving, Kimberlyn forced herself to start. One stiff step, then another, each step loosening her muscles and allowing the next to come easier, faster. Off the curb. Onto the street. Within three paces she was running.

Moving cleared her mind. One act of willful defiance in the face of her fear, her memories, let the next one came easier.

“Someone call 911!” she shouted over her shoulder.

Please, don’t be dead.

She kept her gaze before her long enough to plot a course, then through the windows of every car she passed en route to the man.

She’s okay.

They’re okay.

Awake with head laceration.

Okay.

Okay.

Of course this was how her first week in New York should start.

By the time she reached the motorcyclist he was wholly beneath the SUV and several feet from where he’d landed. Dragged by the front bumper. The driver looked stunned through the shattered glass. He had a gash on his chin and another smaller cut above his left eye, but he was awake, moving…

Over the past year she’d gone from running from accidents to running toward them—but it always felt wrong. Even the times she’d come on the scene after the carnage had been wrought, her very soul had vibrated with the wrongness of it.

Wrongful death. All her fault.

From the first wreck she’d passed on the highway after her accident—when she’d been three months post-op, still in a cast, and on the way to yet another session with her physical therapist—she’d forced her mother to stop the car so she could get out and help. And she hadn’t stopped since that accident. Couldn’t stop.

Only the top of her current patient’s helmet showed his location under the SUV and the only thing she could feel at all good about was the lack of engine noises. It must have shut off during impact.

“Check breathing,” she whispered to herself, words slipping in a steady stream through her lips as she talked herself through the things she needed to do. Order of operations. Mental checklist for emergency scenarios. Only action could keep her focused, let her ignore the tangle of emotion rotting in her gut.

It was also the only way to try to block out Janie’s face, always with her—cut, battered and swollen—at the back of her mind. It became harder to ignore in situations like this.

“Bashing damage to chest. Get to his chest…”

If his heart still beat, he had a chance. If she got to him fast enough… Nothing could guarantee survival. Even if he appeared stable, some injuries just took longer to kill you than others.

“If the patient can’t come to you, you go to the patient. Gotta get under the car…”

She dropped her backpack as she fell to her knees and scrambled over broken glass. Craning her neck, she looked under the car to see if anything besides the helmet had been snagged.

She couldn’t see much besides that he wasn’t moving. To try to take control of her mouth, she began to narrate on purpose—the habit drilled into her as an intern so that the patient knew what you were doing. And on the off chance that he could hear her…

“Sir?” Sir, because this patient wasn’t Janie. Sir. A man. A man she didn’t know. Not her fault. Not her fault, not this time. “Keep still, I’m going to come under there with you.”

Her voice sounded shrill even to her own ears. Anyone would know she teetered on the edge of panic, but she wouldn’t fall headlong into it. She had control. Always. Always. But if her patient could hear her, she should be comforting him. Making him confident she’d help him, not squeaking like a cartoon mouse. Her throat refused to loosen, but she forced a few more words through. “I’m a doctor… We’re going to get you out of there.”

Her heart banged a couple times, popping out of rhythm as it tended to do when dosed with adrenaline. It would settle down. It was nothing, a flutter. Pay no attention…

“Not answering… not moving…” The whispering started again, and something new—the slow, hard beats of her heart, an insistent reminder of the emotion she tried so desperately to ignore. He was never coming out of this. There was nothing she could do.

Be optimistic…

Straightening, she looked around the street to the closest group of people, eyes skating from figure to figure. No police to help yet…

Get under the car. Take a light.

Ripping open her backpack, she fumbled inside for the kit, glad for once that she had to keep it with her.

Once the dented silver case was in her hand, she flipped it open and snatched out the penlight. With only her light clutched in her hand, she looked around again for help.

Running toward her through the scene she saw a figure in ceil blue, the color of the scrubs she also wore.

Someone with appropriate skills coming to help…

She flattened to her belly and crawled under the SUV with her patient. When she was beneath far enough to reach his wrist, she felt for a pulse. Present… but weak. She continued to narrate, as she’d been taught to do. The practice was supposed to help patients manage their own fear in emergency situations, but it saved her from drowning every time. Even now, when the man didn’t move or answer her.

She ran her light up and down the motorcyclist’s body, looking for points of contact with the vehicle. Nothing. No snags. No parts of his body pinned beneath wheels. It didn’t look as if he had any points of contact with the underside or the vehicle, except for where the bumper had snagged his helmet.

“Is he trapped?” a man’s voice yelled from beside her, his words only just registering above the noise of the street and the roar in her ears.

Kimberlyn backed up carefully, doing her best not to bloody herself on the broken glass. When she finally got out, she took the light out of her mouth and straightened to look at her helper. The embroidery on the left breast of his scrubs showed the name of her hospital, where she’d been headed for her first day.

The name DellaToro stood out on the tag beneath the logo for West Manhattan Saints.

Him. Enzo, her cousin Caren had called him. At least she knew he was knowledgeable and skilled. He’d help her.

From the narrowing of his gaze as it rolled over her own embroidered name, he recognized who she was, too.

Neither Caren nor her new friend Tessa had told her how good-looking the man was. Dark hair and olive-skinned, deliciously scruffy. Shockingly dark blue eyes beneath eyebrows built for brooding… No wonder he was so used to people doing what he told them to. Difficult to argue with a jaw that square—made him look hard and unyielding. Like granite. Sexy, sexy granite.

Perfect time to think about the man’s attractiveness. Goodness, what was wrong with her?

The answer hit like a slap in the face. His face had blocked out Janie’s. That was why she’d noticed, and why her cheeks tingled.

What she needed was for her patient’s face to replace Janie’s. He deserved all her attention. But DellaToro’s scruffy good looks would serve as a guilt shield until she could get that helmet off.

“The helmet is wedged under the bumper.” Breathlessness replaced her shrill tone. Was that better? “But it doesn’t look like there’s any crushed areas or snags. We have to get him out from under there.”

“But the helmet is wedged?” He bent to look, then felt around to where it was caught, apparently coming to the same conclusion she had: there was no foolproof way to get him out from under there. “We need to be careful of his spine.”

“I know, but a perfect spine never did anything for a dead man. I can’t even tell how he’s breathing like this. Or if his eyes are open.” Or show her inner demon that the motorcyclist wasn’t Janie, even though she logically knew that couldn’t be the case. “We might be looking at head trauma, too. We have to push the car off him.” She turned toward the sidewalk and the closest pedestrians and called, “Guys, we need some help pushing the car.”

DellaToro straightened to look at the group she’d called to. The group that wasn’t moving at all to help them. He then knocked on the hood and yelled to the driver, who had found cloth in his vehicle to put pressure on his bloody wounds. “Put it in Neutral.”

The man nodded, still mentally with it despite the blood on his face. Should she check on him? He could die from lack of attention while they worked on one man whose chances were much slimmer, by appearances.

She had to stop finding points of comparison. This wasn’t her wreck. That man wasn’t Janie, either.

Then, in a far more commanding voice, Enzo faced the rubbernecking pedestrians and pointed to two specific men. “You and you, help us roll the car.”

The authoritarian edge to his voice seemed to work. The men who had ignored her just moments before came down onto the street, shedding jackets and dropping whatever they carried to come to the front hood.

Figures. Also not worthy of examination right now.

Ignore the handsome doctor’s jaw, help the patient.

His attention turned to her and he continued giving orders. “Reach under and get your hands around the edge of the helmet. We’ll push it. You hold his head in place as well as you can.”

Kimberlyn maneuvered herself to the man’s head. With her cheek mashed against the front bumper, she strained under the car to get her hands around the edge of the helmet. “Got it.” A pause. “Don’t let it rock.”

If it rolled forward even an inch, it might also snap both their necks.

“We won’t.”

At least Dr. Granite Jaw had a plan for this. All she had was grime from the street, a lurking wave of panic and glass shards sticking to her scrubs.

With the three of them pushing the SUV, they managed to roll it smoothly back. Pressure was released from the helmet. She eased her hands loose and when his head held position she flipped the visor open.

Finally. Another face to quiet guilty echoes in her mind.

Young. Very young. Closed eyes. Fast breathing. Still no response.

Had that been how she’d looked? Blood loss sped up respiration and heart rate as tissues and organs became deprived of oxygen, so it stood to reason that it was. Except she’d been pinned inside a vehicle, and the blood loss had been mostly visible, not hidden inside the chest cavity.

As the SUV continued to roll, revealing the man’s body, she reached for her bag again and her kit.

DellaToro joined her, unzipping the man’s protective leather jacket. At least he’d had the protection of sturdy clothing.

“His breathing is labored,” DellaToro announced.

Of course it was. She’d take comfort in him still breathing if she didn’t know how quickly that could change, and give them all a really bad day. One heartbeat to the next, things could turn, and the person you thought was most stable…

Focus.

“I’ve got some…”

She stretched to where she’d dropped her backpack and then tore into it. “Here, Dr. DellaToro.” She produced a stethoscope and handed it to him.

“Thank you, Kimberlyn. Heard you were coming.” He used her first name while taking the instrument.

Was that some kind of dominance display?

Not the time. Correct later.

She dug into the engraved silver kit again. The fact that she could act now steadied her. Those images of her wreck were still there, always there, even a thousand miles away—but now they lurked on the periphery. The rabbit hole she never wanted time to go down.

Just a little longer.

She extracted the gauze scissors and began cutting down the front of her patient’s T-shirt, exposing an already forming bruise. Deep purple stippling slashed across pale flesh, right over the sternum. Bad bruise forming. No way would it be unbroken, and a broken sternum didn’t protect what was inside very well. Bruising organs at least. Heart. Lungs, maybe. Bashing damage could be more destructive than bullets.

She bent forward to listen to her patient’s breathing as Enzo listened to his heart.

Enzo. She could do it, too.

“Steady, but fast and faint…” he announced, pulling the stethoscope from his ears to hang from his neck, and bending to grab for the penlight she’d been using under the car.

“Faint?” She repeated the word—as if she didn’t already expect that exactly to be the case. As if it could be anything else.

Her fingers searched his wrist, and she could barely feel anything but her own thundering pulse. “You’re sure it’s beating?” She fumbled beneath the edge of the helmet to find the carotid, looking for a stronger throb. Her fingers tracked over corded vessels. The jugulars stood out as if he was straining.

Distended veins in the neck. Symptom number two that she’d both expected and dreaded.

The carotid didn’t stand out at all and she felt nothing pulsing in the general region. Blood backing up in the veins and not pumping through the arteries—reason for the distended veins.

“Pupils responsive,” Enzo announced, then listened again. “Faint, but still fast. Maybe speeding up.”

She should be doing that, announcing her findings as she went. Just one more second, one more symptom… Make sure…

He hadn’t picked up on the diagnosis yet. She’d share as soon as she confirmed the third. Even if she was already certain what her fingers and eyes told her, she needed something solid to reference.

Her hand shot into her backpack again, but books and sundries blocked her search. She upended it and dumped the contents onto the pavement. The wrist BP cuff she still carried with her rolled free—her second guilty security blanket. She grabbed it and wrapped it around the man’s wrist.

“You carry a cuff?” Enzo asked, but he was listening to her as he went back to the abdomen and began prodding gently, looking for injury.

Kimberlyn didn’t answer, just pressed the button to start the automated machine and leaned forward to listen to his breathing again. “We need an ambulance. Did anyone call an ambulance?”

A beep announced the measuring of vitals had finished and she looked at the small display.

Pulse one twenty-nine. Pressure ninety-five over seventy-five.

“Crap. Crap, crap…”

Enzo’s eyes snapped to her and then to the display on the little cuff. “That’s not good.”

“No,” she said, looking around again. “Did anyone call 911?” Repeated it louder.

No one answered. The ones who’d helped push the car had already abandoned them. Enzo fished his phone from his pocket and dialed.

“We need a large syringe, and I don’t have one of those in my bag.”

Either he wasn’t worried by the situation or he didn’t realize the extent of what was going on.

“Enzo, listen to me.” She used his first name this time to capture his attention. When his eyes met hers, she had to force the words through her clenched throat. “Cardiac tamponade.”

Attention captured. “How do you know?”

“See the veins in his neck? Fluid’s coming on fast, filling his chest, and there’s no time for the pericardium to stretch and accommodate it to let his heart beat right. Either blood or serum. Probably both. Preferably more serum than blood.” More blood would probably mean a tear, but serum could just be trauma.

A cold pit opened in Enzo’s middle. They were close to the hospital, but that was the kind of diagnosis you wanted to say after remedying it.

He barked their location into the phone and followed it with, “Possible cardiac tamponade.” After demanding two additional crews and the NYPD, he ended the call and stashed his phone again. The borrowed stethoscope replaced the phone at his ear and he listened hard. The faintness bothered him. “You think pericardial effusion from the impact?”

She nodded, and from the lack of color in her face he believed her. No one could go pale for show like that.

He hadn’t had a cardiac tamponade patient in his four years of residency, but she sounded certain and had the look of someone with first-hand knowledge.

Something had to be blocking the sound of the heart. If anything, the man was underweight, nothing else made sense besides a wall of fluid muffling the sounds.

Sam Napier, his best friend in the residency program, had warned him that one of the many women in Sam’s House of Gorgeous Roommates had a cousin transferring in to chase Enzo’s fellowship. He’d expected… well, someone sunnier in disposition and appearance. A duplicate of Caren’s golden-blond curls, dimpled cheeks and the too-cheerful smiles that made it hard for him to be around her before at least two cups of coffee. Not this soft-spoken, dark-haired creature with the delicate features and soulful brown eyes.

“He was hit chest first,” she said, taking the blood pressure again. “As in he landed with his chest on the front top edge of the grille of the car. Then bounced off. I’ve seen this before in another crash. Three big symptoms, Beck’s Triad. Muffled and faint heartbeat. Distended neck veins. A narrow difference in the blood pressure readings… One, two, three.” She pointed as she counted, chest, neck and the cuff. “There’s barely anything between the systolic and diastolic.”

The cuff beeped again, the new results darkening the screen. Pulse one sixty-two. Pressure eighty over sixty-five.

Damn. She really was right. He was either bleeding out or something else was filling his chest.

The sound of sirens close by caught his attention. They were only a couple of blocks from the hospital, and the sound came from the right direction. Closer than Dispatch, and coming toward them now. Lucky.

They’d have a defibrillator, and other tools…

He could hear her little cuff running again, beneath the blessedly loud siren of the ambulance as it rolled to a stop just ahead in the intersection. “You.” He jabbed a finger at a woman in a power suit who still stood nearby, watching, “Meet the ambulance. Tell them we need a huge syringe.” He placed the stethoscope on the patient’s chest again, doing what little he could do to monitor the situation as help arrived.

Before the suited woman even got to the ambulance, the medics came running with a bag of tools, defibrillator and a large hypodermic syringe they slapped into his hand. His order had done the trick.

“Have you aspirated a pericardium before?” Enzo asked, looking at Kimberlyn. He hadn’t. Normally he’d like to try, but she’d made the diagnosis. Even if it weren’t a professional courtesy, he wanted to see her perform so he could gauge her skill level. It was the best way to ascertain if she was simply another trauma resident or an actual threat to his fellowship.

Whether she had ever done it before or not, the small brunette crammed her hands into the gloves presented by the medic and indicated an area on the right side of the man’s chest, “I can do it. Swab around and between the fourth and fifth ribs.” She joined him on the patient’s right side.

He ripped into the alcohol prep and broke the canister within the squeegee to disinfect the area.

“Tell me if his heart starts sounding louder or if there’s any other change.”

Would chest compressions even work if the pericardium was full of fluid? It’d be like trying to squeeze a water balloon inside a larger, overfilled balloon…

Even with the stethoscope buds in his ears, he could hear the tremor in her voice. Still scared. Was she steady enough to perform the aspiration?

“I will.” He listened and directed the EMT, never taking his eyes off Kimberlyn, “Get him wired up and on the monitor.”

Cardioversion was possible now at least.

With the extra-large hypodermic in hand, she braced one elbow on her knee for support and explained. “I’m going from the right side because the heart juts to the left, and I don’t want to hit it.”

Yeah. Don’t hit the heart…

She looked steady enough now. Whatever had her fighting panic, it came and went in waves.

Enzo backed up enough to make room but stayed close enough to keep the stethoscope in place to listen while the monitor was hooked up.

This might have been a bad call. She seemed competent except for those nerves. Her nerves triggered his. If she ended up doing more damage… Maybe they should just move him now and hope he lasted another five minutes, or however long it took to get to the hospital.

With her arms steadied and braced, she waited patiently the long seconds it took for the electrodes and wires to be placed.

He listened hard, holding his breath to cut out as much sound as possible. His own pulse sounded in his ears louder than what he was hoping to listen for…

Closing his eyes helped, cutting down the external stimuli. Without vision in the way, he could hear the heartbeat faintly in the background. Fast. Very fast. And with an abnormal rhythm.

This heart didn’t just inch toward failure, it galloped. The man would never make it to WMS.

What kind of fibrillation—atrial? Ventricular? He opened his eyes and craned his neck to see the green line denoting the rhythm tracing across the black screen of the monitor.

The line swung wildly in an undulating wave that told him nothing.

Check the leads.

Okay, check the placement of the electrodes.

He grabbed an extra electrode and placed it beside the one that looked somewhat off-center, then reattached the lead. The line settled into the regular, horizontal position, allowing him to really see the points.

Ventricular fibrillation. And tachycardia. He listened again, with his eyes following the line. The sounds were almost too faint for him to hear—something that backed up her diagnosis: there had to be a massive amount of fluid compressing the heart. “He’s in V-tach.”

“Thought he might be. His time is running out.” She breathed in. When all hands were still, she breathed out slowly as she pushed the needle into the man’s chest.

She could’ve done this a thousand times. Smooth and slow enough to be cautious but quick enough to feel the texture of the different tissues she penetrated. Her eyes had taken on that out-of-focus quality that came with pinning all your attention on feeling your way to a site unseen. He’d seen that look on the real pros so many times—an amazing ability to visualize the path through and the imagination to picture the diagnosed problem. It almost felt like sorcery.

As she drew back the plunger, bright, arterial crimson began to fill the clear tube. As pressure was siphoned off, the heartbeats became a little louder, a little more distinct.

She withdrew the full syringe and looked at him, those eyes dark with fear… not the exhilaration he’d expected. But, then, he’d never been in this situation, either. Exhilaration was hard to come by. Something entirely more primitive took its place.

“No change?” So hopeful.

“Still in V-tach.” Enzo listened a few more seconds to give him time to convert. He tried counting beats but found it impossible and shook his head. “No change.” He gave the heart a few more seconds, listening again, then shook his head, “Clearer, but still distant-sounding and out of rhythm. Drawing off the fluid wasn’t enough to convert him to normal sinus.”

She paused another few seconds, pinned by those soulful eyes. Dr. Ootaka, his mentor, counseled distance. Emotions clouded reactions. Enzo had never had reason to doubt this mantra, though right now he couldn’t claim to have that distance. He wanted to give the hope her eyes begged him for.

Hoping wouldn’t get the job done. “I’ve never dealt with this. How did they do it at your old hospital?”

“The only one I saw treated was done in the hospital and they used imaging equipment to verify the diagnosis and location of the fluid before they aspirated.” She answered quickly, her focus returning, and her voice firmed as she spoke. One word led to the next, and she focused on the EMT. “I need another hypo. Bring two, just in case.”

She’d only seen it done once. Ugh. At least she didn’t look it. Move past it. Enzo gestured to the defibrillator and she followed his gaze.

“Not yet. He’s already banged up enough. Let’s give him one more chance to convert. Honestly, it’s not electrical, it’s the pressure in his chest. I doubt cardioversion would do any good for him unless his heart stops entirely.”

She rose on her knees and shouted toward the back of the medic, “Bring epi if you have it! Enzo, start the cuff again. I want the pressure before and after each draw.” With a fresh alcohol prep she swabbed the area where she’d just gone in, readying the chest for another puncture.

Long, torturous seconds passed and the other medic arrived. As soon as the pressure was displayed, she pushed through with the second needle.

Enzo watched another rush of bright red fill the tube. It looked thinner and more translucent than it had before. “It’s part serum, or he’s filling with more serum than blood now.”

“Good. The pressure might stop his heart still, but maybe it’s not an aortic dissection. Buys us some time.”

If it was only a small cut in the aorta rather than a hole through it, they had a chance of getting him stabilized and to the hospital before he crashed.

He concentrated on what he was hearing—the monitor couldn’t tell him how loud the heartbeats sounded so the stethoscope was still needed. It was easier to look at the monitor—or even the dark, eggplant-like bruise on the man’s chest—than at her worried face. He could tell from her complexion that she was normally a warm tan, but today she looked pale and fragile. Not a great look for a trauma surgeon. Even a trauma resident.

With the second round of pressure relief, the speed of the man’s heart slowly decreased and the rhythm began to convert to something closer to normal. First, a few normal beats amid the pre-ventricular contractions. Then louder. Then steadier.

“It’s working.” He pressed the button on the cuff again and then leaned back to place the stethoscope in her ears, holding the chest piece over the heart again. He let her listen as she was the one performing the procedure.

After a few seconds she nodded. “I don’t want to go again, I might hit the heart. The less fluid that’s in there, the closer the pericardium is to the heart, the less balloonish padding to protect it.” And they didn’t have the luxury of imaging equipment here to see how thick that fluid balloon was.

“Agreed.” Enzo checked the cuff again. “One hundred and forty-three over eighty-one.” The tension that had held him stiff and hard in the preceding moments left in one rushing wave, so swift his shoulders slouched forward briefly.

Without thinking, his nearest hand landed on the back of her neck to lightly squeeze as he directed her gaze to the cuff. Her skin felt hot beneath the ponytail she wore, and his palm prickled where it touched her.

“Blood circulating again,” she whispered, her breathless smile hitting him square in the chest. Shared relief. Before he could think it through, he pulled her into his arms for a hug. She sagged against him, her hands fisting in the back of his scrubs.

Apples. Her hair smelled faintly of apples, and something earthier. Clean. Sweet.

The comfort was fleeting as within seconds she’d stiffened. Her hands released the material of his shirt, reminding him it wasn’t the time to be hugging this stranger with the soft womanly curves, or smelling her fruity hair.

He let go and put a little distance between them. What was worse, looking overly familiar or overly emotional?

Color had returned to her face and was focused on her cheeks now. He’d definitely crossed some line.

Right. “Get a line in him, and we’ll ride with you.” He redirected his thoughts to the paramedics, who really didn’t need to be told what to do except that they’d come to a scene with two surgeons running things.

Kimberlyn left the cuff in place but went about gathering the contents of her bag as if the contact had never happened. He reached for his cell again.

Ootaka answered on the first ring. “Dr. Ootaka, there was an accident a few blocks from the hospital. Assisting with a cardiac tamponade. Thought you might want a heads-up to meet the ambulance.”

The conversation was brief. A neck brace and helmet removal later, they lifted the man onto a backboard, then the stretcher, and trotted for the ambulance.

“He’s on call today?” She climbed into the ambulance after the stretcher had been rolled in.

Enzo nodded, keeping his hands off her even though his natural instinct was to help her into the ambulance. “He’s going to meet us.” He stashed his phone and jerked his head in the direction of the hospital. “I’m running. Keep our patient alive. It’s only a little way to the hospital.”

Some physical exertion would help. So would avoiding any enclosed spaces with her. Good for all concerned. Or good for him, which was the important bit. And she wouldn’t have to worry that he was about to hug her again. What the devil had that been about? He was happy about the patient, but still—weird.

Probably some kind of natural instinct in the wake of all that fear and hope warring on her face roused his protective instincts. Unfortunately.

He closed the doors, banged once to let them know it was safe to drive and then took off at a run for a nearby alley. Three blocks by vehicle, one on foot.

After her showing up on the scene, even if Ootaka would’ve been put off by the emotion, he still would’ve been impressed by the woman’s knowledge. Which was okay, so long as Ootaka remained most impressed with him. Enzo hadn’t fought his way through school and years of residency to lose it at the eleventh hour to a little scared Southern nobody…

If his luck held, Ootaka would meet him at the ambulance bay and he’d have a couple of minutes to speak with him before the ambulance—and his shiny new competition—caught up.

CHAPTER TWO

ENZO MET DR. TAKEO OOTAKA at the ambulance bay doors. Normally, sprinting a block would do very little to his heart rate. Not today. Today he was winded by the time he jogged through the automatic doors. Winded and annoyed. Off his game.

The older Japanese surgeon stood waiting, leaving Enzo no time to work out his problem. He barely had time for a good breath. Ootaka stared past Enzo to the empty ambulance bay, a look that demanded answers.

During the past four years, and especially the past year when he’d largely been Ootaka’s primary assistant, he’d become used to anticipating Ootaka’s questions from his expression alone. So he answered, “I ran ahead. It was faster on foot and I wanted a better chance to brief you.”

And it’s hot, he wanted to say. Hot and muggy, which no doubt contributed to his elevated pulse and respirations.

He took another deep, cleansing breath and launched in, giving the pertinent details even as he heard the sirens drawing closer to the building. “Massive bruising, likely fractured sternum, probably some ribs, too, but structure mostly intact.”

From where the ambulance bay was located, he could see the vehicle turning into the parking lot. If he wanted to ask, it was now or never.

“I expect that there will be a need for surgery.” He waited only long enough for the usually taciturn surgeon to nod, and added, “I’d really like to stay with the patient and assist you.”

Underhanded? No. Smart.

She’d been the one ahead of the curve with the diagnosis and field aspirations. While he wouldn’t ever claim the spot of underdog, or let himself be relegated there, winners made their own fate. Preemptive maneuvers. Offense, not simply defense.

Besides, Davis had to learn sometime that the laid-back Southern lifestyle wouldn’t fly in the city—something she clearly needed to work on, in addition to learning some leadership qualities. Let that be her second New York lesson: if you want something, you have to fight for it. Everyone wanted something, so chances were if you wanted something, then someone else wanted to take it away from you.

And that was enough justifying. What in the world was wrong with him?

He blew out a steady breath as his vitals came back under control.

“Let’s see what we have, then.” Ootaka finally spoke as the ambulance rolled to a stop, triggering the automatic doors. They moved off to one side to clear the route for the stretcher.

Ootaka stood with his hands at his sides, placid and waiting attentively. No indication anything was amiss.

Never in his entire career so far had Enzo ever felt this rattled in front of his mentor.

Only one person in the hospital had ever been able to rattle him, and they had an unspoken agreement of avoidance.

Even while watching his fellow residents fall out of the grizzled surgeon’s favor, Enzo had always been the one in control and confident in his abilities. He knew Ootaka’s rules. He understood the detached perfectionism that made up nearly the entirety of his operating-room demeanor. His professionalism, steadfast confidence and resolve were perfection in Enzo’s eyes. Ootaka was precisely the kind of surgeon Enzo wanted to be. The best. Second to none after Ootaka retired. There could be no better place to learn that than Ootaka’s OR.

Tension rolled over his shoulders and down his arms. Not like Ootaka’s relaxed stance. In the reflection of the glass doors he could see his own arms… hanging at his sides, but stiff, ready for a fight. He rolled his hands at the wrist and settled. Shaking his arms out would only look even more affected.

He couldn’t avoid Davis as he did Lyons. Did he even want to? He took an inventory of his goals. Staying on top would mean a better understanding of whether she truly was a threat or just another future ex-contender. Having a good understanding of his obstacles was the only way to overcome them. It was the not knowing that had him rattled. Once he had figured out the situation, there wouldn’t be any weird emotional responses to taint Ootaka’s opinion of him.

Whatever it took. Even if it meant angering a new colleague when she figured out he’d outmaneuvered her. But what did that matter to him? Another fact for her to get used to. She would’ve had to anticipate the sharp learning curve to come into the program this late in the game, and there was zero chance of her assisting on her first day anyway.

Ootaka never trusted one of his patients to anyone with untested skills. In that light, his request wasn’t anything more than a formality when you got down to it. Asking first just showed initiative, a good practice. He wouldn’t feel guilty about it.

Bonus: it’d give Ootaka an easy out if Davis came in asking, because she’d definitely want to assist. Helpful, like someone he’d want around for the next two years. As she exited the ambulance, Enzo added, “There was another resident on the scene. The transfer, Davis. She rode in the back with the patient.”

“I wondered why she wasn’t here yet.”

In addition to untested surgeons in his OR, Ootaka also hated tardiness. The man kept an updated list of sins that could get you banned from his OR forever. She probably hadn’t a clue about them. His action now might actually save her career—give her time to learn the rules before she went in blind and violated them. It was a good-guy thing to do. The idea that her competence might come into question because she’d been late saving a life didn’t sit well. He could throw her a bone, let Ootaka know she’d made the call and aspirations.

“She—”

As the first word came out the two EMTs, Davis and the gurney rolled in, the little motor on the wrist cuff whirring to take another reading.

Ootaka cut in, “Who diagnosed the cardiac tamponade?”

“I diagnosed Mr. Elliot’s tamponade, Dr. Ootaka.” She immediately answered the question while still passing through the sliding doors.

All the mousiness he’d glimpsed earlier was gone. That was something at least. She recognized Ootaka on sight, which really shouldn’t surprise him—she’d transferred in for his fellowship if the rumor mill was to be believed. She’d have done some research.

Though Ootaka was hard to miss. He had a kind of forbidding quality to his expression, even when he was in a good mood. Smiles actually involving his mouth were rare. Ninety percent of his expressions were in the eyes.

“The aspirations are what stabilized Mr. Elliot.” He rolled with the name they must’ve discovered on the way. “Brought him back into normal sinus rhythm. He was in V-tach before the serosanguineous fluid was drawn off.”

She still wouldn’t be asked to assist, but she deserved to observe. It’d be the honorable thing to do, help her get a foot into Ootaka’s OR in a way she probably couldn’t unwittingly screw up.

At the scene he’d noted at least three behaviors Ootaka would cut her over: inability to speak with authority; lackluster leadership skills; and visible displays of emotion. From the sidelines she’d be able to get a feel for things without being in the spotlight.

“It had stabilized him, but he’s popping more PVCs than he was, and his blood pressure range is narrowing again,” she added, directing all attention to the patient and the display on his wrist. “One hundred over seventy-five.”

Enzo had gotten used to being the main one to answer questions or brief Ootaka on patients. It was only to make sure that he knew the whole situation that Enzo tacked on, “Pressure had normalized to one hundred and forty-three over eighty-five after the second aspiration.”

“One hundred and forty-three over eighty-one,” Davis corrected.

Right. No more giving her credit. Those four measly points didn’t make any difference to the situation, other than highlighting that he’d made a tiny mistake. Not precisely underhanded but kind of snotty all the same. Apparently she was capable of a modicum of backbone. But squabbling over insignificant details wouldn’t impress Ootaka, so he held his tongue.

Ootaka nodded in the direction of Trauma 1 and led the way. In less than a minute the stretcher was locked into position amid the equipment in the trauma suite, all gloved hands on deck.

“Davis,” Ootaka directed. “Another aspiration.”

Davis? Damn.

A larger hypo than the ones she’d used on scene landed in her hand. A nurse took over the job that Enzo had performed earlier, swabbing the chest.

Again he watched Davis carefully position and guide the needle into the man’s chest, then another flow of bright blood pulled back into the hypodermic. Not so watery as it had been on the second draw.

“For the third draw, it’s a lot thicker than it was even the first time.”

Enzo locked his jaw to keep quiet. Something he never did with the other residents… but this was Davis’s show.

Davis withdrew the needle and concluded, “His chest isn’t simply filling with serum again. There’s bleeding. He’s got a tear somewhere.”

“He does,” Ootaka confirmed. “Going to have to go in. Correct call, DellaToro.”

Of course it was. Enzo stepped forward again. Before Enzo could do more than nod, Ootaka turned to Davis. “Welcome to West Manhattan Saints, Dr. Davis. An OR has been prepped. You’re with me.”

Enzo’s head jerked back as if he’d been slapped.

Ootaka had invited her to surgery.

A slower step back to get out of the way again and Enzo found himself blinking, as if clearing his vision would do something to clear up what he’d just heard. But nothing had changed. The situation settled like lead in his belly.

Ootaka was definitely impressed with her.

The man told all the first-year residents they couldn’t assist him until he’d seen them in the OR to weigh their ability. They observed, he gave them small tasks, and gradually built up to assisting. Usually other surgeons did much of the initial surgical instruction, Ootaka was next-level surgery. And if you didn’t meet his expectations…

It wasn’t so much that Ootaka made a production of letting the resident know they were no longer welcome—big displays of emotion were the same as big displays of drama—he simply stopped extending invitations. It usually took the resident a few weeks to realize they were no longer welcome or even on his radar. Enzo had even seen the man forget the name of residents once he’d stopped shining attention on them.

Davis wasn’t precisely a first year, but it was her first year at WMS. Ootaka had never seen her perform.

A pericardial aspiration by hypodermic, while tricky, didn’t compare to using a scalpel…

The team wheeled Mr. Elliot out of Trauma 1 and down the fastest hall to the OR, leaving Enzo to find something else to do.

A now-familiar Scottish brogue came from just outside the door. “Kimberlyn got Ootaka already? Caren said she was good.” He looked around the door frame.

“Don’t make me hit you, Sam.” Enzo stepped out, uncrossing his arms to let them hang, feigning the relaxed appearance he’d rather others see. He just couldn’t get his shoulders to loosen up. “What are you doing down here anyway? Aren’t you supposed to be with the babies?”

“I came to make sure Kimberlyn had made it, actually. We were going to walk together today, but I ended up needing to leave early for an errand.”

“Miss Scarlet needs an escort?”

Sam gave a low chuckle. “She really did get under your skin.”

“She’s not under my skin. It was a quick reference to that dark-haired Southern pretty girl thing she’s got going on.” Enzo had lied, and he wasn’t a liar. It was a point of pride that he could be blunt and honest about anything. She’d thrown him off his game for a third time. “It takes more than a strong base of medical knowledge to impress Ootaka. She’s got steady hands, but her leadership is nonexistent. Couldn’t even rally some rubberneckers at the accident to call 911 or to push the vehicle off the patient.”

“Want to grab a pint after your shift? You can find some pretty lass to take your mind off Cricket.”

“Yes,” Enzo answered, because a beer sounded good, as did the idea of finding a pretty lass. Someone more his flavor. Not dark and soulful. Davis probably wrote poetry and wore black all the time when she wasn’t in scrubs. Also not a lass. That sounded entirely too much as if it could fit Davis, and he’d rather have someone real. Overly emotional just didn’t do it for him, either.

Hold on. “Did you call her Cricket?”

“It’s her nickname. Don’t tell her I told you.”

Enzo snorted, but nodded to his friend—Dr. Cricket’s new housemate—and headed off to look at the surgery board. Maybe they’d be in one of the surgeries with an observation gallery so he could at least watch…

A short walk and he stood, looking the whiteboard over. Head of surgical residents Dr. Gareth Langley had taken one of the rooms with a gallery. The name Lyons stood out on the list. He looked only long enough to determine he wouldn’t accidentally walk in on that man’s surgery, then moved on. Ootaka had indeed reserved the last gallery.

If he hurried, he might even avoid accidentally running into Lyons on the way. That had been the other bit of information to stand out on the board: times and approximate duration. His father was the last person he wanted to see today. Or any day. The fact that they frequently shared a hospital made it impossible to avoid him altogether, but Enzo did his best. Always did, and he imagined Lyons did, as well. In four years they’d managed to avoid saying even a single word to one another and that level of avoidance couldn’t happen without two people actively working at it.

He relaxed only when he’d stepped through the door leading up to Ootaka’s gallery.

In his time in the program nearly all of his competition had fallen by the wayside. Winning this fellowship was a marathon, but Davis was here to sprint the last leg. An immediate invitation into Ootaka’s OR definitely meant she had started the sprint and he felt as if he was standing still, which was ridiculous. She couldn’t cover that much distance in one surgery.

Time to get his head back in the game. Observe the new surgeon. See how much of what Sam had said was actually correct. See if she really was a threat to his goal or if his mind was playing tricks on him. However unlikely the possibility might be, he needed to judge for himself. If her backbone wasn’t full-on displayed, it didn’t matter how much she knew. She wouldn’t threaten his position as favorite horse in the race for Ootaka’s final fellowship.

But it might do the pit in his gut some good to see her getting the unavoidable dressing-down coming her way.

God, he sounded like a petulant child wanting Daddy’s approval. His stomach churned.

No one could survive Ootaka’s surgery without learning his particular rules. He should feel sorry for her.

If her arrival hadn’t felt like another shadow he’d have to fight his way out of, he might actually muster some sympathy.

The only way to find whatever was bleeding inside Mr. Elliot’s chest was to crack it.

Kimberlyn had been in a few thoracic surgeries since the accident, during the last months of her first year back… but seeing a chest open still made her scar burn.

This was someone else’s sternum, someone else’s pain.

The words danced through her mind on repeat every time she started to feel her chest tighten or her heart speed up.

Mr. Elliot deserved undivided attention, and the likelihood he’d one day have his own scar to fixate on hinged on the talent and skill of his surgical team. Mainly Ootaka, but she mattered.

Luckily, Ootaka was the best. One day she’d be that good—another mini-Ootaka to save those poor wretches who had to be cut out of ugly car crashes. Just as she had.

Ootaka’s fellowship was the reason she’d come north. He announced last year that it was the last fellowship he was going to do, which was why she had ended up transferring to West Manhattan Saints when she’d been set up perfectly and had enjoyed her former hospital.

Waiting two years to apply for his next fellowship? No longer an option.

The intention toward trauma hadn’t really existed before her accident. She’d thought about it but had floated between cardiac, cardiothoracic and plain old general surgery, too.

Her life had become a series of dominoes that day…

As much as she hated what had happened to Mr. Elliot, his pain was her good fortune. It had gotten her noticed immediately. Now she just needed to perform well in this surgery. Keep Ootaka’s attention. Build his appreciation and belief in her. Do everything in her power to make this year count. Keep her promise: save the good people like Janie from the bad people like her.

Or, better, save the victims so the idiots who’d caused the wreck could learn and avoid turning into her. Normal lives for all involved. Two birds, one stone. That was a worthy goal. That would make her worthy.

Which meant outshining Ootaka’s star pupil, Dr. I’m-Running-Ahead…

“Suction.”

So Ootaka started her with the basics. Minding the blood was important enough. Suctioning it off where he needed to see what he was doing, keeping an eye on the pressure to alert him when they needed to give fluids…

Which was now.

“He’s lost a… bit of blood,” she began. Assisting a surgeon for the first time always meant getting used to the way they liked to do things. Very few things were standard when it came to OR etiquette. Hence her needing to ask, “At what point do you like to hang blood?”

“Are you saying that you believe we should be doing so now, Dr. Davis?” Ootaka never took his eyes off the patient, but movement in the corner of her eye pulled her gaze up. Someone in the gallery.

Enzo. Could he hear them up there?

Okay, she was being paranoid. Why would that matter? If he could hear, maybe he’d just pick up on how to be professional and not sneaky with a colleague.

Focus on the OR, not on who lurked above it.

“Yes, Dr. Ootaka. I would like to give him some packed red now.”

“Better. In my operating room, do not couch your concern for the patient in question. You’re a surgeon. Asking questions you know the answer to makes you sound uneducated. Save your questions for when you really don’t know the answer.”

Right. She could do that. Most of the surgeons she’d worked with preferred deference, but maybe that was their way of keeping a hierarchy in place. Ootaka’s air and reputation did that well enough—maybe he had no need to force protocol through some etiquette dance.

“Yes, Doctor. I’ll remember that.” While she usually handled change well, not knowing how she was to behave wasn’t one of those changes she could just float with. If she wasn’t supposed to ask questions, did that mean she should just do what she thought was best? Mr. Elliot was Ootaka’s patient now, not hers.

He did glance up long enough to look her in the eye. “Yes?”

“Does that mean for me to go ahead with what I think is the right decision, or—”

“No. Announce first with clear intentions and reasons. Always reasons.” He’d started to sound a little annoyed, so she was happy when he immediately switched back to the subject. “Why packed red cells?”

As far as reprimands went, it wasn’t much of one, but all corrections made her cheeks burn. Luckily, the surgical mask kept anyone from noticing, even if the inside of her mask was getting a bit stuffy.

Before moving to carry out the task of replenishing the man’s blood, she answered Ootaka. Minimize chance of rejection or reaction. Saline could do the job of plasma for now. Oxygen depletion to traumatized tissue was best avoided, so red cells were her choice. Reasons anyone in medical school would know, let alone a fifth-year surgical resident.

But at least there was some comfort in the sameness—questions and answers accompanied all lessons, no matter what hospital or surgeon you were with. She looked up at the galley again, and this time Enzo was looking at her. Not just watching the table. When she looked up, his gaze was locked on hers. Her belly trembled.

How was she supposed to keep her eyes on the patient with him staring? Correction: staring and smirking? Or was that a grimace?

Ignore him.

With the Q&A finished, she ordered the packed cells and another bag of saline.

So he could hear them. Whatever. Not that she expected any less from her competition. Caren had warned her he could be a jerk. He’d wanted to assist. She’d seen it in his eyes when Ootaka had invited her into his OR. And what was that about him being right about the need for surgery? She had to wonder what else he’d told Ootaka after running to get there first. She should’ve run with him. Only that would’ve meant leaving Mr. Elliot—and even for a couple of minutes she couldn’t have made herself do so, knowing that neither of them would be with him.

What she needed to do was not think about him as an attractive man. Focus on the jerk, not the jaw. The arrogance. And all that jaw did was frame a smirking mouth.

Jerky, not to mention manipulative. Keep our patient alive indeed. Those words had assured she’d stay put.

But, worse, they’d made her feel important enough that she’d hardly questioned why he wasn’t riding with them in the ambulance.

They’d made her underestimate him…

Later she’d send Caren a crankygram—an email she’d no doubt check in a couple of weeks. Maybe she could find Tessa after the surgery ended to get information. See if her new friend knew Enzo’s tactics. Plot some ways to outmaneuver him, or at least figure out his usual manner of manipulation. It would certainly behoove her to know what his weaknesses were. Aside from arrogance.

Or maybe just vent. His attempt to maneuver the situation hadn’t worked out so well for him this time. Maybe she didn’t need to try to learn to do that. Maybe it was just a case of where the cream rose, and she just needed to focus on herself and… stuff. That’s what she’d like. Avoid confrontation. Be pleasant and easy to work with. Be the person that everyone liked, or at least felt no overt hostility toward.

Be exactly who she’d been before the accident. That’d be awesome.

And impossible.

Think later. Pretend Caren had been overreacting when she’d focused on how hard Kimberlyn would have to fight for the fellowship.

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