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CHAPTER ONE

‘IF THERE’S a doctor on the plane, please could you make yourself known to the flight attendants by switching on the light above your head.’

The announcement that every doctor secretly dreaded. Especially on a plane, where space was so tight that it was difficult to work. Eleanor knew that the crew were trained in basic life support, so the problem was obviously something more complicated than that. They needed her help—her knowledge, her experience in emergency medicine. She switched on her light, and one of the flight attendants came over to her.

‘One of our passengers has collapsed. Would you be able to take a look at her, please?’ she asked in a low voice.

‘Of course,’ Eleanor said, keeping her voice equally low. She knew some people wouldn’t want to get involved, but she’d never stand by and leave someone needing medical help. And in a way this was going to help her, too: instead of spending the whole of the flight from London to Naples wondering just what she was letting herself in for and worrying that maybe she wasn’t doing the right thing, she had something to keep her mind occupied.

‘Oh—do you have any identification?’ The flight attendant swallowed hard. ‘Sorry, I should’ve asked you that first.’

‘No problem,’ Eleanor said. Either the flight attendant was new to the job, or the emergency was something that had thrown her. Eleanor really hoped it was the former. The cramped aisle of an aeroplane, several thousand feet up in the air and half an hour from an ambulance wasn’t the ideal place to deal with something major. ‘You need proof that I’m a qualified doctor.’ Luckily she kept her hospital ID card in her credit-card holder. She fished it out and showed it to the flight attendant, who looked relieved.

‘Would you come this way, please, Dr Forrest? One of my colleagues is fetching the emergency kit.’

Eleanor followed her up the aisle to where a middle-aged, plump woman was slumped in her seat. A quick check told her that the patient wasn’t breathing and didn’t have a pulse. She needed to get the woman flat and start CPR now.

‘Did she bang her head at all?’ she asked the woman seated next to her patient, who was sobbing.

The answer was a flow of Italian that Eleanor really couldn’t follow.

Ah, hell. The chances were that the patient hadn’t hit her head so there wasn’t a risk of a spinal injury, and right now the most important thing was resuscitation. Just as she was about to ask the flight attendant to find someone who could speak Italian and English, to translate for her and get some help in moving the woman so Eleanor could start giving CPR, a man made his way down the aisle, following another flight attendant.

‘Orlando de Luca, family doctor,’ he introduced himself. ‘May I help?’

His English was perfect, not halting in the slightest, though she was aware of his Italian accent. And he had the most beautiful mouth she’d ever seen.

Though now was absolutely not the time to be thinking about that. They had a patient to save. And right now she needed his skills—language as well as medical. ‘Eleanor Forrest, emergency registrar,’ she replied. ‘Thank you. Her pulse and respiration are flat, so we need to start—’

‘CPR,’ he finished, nodding.

Good. They were on the same wavelength.

‘I don’t speak much Italian. The patient’s travelling companion either doesn’t speak English or is too upset to cope in a different language. Can you ask her if our patient hit her head, is taking any medication or has any medical conditions?’

‘Of course. But first…’ He turned to the flight attendant who’d brought him to the patient. ‘We need your help, please, to fetch supplies. Do you have an Ambubag and a defibrillator? It should be kept with the captain.’

‘I’ll check,’ she said, and hurried away.

Then he spoke to their patient’s travelling companion in Italian much too rapid for Eleanor to follow, given the basic Italian she’d started learning two weeks before. The only word she could catch was ‘dolore’—what was that? Sorrow?

And then she heard him say ‘l’infarto’—it sounded close enough to ‘infarct’, she guessed, for it to mean ‘heart attack’. Usually if a patient was unconscious and there was no pulse, it meant a cardiac arrest—though it could also be a grand mal epileptic seizure.

As if Orlando had guessed what she was thinking, he said, ‘Our patient’s name is Giulietta Russo. She’s travelling back to Napoli—Naples—with her daughter Fabiola. Giulietta complained of a pain in her chest and then collapsed. No history of epilepsy, no history of angina, no other medical condition Fabiola can think of, and she didn’t hit her head when she collapsed.’

So far, so good. ‘Can you ask Fabiola if her mother has a pacemaker?’ she asked.

Another burst of rapid Italian. ‘No,’ he confirmed.

At the same time, Orlando and Eleanor moved the unconscious woman to the aisle and laid her flat. Gently, Eleanor tilted the patient’s head and lifted her chin so she could check the airways. ‘No sign of blockage. Airway’s clear.’ But the B and C of ‘ABC’ were a problem: Giulietta still wasn’t breathing and there was still no pulse: no sign of circulation.

‘Then we start CPR,’ Orlando said. ‘You bag and I do the chest compressions, yes? Five compressions to one breath?’

‘Thank you,’ Eleanor said.

At that moment, the flight attendant arrived with an Ambubag. ‘We’re still checking for the defibrillator and the drugs kit,’ she said.

Eleanor really hoped there was a defibrillator on board. Otherwise their patient had no chance, because even if they landed at the nearest airport it’d take too long to get the help she needed. Without defibrillation, even with CPR, their patient’s chances of survival dropped drastically with every minute.

‘Thanks,’ she said. At least the Ambubag meant that they could give their patient positive pressure ventilation. But when their patient recovered consciousness, she’d need oxygen—more than that available from the aircraft’s emergency oxygen masks. ‘Is there any supplemental oxygen, please?’

‘I’ll check,’ the flight attendant said, and hurried away again, quickly returning with the defibrillator.

‘I’ll attach the defibrillator. Do you mind carrying on with the CPR?’ she asked Orlando.

They both knew that you couldn’t stop the CPR except for the moment when she was ready to administer a shock—if this was a case where she could use a defibrillator. If the monitor showed a different heart rhythm from VF, they were in real trouble.

‘No problem,’ Orlando said.

Lord, he had a gorgeous smile. The sort that would’ve made her weak at the knees if she hadn’t already been kneeling next to their patient. She glanced up at the flight attendant. ‘I need your help to keep doing the breathing while I attach the defibrillator,’ she said. ‘If Dr de Luca tells you what to do, can you keep going for me, please?’

The other flight attendant nodded, and followed Orlando’s instructions while Eleanor attached the defibrillator and checked the monitor reading.

‘She’s in VF,’ she told Orlando, hoping that the abbreviation was the same in his language. Certainly the words would be: ventricular fibrillation, where the heart wasn’t contracting properly and was just quivering instead of beating.

She really needed access to Giulietta’s neck veins to administer the adrenaline, but in the confines of the aisle space she didn’t want to interfere with ventilation. ‘I’m going for IV access in the right subclavian vein,’ she said to Orlando. ‘Administering one milligram of adrenaline. Six-oh-six p.m.’

‘Got you.’ Although he was a family doctor—a GP—obviously he knew the protocol in this sort of case: one milligram of adrenaline every three minutes. He smiled at her, and kept directing the flight attendant while Eleanor put the paddles of the defibrillator in place.

‘Shocking at two hundred joules. Clear,’ she said.

As soon as Orlando and the flight attendant had taken their hands off the patient, she administered the shock and continued looking at the readout. ‘Still in VF. Charging to two hundred. And clear.’

Another shock. Still no change. ‘Still VF. Charging to three-sixty.’

‘Mamma?’ Fabiola asked.

‘Um, bene. Soon,’ Eleanor said, trying to remember the Italian phrases she’d learned and hoping that her voice sounded soothing enough for Fabiola to understand what she meant.

She didn’t have time to react to the amusement in Orlando’s eyes. ‘And clear.’

This time, to her relief, Giulietta responded.

‘Sinus rhythm. Can you tell Fabiola that it will be all right? We just need to get her mother to the hospital.’

Orlando nodded, and turned to the flight attendant. ‘Can you ask the captain if he can divert the plane to the nearest airport? And talk to the pronto soccorso at the hospital—we need the paramedics on standby. Autoambulanza,’ he added.

Then he talked to Fabiola again in Italian.

‘I’ve explained that her mother needs to go to hospital,’ he told Eleanor. ‘And we will stay with her until the paramedics can stabilise her.’

It was part and parcel of being a good Samaritan—if there was an emergency and you were present simply as a passer-by and not officially as a doctor, you didn’t charge for your service and you stayed with the patient until he or she was stabilised or a doctor with equivalent or higher training took over. Eleanor had heard horror stories of doctors being sued for good Samaritan acts, but she knew if you kept to the protocol and delivered as near to hospital-standard care as you could, you’d be indemnified by either the travel company or your medical union.

The flight attendant who’d been acting as runner came back. ‘Captain says he’ll land us at Milan. We have clearance, so we should be on the ground in about twenty minutes. The airport’s contacting the hospital for us. Oh, and the supplemental oxygen…?’

‘Excellent work.’ Orlando said with a smile. ‘Thank you, signorina…?’

The flight attendant blushed. ‘Melanie.’

Orlando de Luca was living up to the stereotype, Eleanor thought. Charming every female in the vicinity.

Just like Jeremy.

Well, she wasn’t falling for that sort of charm again. Anyway, this relationship was strictly emergency. And strictly medicine. It shouldn’t bother her who Orlando de Luca flirted with. It was nothing to do with her.

She busied herself fitting the mask over Giulietta’s face.

‘Eleanor, your party must be wondering what happened to you.’

Party? Oh. He meant travelling companions. ‘It’s not a problem, Dr de Luca.’

‘Orlando, please.’

Even his name sounded sexy. Her best friend’s words echoed in her head: Even if this thing doesn’t work out, a week in Italy will do you good. What you need is some Italian glamour…and a fling with a gorgeous man to get that sleazebag Jeremy out of your head.

Tamsin would definitely describe Orlando de Luca as gorgeous. Her exact words would be along the lines of ‘sex on legs’. Eleanor couldn’t help smiling at the thought.

‘My name makes you laugh?’

‘No.’ Though she certainly wasn’t going to explain why she was smiling. What was ‘sorry’, again? ‘Mi dispiace.’

‘You speak some Italian.’

She needed to turn this back to business. Fast. ‘A little. But not enough to help Fabiola. Thank you for that. Grazie.’

‘Prego.’ He inclined his head.

At that moment, Giulietta recovered full consciousness and pulled at the mask.

Immediately, Orlando went back into doctor mode, taking her hand and calming her and speaking to her gently in Italian. Eleanor guessed he was telling Giulietta what had happened and where she was going as soon as they reached Milan. She caught the words ‘Inglese’ and ‘dottoressa’—clearly he was explaining who she was, too.

The flight attendants managed to persuade people in the aisle seats to change places with Eleanor and Orlando, so they could continue monitoring Giulietta throughout the descent—both of them were aware that she could easily go back into VF and need shocking again.

But at last they were at the airport. The paramedics boarded the plane with a trolley, and Orlando gave them the full handover details in rapid Italian, pausing every so often to check readings with Eleanor. Fabiola accompanied her mother off the plane, and Eleanor returned to her seat—at the opposite end of the plane to Orlando’s.

She wasn’t sure whether she was relieved or disappointed when he didn’t suggest changing places and sitting with her. Relieved, because then she wouldn’t have to make polite conversation and her stomach was already in knots with her impending meeting tomorrow. Yet disappointed, because there was something calming about Orlando—the way he’d assessed the situation, acknowledged that she was the one with emergency experience and hadn’t made a fuss about her leading, and had gently turned Fabiola’s reaction from panic to understanding. He was the kind of man who made people feel safe.

But then again, she knew her judgement in men was lousy. Just because he was a good doctor, it didn’t mean he was a good man: Jeremy certainly wasn’t. And Orlando was probably married anyway. A man that good-looking couldn’t possibly be single. Even if Eleanor was going to act on Tamsin’s suggestion of having a holiday fling—which she had no intention of doing—Orlando de Luca wasn’t the one for her.

Their paths would probably never cross again, so there was no point in dwelling on it. Besides, she had something else to think about.

Her meeting tomorrow, with the man who might just turn out to be her real father.

And maybe, just maybe, she’d have a family to belong to again. Wouldn’t be alone any more.