Excerpt of The Surgeon's Engagement Wish by Alison Roberts

THE car should not have been there.

In the small car park adjacent to the emergency department of Ocean View hospital, yes. In the space reserved for the ambulance, even, if the emergency was dire enough.

But three quarters of the way through the wide electronic doors that led into the reception and triage area?

No way!

Nurse Elizabeth Dawson's astonishment rapidly gave way to alarm. The car would have been suspicious enough tucked neatly into an acceptable car-parking slot. An ancient, rusting hulk of a V8. A status symbol amongst the elements of society who preferred to simply ignore any restrictions the law might impose on their lifestyle.

The man climbing out of the driver's seat was even more intimidating. Clad in battered leathers with the 'patch' of his gang emblazoned on the back of the jacket, the heavily tattooed and menacing figure would have alarmed even the most confident of any emergency department staff.

And Beth Dawson was far from the most confident right now. She had started a new job in a new town only a couple of hours ago, for heaven's sake, and everything was still completely unfamiliar.

No. Not quite everything. The aggression emanating from the gang member she was watching was all too familiar.

An unexpected flash of anger cut through her fear. This type of scenario was precisely why she'd left her job in a huge south Auckland hospital so recently. She'd had a gutsful of dealing with violent and uncooperative patients who took any pleasure or even satisfaction out of demonstrating the level of skill she had attained in her chosen profession.

The anger couldn't last long enough to fuel courage, however, given the fact that she was alone in this part of the department. At 1 a.m. in a semi-rural area you wouldn't expect a full waiting room, and the only patient who had come in since midnight was now having his chest pain investigated in one of the two resuscitation rooms.

Beth's finger was pressed firmly against the button summoning assistance and any trace of saliva vanished from her mouth as she watched another two figures emerge from the vehicle. The bizarre sight of the car under the bright lights and filthy tyres on the spotless linoleum had already become just a background to an unpleasant drama unfolding. So had the rhythmic and futile attempts the electronic doors were making to close the small gap left around the obstacle. They touched the rear of the car and then bounced open again. And again.

The movement of the doors did not impede two of the men dragging the final occupant from the rear seat of the car. Little care was afforded the potential injuries of an apparently unconscious victim and a large smear of blood appeared on the pale floor as his feet dragged.

Two more nurses rushed into the space behind Beth, closely followed by the only doctor on duty, Mike Harris. Beth could feel all three of them virtually skidding to a halt as they caught sight of the car inside the building, but she didn't turn her head. Her gaze was fixed on the slumped figure being held up by the armpits. She drew back instinctively as the gang member who had been driving the car started walking towards them.

"Jackal's been shot."

Beth was aware of broken teeth and the smell of alcohol as the man spoke. She was also quite well aware that the incongruously casual tone of voice was no insurance against the level of implied threat in his next succinct words.

"You'd better do something."

They would be armed, Beth had no doubts about that. There would be knives tucked inside those commando-style boots. At least one of the men was wearing knuckle-dusters and she was quite certain there would be more than one sawn- off shotgun easily accessible in that vehicle.

Her breath escaped in something like a strangled laugh. She had left a big city hospital that had protocols for dealing with precisely this type of incident. Any number of security personnel would be available within seconds and a well-rehearsed police squad only minutes away. And even that kind of back-up hadn't been enough to prevent her best friend, Neroli, giving up her nursing career, having been held at knife point in Beth's old emergency department.

Beth had come to a small-town hospital near the tip of the south island of New Zealand to find a peaceful place to settle and refocus her life. She had barely begun her first night duty in this tiny emergency department and here she was, facing one of her worst nightmares. A recurrent one, thanks to the trauma she had unsuccessfully tried to help Neroli overcome.

Did Ocean View hospital even have security?

How far away were any police? The closest large town was Nelson and that would be at least ninety minutes away by road.

The tension escalated several more notches as the spokesmen for the gang members moved. His shoulders hunched and the fingers of one hand flexed and then clenched. The fist was thrust towards the only male member staff member present.

"Now!"

Just do what he says, Mike, Beth urged silently. Please! But Dr Harris hadn't even flinched.

"Sure." Mike's face was impassive and Beth found herself suddenly feeling slightly more confident. Well into his fifties now, Ocean View hospital's emergency department consultant probably had more than enough experience to cope with situations such as this. "But I'm not going to tolerate my staff — or anyone else — being intimidated."

There was a tiny silence as each side weighed up the implications of non-cooperation. It was broken by a groan from the injured gang member and the attention of everybody present was instantly diverted.

"What's happened exactly?" 'He's been shot, man. I told you." 'Yes, but where? And how long ago? How much blood has he lost?" Mike was moving calmly towards the victim. Beth looked at her nursing colleagues. Should they all follow him? Chelsea was looking as nervous as she felt herself, and Maureen looked grim. The older nurse tilted her head.

"Chelsea, why don't you and Beth go and get a stretcher? I'll stay and help Mike." She turned as she spoke so that her back was towards the gang members. "Call the police," she whispered faintly, her lips barely moving. "Fast."

Chelsea's nervousness seemed to wear off the moment she was assigned a task. She even grinned at Beth as they hurried from the triage area.

"Here we go," she said almost cheerfully. "Again!" Beth's heart sank to a new low. "You mean you get this type of incident on a regular basis?"

"We do get bit of trouble from gangs now and then." Chelsea paused as they entered the main section of the emergency department and she reached for the wall phone. "You'd be used to it, though, wouldn't you? Didn't you say you've been working in south Auckland?"

"Yes, but I didn't expect..." Beth's words trailed off as Chelsea started speaking to whoever was on the other end of the phone.

"We seem to have a code yellow in ED," she said briskly. She listened for only a few seconds. "Cool...thanks."

Beth grabbed the tail end of the stretcher and she and Chelsea headed back the moment the phone was replaced.

"What's a code yellow?" 'Trouble with gangs."

Good grief! So it happened often enough to have its own code? "What happens on a code yellow?" 'Sid will get here first. He's our night orderly cum security guard. Then one of the local cops who lives just down the road will come in." Chelsea was looking almost excited now as she glanced back at Beth. "If he thinks it's necessary, he'll call Nelson and they'll chopper in the armed offender squad to help out."

"But there's only one patient!" 'So far." Chelsea gave Beth a questioning glance now. "This really bothers you, doesn't it?"

"I'm OK." Beth wasn't about to demonstrate any inadequacy on her first shift. "Like you said, I'm used to it.A bit too used to it, maybe.A friend of mine had a knife held to her throat by a gang member not so long ago."

Chelsea looked horrified. "Was she hurt?" 'Not physically. She's given up nursing, though, and gone to work in her sister's coffee-shop in Melbourne."

"Was that why you decided to move as well?" 'Partly." Beth smiled wryly as they turned the corner. "I was rather hoping I'd be getting away from this kind of thing by moving down here."

Chelsea's quick smile was sympathetic. "I hope it wasn't the main incentive for the shift, then."

"It wasn't."

Beth's words were lost as they entered the front of the department to find the stretcher was now superfluous. The injured man's colleagues had dragged or lifted him as far as the bed in the empty resuscitation area.

"I said don't cut his leathers, man!" 'We've got to get his jacket off so I can assess his breathing." Mike was still managing to sound calm but Beth could see that his frown lines had deepened perceptibly.

Maureen was plugging the tubing attached to an oxygen mask onto the overhead outlet. "I'm just going to put this on your face," she warned their patient.

The stream of obscene language made Maureen look even grimmer than she had on first spotting this patient.

"Airway appears clear,'she told Mike dryly. Stepping back as two silent gang members unceremoniously stripped the leather jacket off the now groaning man, she noticed the return of the younger nurses.

"Perhaps you two could clear Resus 2.'She and Mike seemed practised in trying to keep the atmosphere as casual as possible, but the undercurrent of urgency was easy enough for Beth to detect.

And no wonder. The man in the adjacent resuscitation area was looking alarmed and his wife was terrified. It was just as well that the chest pain he was having investigated had been deemed to be angina rather than a heart attack because otherwise the anxiety caused by the arrival of the new patient might have made his condition a lot worse. He probably didn't need admission but he certainly needed to be moved.

It took a minute or two to disentangle the patient from the ECG electrodes and other monitoring equipment anchoring him to the area. Beth looked over her shoulder as she pushed the foot end of the bed clear of Resus 2. The injured man in Resus 1 was alone with his medical attendants now. The other gang members had vanished. A second later they all heard the roar of an unmuffled engine as the car blocking the doors was restarted.

"Our first job is to clear the department of any other patients if it's possible," Chelsea told Beth as they manoeuvred the bed along the corridor separating the emergency department from the rest of the hospital. "We close the department to any arrivals that could be seen by a GP as well." She shook her head. "There was a major riot in the department a few years back apparently, and a bystander in the waiting room got stabbed. That was when code yellow came into force."

Their patient's wife was clutching her handbag in both hands as she trotted beside the swiftly moving bed. "Did you hear them say they were going to deal with whoever did the shooting? Where's it going to end?"

"At least most of them are out of the department for a while," Chelsea responded. "It'll give the police time to deal with them before there's any real trouble here."

There was a curious calm in the emergency department when Beth and Chelsea returned. Mike was doing an ultrasound on the exposed, tattooed belly of their patient. Maureen was setting up a new bag of IV fluids.

A burly man wearing an orderly's uniform was standing with his arms folded by the head of the bed, and an equally solid man in police uniform stood in an identical pose at the foot. They both gave Beth a curious stare.

"Gidday," the orderly said. "You're new here, aren't you?"

"This is Beth," Chelsea told them. "It's her first shift tonight. Beth, this is Sid and that's Dennis."