The Doctor's Christmas Homecoming, page 2
Popularity wasn’t Harry’s goal. He would be happy to settle for being able to keep all the balls he was juggling up in the air without dropping any of them. He had a patient with severe abdominal pain that could be appendicitis. Or a kidney stone. Or possibly a urinary tract infection, but she’d been unable to provide a sample for analysis. She was due back from a CT scan but Harry needed to find the swab for Talia’s rapid antigen test and check on the diabetic patient from earlier in the night who was being observed as he recovered from a hypoglycaemic episode. When Talia’s test result was positive for strep throat, he went back to let her know.
‘You can have a one-off injection of penicillin,’ he told her. ‘If that’s preferable to taking a ten-day course of pills twice a day. It’s very important that you don’t miss any doses with the pills or stop them in a few days because you’re feeling better. This bug can come back or hang around and cause other problems down the track. It can even damage the valves in your heart, which can be very serious.’
‘I’m going camping for Christmas with my friends.’ Talia bit her lip. ‘So it might be difficult to remember to take pills. Is the injection really painful?’
‘It’s got local anaesthetic in with it, so it’s not too bad,’ Harry promised. ‘Then you just need to wait here for twenty minutes or so to make sure you don’t have any kind of allergic reaction.’
Harry was thinking about Talia’s planned trip as he headed for the drug room to prepare her medication. It was another weird thing about this side of the world, wasn’t it? He’d heard that some New Zealand camping grounds were magnets to celebrate Christmas or see in the New Year in the sun, preferably beside a beach or a lake, but he could remember how excited he’d been as a kid when it started snowing in time for the big day. He still had a photograph somewhere of him and his mother standing beside the best snowman in the world that they’d created.
‘Are your friends going to take you home?’ he asked Talia.
‘Yes. They got sick of waiting so they went to get hamburgers.’
‘I’d like to talk to them before you go. About being careful with sharing food and drinks while you’re camping and that they’ll need to see a doctor if they get any symptoms themselves.’
When Harry came out of Talia’s cubicle having administered the injection, he saw a patient being wheeled out of Resus with a medical team surrounding the bed that included the senior consultant on duty. If it was the same one who’d been rushed in, the change was astonishing. He wasn’t being ventilated any longer. He wasn’t unconscious. Propped up on pillows, the middle-aged man was awake. Smiling, even.
Harry veered towards Resus as Tilly emerged. ‘Is that the post-cardiac arrest guy?’
Tilly nodded. ‘He’s finally stable enough to be on his way to the cath lab for angioplasty.’
Managing the critically ill patient had obviously been a challenge. Tilly’s cheeks were pink and there was a strand of long dark hair that had managed to work itself loose from the tight braid she always wore. He could sense her satisfaction in the case and he knew what that felt like. He could feel a corner of his mouth lift in a wry smile. Dr Matilda might not like him very much but they had something quite significant in common, didn’t they?
‘Well done,’ he said quietly. ‘He’s a lucky man.’
‘He’s had a massive left anterior STEMI so he’s not out of the woods yet.’ Tilly was scanning the department as if she was trying to decide where she might be most needed next. An ambulance stretcher was being rushed into the second resuscitation area beside them, where the trauma team being led by the HOD was waiting. That could mean there were other patients who’d been temporarily abandoned so that the incoming emergency could be dealt with. The whole department was on a knife-edge that could tip them into chaos at any moment.
And Tilly was frowning. ‘Oh, no...’ she muttered. ‘What’s wrong this time?’
Harry followed her line of sight to see Charlotte rushing out of the cubicle he’d been in only minutes ago, to administer Talia’s injection. And something was very clearly wrong. Charlotte looked absolutely terrified.
‘Help!’ she called. ‘Someone? I need help...’
* * *
Tilly followed Harry.
She’d been about to confirm she wasn’t needed by the trauma team before focusing on whatever priority was deemed most urgent elsewhere in the department but Harry’s reaction to spotting Charlotte trumped any other option. He knew something bad was happening—she could feel it by the sudden tension in his body language. No, it was more than tension. It felt like fear...
Any opinion that his reaction was a bit over the top vanished as Tilly stepped into the cubicle. A young girl was sitting bolt upright on the bed looking even more frightened than Charlotte. Her eyes were puffy and a rash was making the skin on her arms look oddly lumpy. More alarmingly, the high-pitched sound she was making as she sucked in each breath told them that there was a potentially life-threatening problem with her airway.
‘Talia had intramuscular penicillin about five minutes ago,’ Harry said tersely. He stomped on the brake at the end of the bed and started pushing it. Charlotte leapt out of the way, pulling the curtain open at the same time. ‘Resus One’s clear, isn’t it?’
Harry didn’t wait for Tilly’s affirmative response. The area might not have been cleaned yet, with the last critically ill patient having only just been transferred, but it would have everything they could need in the way of equipment and drugs available for a respiratory emergency.
Everything except perhaps assistance at the level of skill that could be required. Tilly could see more staff rushing into Resus Two and caught a glimpse of what looked like a traumatic cardiac arrest being managed in there. The bedside space was already crowded so it was a no-brainer for Tilly to stay with Harry. She might have heard good things about his professional abilities, but she’d never worked closely with him personally and there could be a young girl’s life hanging in the balance with what appeared to be an anaphylactic reaction to antibiotics unfolding in front of them.
Harry went straight to the drug cupboard in Resus One to draw up adrenaline.
‘Can you get some high-flow oxygen on, please, Charlotte?’ he directed. ‘And we’ll need the IV trolley. Tilly, could you get some ECG dots on and a set of vital signs?’
Tilly worked fast, sticking electrodes onto Talia’s shoulders and abdomen so that they could monitor her heart rate and rhythm. She wrapped a blood pressure cuff around her upper arm to enable automatic measurements and clipped a pulse oximeter to her finger. She could feel her own heart rate increasing as the figures started appearing on the screen of the monitoring equipment.
‘Heart rate’s one thirty-two,’ she relayed to Harry. ‘Blood pressure’s eighty-six on fifty, respirations twenty-eight and pulse ox ninety-four percent.’
In other words, her heart rate was too high, the blood pressure was too low and, despite rapid breathing, there was not enough oxygen circulating in Talia’s blood, but Harry’s words to their patient were as calm and reassuring as if this was nothing to be overly concerned about.
‘I’m going to give you an injection in your leg,’ he told her. ‘It should start to help your breathing very soon. I know this is scary, Talia, but hang in there. We’ve got this, okay?’
Talia nodded. Charlotte, her hands shaking, was trying to fit an oxygen mask over Talia’s face at the same time Harry was injecting the adrenaline into the muscle of her thigh.
‘Let’s find a non-rebreather mask instead of this one,’ Tilly said calmly, taking the mask from Charlotte’s hands. ‘And we need to turn the rate up as high as possible.’ She caught Harry’s glance and the flash of appreciation that she was here and he wasn’t having to deal with an emergency with an inexperienced and extremely nervous young nurse.
‘Could you set up for a fluid challenge?’ he asked. ‘I’ll get some IV access.’
Tilly found and checked a bag of IV fluid, hung it up and then opened a set of tubing and flow control to get it ready to attach to both the bag and an IV cannula. There was also a pressure infusion cuff that needed to be wrapped around the bag to enable rapid delivery to counteract the hypovolaemia that anaphylactic shock could cause. She was watching what Harry was doing from the corner of her eye at the same time. The combination of urticaria, dark skin and low blood pressure would make it a challenge to find a vein, let alone slip a wide-bore plastic cannula into place but, again, Harry gave the impression of being calm and confident, so Tilly wasn’t surprised that he completed the procedure within seconds. She was, however, impressed enough to nod at him.
‘Well done,’ she murmured.
The few minutes it took to accomplish these first steps meant that it was time for a second dose of adrenaline. Judging by how little response there had been to the first dose, Tilly wondered if Harry was thinking of starting an IV infusion of the drug. He was certainly on top of his plan of action.
‘I’ll draw up an antihistamine and steroids too,’ he told Tilly. ‘We’ll get a twelve lead ECG, chest X-ray, an arterial blood gas and some bloods off to check her urea and electrolyte levels. Could you set up a racemic adrenaline nebuliser, please?’ His gaze slid sideways. ‘Talia?’ He was focused on her face beneath the oxygen mask. ‘How’s your breathing feeling now? Is it getting any easier?’
But Talia didn’t nod. Or shake her head. Her mouth was opening and closing beneath the mask and her eyes were wide and terrified. Then her eyelids fluttered and closed.
‘Talia?’ Harry was at the end of the bed in a single step. He lowered the end of the bed, pushed the pillows off and tilted her head to open her airway.
‘She crashing,’ Tilly said quietly. ‘Blood pressure and heart rate are dropping.’ She turned to pull the airway trolley closer. ‘SPO2s under ninety.’
Talia’s level of consciousness was also dropping fast and she was clearly struggling to breathe.
‘We’re losing the airway.’ Harry’s words were quiet but he was dropping a verbal bombshell.
Charlotte made a distressed sound and stepped back, her fingers pressed to her mouth. This time Harry’s gaze caught and held Tilly’s for a heartbeat. And then another. The decisions they had to make in this space of time were huge but could mean the difference between life and death for a young woman. A normal intubation via the mouth or even the nose was highly unlikely to be possible due to the swelling of the tissues at the back of the tongue and in the larynx, which left only one alternative to secure an airway in time—to go in through the front of the neck.
There was no time to summon extra help, like the anaesthetist who was currently busy anyway in Resus Two, dealing with the major trauma case. Charlotte was too overwhelmed to be useful, so this was down to Harry and Tilly and part of their swift, silent communication was deciding who was going to perform this invasive procedure. In the end, that decision was as much of a no-brainer as having come to assist Harry in the first place because Tilly thought she saw Harry’s confidence falter. Just for a nanosecond, but it was enough.
‘I’ll do it,’ she said.
* * *
Oh, man...
Tilly couldn’t possibly know what was going through Harry’s mind in that instant—a flashback to a scene that had started in an almost identical fashion to this and ended in catastrophe—but she saw enough to take the lead and...and it felt like a lifeline. He could—and would—have stepped up to this challenge with every expectation of success but, for this young girl’s sake, it was much better for it to be done by someone who didn’t have a demon to fight.
He could step back. Not as far as Charlotte had, of course. He could provide the skilled assistance that Tilly needed with drawing up drugs needed and having all the equipment available. He arranged the scalpel, artery forceps, bougie and the endotracheal tube on the sterile drape and made sure he had an ambu bag with an end tidal CO2 detector attached. He helped position Talia by hyperextending her neck when the drugs took effect but he didn’t have the responsibility of identifying exactly where to make that incision through the cricothyroid membrane and then open it, insert a guidewire and then slide the hollow tube over the top to create a patent airway.
He just needed to hold his breath and hope like hell that Tilly really knew what she was doing.
She certainly seemed to. Her focus was intense enough to suggest that failure wasn’t allowed to be an option, the movements of her hands suggested that this wasn’t the first time she’d performed this procedure and within a commendably short space of time the bag mask was attached to the tube and oxygen was flowing to where it needed to go. There was still a lot to do to ensure this patient’s condition was stable but, as Tilly’s gaze snagged on Harry’s as she looked up to check the readings on the monitor, it was an acknowledgment that they were already well on track to a successful outcome in an unexpected crisis. And that they’d done it together, as a team.
He could see something else in her eyes he’d never seen before.
Respect? He knew she’d been impressed at the speed with which he’d managed that tricky IV cannulation but there was an edge of something else in that brush of eye contact and it looked like curiosity. Had she guessed that when a surgical airway had to be done he’d been facing a personal challenge of a scenario he’d never wanted to see repeated? If so, she wasn’t judging him for it but rather wondering what it had been about. Maybe he’d tell her about that case at a more appropriate time.
For now, it was enough to know that that ghost had been laid, so he was unlikely to feel that frisson of doubt that could potentially affect his performance if he was ever faced with this situation again.
Which meant that he was most definitely in Dr Matilda Dawson’s debt.
Big-time.
CHAPTER TWO
THERE WERE TEARS in those big blue eyes.
‘It’s okay.’ Harry handed Charlotte some tissues. ‘It was a pretty confronting situation. You did the right thing by calling for help as fast as you did.’
‘I thought she was going to die. And when you had to cut into her throat like that, I thought I was going to faint...’
‘Getting her airway secured is what saved her life. And she’s doing very well now. She’ll need to be kept under observation for a while but she’ll be absolutely fine and she knows about her allergy now so she’ll be able to wear a medic alert bracelet and it’s very unlikely to happen again.’
Charlotte blew her nose. ‘I’m not sure I’m cut out for nursing.’
‘Give it time,’ Harry advised. ‘It might just be that Emergency isn’t the right fit for you.’ He checked his watch. ‘It’s time for you to go home now, so have a rest and don’t make any big decisions in too much of a hurry.’
Charlotte nodded. ‘Thanks ever so much for this talk. I feel a lot better now.’
Harry got to his feet. ‘Happy to help.’
‘I’d like to say thanks properly.’
‘No need.’ He opened the door of the office but Charlotte didn’t take the hint.
‘What are you doing for Christmas?’ she asked. ‘If you don’t have something planned you’d be very welcome at our place for Christmas dinner. My family would love to meet you.’
‘Ah... I do have something planned,’ Harry lied. ‘I’m heading out of town, in fact. With a...a friend.’
‘Oh...’
Harry saw the moment that this young nurse gave up any hope of catching his interest. He could almost see her catching hold of a new level of maturity instead.
‘I hope you have a wonderful day.’ She was smiling now. ‘I can’t wait. It’s my favourite time of the year.’
Harry headed for the staffroom. A cup of coffee before navigating rush-hour traffic to get home might be a good idea. Traffic that would be far worse than usual on one of the last shopping days before Christmas. It certainly wasn’t his favourite time of the year. When you didn’t have family, the celebration lost any real significance. And when you were somewhere where it was in totally the wrong season it was just...downright unappealing. Frankly, he couldn’t wait until it was over.
With the handover of patients complete, the night shift heading home and the day shift getting into gear, the staffroom was almost empty. The only person there was Tilly, who was holding her phone up to her face as she spoke to someone on a video call.
‘So there’s nothing wrong?’ There was still an anxious note in her voice. ‘You had me so worried when I saw I’d missed those calls.’
With the room being so quiet, it was easy to hear a male voice. ‘No, no, sweetheart. Not at all. I just wanted to know what time to pick you up from the airport tomorrow, that’s all.’
Sweetheart? The Ice Queen had someone in her life who called her sweetheart? Harry was almost shaking his head in disbelief as he headed towards the bench, where a glass jug of filter coffee was staying hot on its element. He was about to walk behind Tilly as she told the man what time her flight was due.
‘Are you sure Harry can’t come too? He’d be more than welcome, you know. He does know how keen I am to meet him, doesn’t he?’
Hearing his name was startling enough to make Harry stop in his tracks and turn his head. He could see a much older man on the screen of Tilly’s phone. A man who seemed to be staring back at him. Grinning.
‘Is this a case of speaking of the devil? Are you Harry?’
‘I am indeed,’ he said. He could feel Tilly flinch. What on earth had she been saying about him to this person?
‘This is my father.’ Tilly sounded as if she was speaking with her jaw muscles tightly clenched. ‘Jim Dawson. Dad...this is Harry Doyle.’
‘Delighted to meet you,’ the man said. ‘And it’s about time.’
