The Consultant's Special Rescue

Amber had the feeling that he didn’t trust her to assist, and already he was moving away, his mind seemingly elsewhere. Surely she would be able to prove herself to him over the next few hours and days?

She did as he had suggested, going on a quick tour of the department before she started work. She was worried about making a mistake—her nerves were already in shreds—but as the morning wore on, her professional instincts took over.

‘There’s a patient waiting for you in room three,’ Mandy said at one point. ‘Jack Carstairs. He’s complaining of a sudden loss of vision, and the paramedic was querying migraine.’

‘OK, I’ll see to him.’ Amber glanced at the chart Mandy handed to her and then hurried towards the room.

Her patient was a man in his late fifties. ‘Hello, Mr Carstairs,’ she greeted him warmly, trying to put him at ease. It was clear that he was unsettled and anxious. ‘I’m Dr Cavell, and I’m just going to have a quick look at you and see if we can find out what’s causing the trouble. Can you describe the loss of vision to me?’

He answered her questions as best he could, and she made a quick examination, checking his perception of light and his ability to detect hand movement or count the fingers she held up before him. She became increasingly concerned as she went on to examine the affected eye through a slit lamp.

‘There are one or two more things that I want to check, Mr Carstairs,’ she said. ‘I’d like to listen to your heart through my stethoscope to check for any murmurs and so on, and then I want to take some blood from your arm for testing.’

He let her proceed, and when she had finished and sent off the relevant samples to the laboratory, he asked worriedly, ‘Do you know what’s causing the problem?’

‘I can’t say for certain just yet,’ she answered. ‘It will depend on the results of all the tests. I’ve arranged for an ophthalmologist to come and take a look at you.’

‘Am I going to lose my sight permanently?’ It was a blunt question, and Amber thought he deserved an honest answer.

‘I’m not sure,’ she said. ‘It’s possible that you have a blockage in the retinal artery, and the outcome very much depends on how quickly we can move that blockage. We need to find out what’s causing the obstruction in order to be able to treat it.’

‘But you must have some idea?’

‘It’s probable that you suffered an embolism, and that might be because you have a degree of atherosclerosis. We won’t know until the results come back. In the meantime, I’m going to attempt to lessen the pressure within the eye. That’s probably the best way of trying to save your sight.’

He looked frightened, and she did her best to reassure him. ‘I need to massage your eye,’ she told him, ‘because that may dislodge the embolus and allow the eye to recover a little.’

She settled him into a comfortable position and then for a few seconds she applied direct pressure to the globe. Then she released it and repeated the action several times.

There was still no sign of the specialist putting in an appearance, and Amber was beginning to be concerned. ‘There is something else I can try, while we’re waiting for the consultant,’ she told the man. ‘I can draw a little fluid from the eye to move the embolus even further away. It sounds horrible, I know, but don’t worry—I’ll give you a local anaesthetic. Try to relax and I’ll do what I can to save your sight.’ She called for assistance from a nurse, and Chloe came to help.

‘Are you going to use the slit lamp?’ Chloe asked, and Amber nodded. ‘I’ll need a tuberculin syringe and 27-gauge needle.’

Amber worked carefully for some time, and eventually she was relieved that the pressure within the eye had been reduced. She said, ‘All right, Mr Carstairs…that’s all finished now. Just rest for a while, and then I’ll arrange for you to have a magnetic resonance angiogram so that we can see what’s happened to the embolus now.’

He looked anxious and she said, ‘It’s nothing to worry about, I promise, and when we have a clear picture of what we are dealing with, we’ll be able to give you further treatment to dissolve the blockage and to prevent any further damage. It all depends what the specialist decides once he’s looked over your case notes.’

She smiled at him. ‘You’ve been very brave. Take it easy now, and I’ll leave you with the nurse for a while. I’m sure she’ll answer any questions that you have.’

Chloe went to attend to him, and Amber hurried away to chase up the specialist.

‘He’s dealing with another emergency,’ Mandy said. ‘He said he would get down here as soon as he could.’

Amber wasn’t happy about that. In cases like Jack Carstairs’s, she knew that speedy treatment was imperative. A matter of a few hours could make all the difference. She had done what she could to save his sight, but it all depended whether he had been treated early enough.

She laid her stethoscope down on the desk, and began to write up her notes. Perhaps she should enquire into the possibility of Jack being treated with hyperbaric oxygen therapy. At least if she had set the wheels in motion, the treatment would be available if the specialist decided to go ahead. It was a fine line to tread, but she went ahead anyway and organised it.

The last thing she needed was to be taken to task by the ophthalmologist for not acting quickly enough or for taking on too much and impinging on his area of specialisation. She didn’t know what the rules were here, or anything about individual sensitivities, and she didn’t want to tread on any toes, but her patient’s welfare had to come first. If the consultant decided not to go ahead with what she had arranged, nothing had been lost.

She was just signing off on the chart when she felt something tugging at her cotton over-shirt. Looking down, she was startled to see four-year-old Lucy standing by the desk.

‘Do you know where my mummy is?’ the little girl asked.

Amber knelt down beside the child. ‘Hello, Lucy. What are you doing here? Is someone looking after you?’

‘Mrs Denney’s looking after me. She’s over there.’ Lucy pointed to where a woman was in conversation with Mandy. ‘I wasn’t very well,’ Lucy said, ‘and she brought me to see my mummy. Where is she? Do you know?’

‘Yes, she isn’t far away. I’ll go and find her and tell her that you’re here, shall I?’

‘It’s all right. Mandy said she would find her, but she’s talking to Mrs Denney. I want Mummy to come and take me home.’

‘She’ll be here in a minute or so, I expect.’ Amber paused. ‘You said you weren’t feeling very well…what’s the matter? Is there anything I can do to help?’

‘My chest hurts. I want to go home.’

‘Do you think you’ll feel better there?’

Lucy nodded and Amber said cautiously, ‘Does Mrs Denney look after you while your mummy’s working?’

Lucy nodded again. ‘She works in the nursery upstairs.’

‘Oh, I see.’ She looked at Lucy’s pale face. ‘I wonder why your chest’s hurting. Did the smoke upset you the other day? I saw you coughing.’

‘Yes, it did.’ Lucy’s chin jutted. ‘It made me cough and cough and cough, and the man from the ambulance gave me some medicine. It still hurts, though.’

‘Poor you. I expect your mummy will be here soon, and you can tell her all about it.’ She got to her feet and put her hand out to the little girl. ‘Shall we go and talk to Mrs Denney?’

Lucy went with her, and Mrs Denney put an arm around the child’s shoulders. ‘Your mummy’s coming to see you, chick,’ she said. She glanced around, and added, ‘Here she is now, look. Why don’t you go and give her a cuddle?’

The little girl ran off to her mother, and Mrs Denney said, ‘Thanks for bringing her back to me. I was keeping a discreet eye on her, just in case.’

‘Do you think Chloe will take her home?’ Amber asked.

‘I’m not sure. It may be that Lucy just wants a little bit of reassurance, and then she’ll be fine. If that’s the case, I expect they’ll have a few minutes together and then I’ll take her back up to the nursery. Chloe said it’s all right to bring her down here if there’s a problem. It’s better than having the child upset.’

‘It must have been a bit unsettling for her, having to move out of the flat,’ Mandy put in. ‘I expect she’ll be fine in a little while.’ She glanced at Amber. ‘Do you want me to go and take over from Chloe?’

‘That would be good, thank you. I have another patient waiting. Will you let me know when the specialist arrives?’

‘Will do. Leave it with me.’

Amber went to tend to her next patient, a woman suffering from a fractured hand. It was a nasty injury, and Amber took her time checking that blood circulation had not been impeded.

When she had finished, she walked out of the treatment room and straight into her new boss.

‘Sorry,’ she said. ‘I didn’t see you there.’

‘I gathered that,’ he said dryly. ‘It helps if you look around, you know.’

Amber winced. ‘I was thinking about the patient I’ve just attended to. You’re right, though. I’ll look where I’m going next time.’

‘You can come and examine the youth in room two,’ he said, ‘since you’ve finished in there. He’s having some difficulty with his breathing. I’d be interested to see what you make of him.’

Amber followed him to the room. She guessed he was intent on watching her at work, as he was in between patients just now. She might have known he would check up on her.

Going into the room, she greeted the youth. ‘Hello, Sam. I’m Dr Cavell. I understand you are having some problems with your breathing?’

The young man nodded, and she guessed from the way he spoke and outlined his symptoms that he was suffering from asthma. ‘I’ll just listen to your chest, if I may,’ she said. Reaching into her pocket, she searched for her stethoscope. It wasn’t there.

She looked around, a sense of impending doom settling on her.

‘Is anything wrong?’ Nick asked.

‘Uh…no…that is, I seem to have put my stethoscope down somewhere.’ She turned back to the youth. ‘If you will just excuse me for a moment, I’ll go and retrieve it. I’m fairly sure I know where I left it.’

The boy nodded, seeming unfazed by her lapse, but before she left him, Amber placed an oxygen mask over his face. ‘Just breathe in as deeply as you can,’ she said. ‘I’ll leave you with the nurse for a moment.’

She felt like a complete fool, and she daren’t imagine what Nick was thinking. He didn’t say anything aloud, but his expression said it all.

He followed her over to the desk, and watched her scan the surface. ‘Is there a problem?’ he said.

‘Um…well, I know I put it down here,’ she began, looking around, ‘but it doesn’t seem to be here any more.’ She frowned. Where could it be?

‘I’d advise you to keep your equipment close to you,’ he said crisply. ‘I wouldn’t like to think of a patient expiring through lack of attention because you aren’t able to examine him.’ His eyes narrowed on her. ‘Are you sure that you left it here?’

‘Yes, I’m quite sure.’ Her gaze ran over the desk and the assorted clutter. The stethoscope was nowhere to be seen. ‘Perhaps,’ she said weakly, ‘I could borrow one?’

‘Ask the desk clerk to issue you with one from supplies until you retrieve your own,’ he said, his voice curt. ‘But do try not to lose it, won’t you?’

‘I’ll guard it with my life,’ she said.

His brows drew together in a dark line. ‘You know, Amber, I was brought in here by the management because they thought I could do something to improve the star rating of this department. Up to now, I consider that I have been doing a fairly good job. I would hate to think that all my work was going to be for nothing because you have joined my team. Bear in mind that we are already shorthanded because we have lost one of our senior house officers after the fire the other night, and I really need everyone to pull his or her weight.’

She stared at him, her expression stricken. ‘I’ll do my best, I promise,’ she said feebly. From the way he was looking at her, she wouldn’t be at all surprised if he wasn’t thinking that she had been responsible for the fire in the first place.

‘I really do hope that your best is good enough,’ he murmured. He walked away from her and walked towards the treatment room they had just left. Halfway there, he turned, and said, ‘Perhaps when you have found the equipment you need, you would do us the honour of joining us.’

Amber wished that the floor would swallow her up. He had sarcasm off to a fine art, didn’t he? Wasn’t she allowed to make any mistakes?

Mandy approached the desk. ‘I’ve just had word that the ophthalmologist is on his way to see to your patient with the eye problem,’ she said. She glanced at Amber. ‘I couldn’t help hearing some of what Nick was saying.’ She made a faint grimace. ‘You shouldn’t take it to heart, you know. I think he’s a bit under pressure just now, with Rob going off sick because of the burns, and now Chloe’s asked if she could go home with her little girl. He’s usually not too bad to work with.’

Amber made a face. ‘I don’t think I’ve made a very good impression,’ she muttered. ‘I don’t know if he’s going to take to having me around.’

A few minutes later, she picked up a chart and headed towards the treatment room where Jack Carstairs was waiting. With any luck, the specialist would be a bit more amenable than Nick Bradburn.

She wasn’t very hopeful about her future working relationship with her new boss. He was cool and calm and in control, and he exuded authority from every pore, and that was all very well, but she had looked forward to working alongside someone with just a little more give and take.

Right now, it seemed that Nick was on his way to being a faint copy of her father, except that Nick had far more subtlety about him. He was an unknown quantity, but she hoped he would lighten up. She’d had her fill of overbearing, high-handed men.

She wasn’t at all happy about what lay in store.

CHAPTER THREE

‘HAVE you met the new senior house officer?’ Mandy asked a few days later. ‘I must say I didn’t think we would have a replacement for Rob so soon. Nick did well to find him so quickly.’

Amber finished writing out her lab request forms and glanced up at the nurse. ‘You mean Casey? Yes, I met him this morning as I was going for my break, and we shared a table in the cafeteria. He said that he was here as a locum until Rob was well enough to come back to work. I thought he was really nice.’

‘I did, too. He wasn’t too uppity to ask the nurses if he wasn’t sure of anything, and I thought that was really good. Some doctors think it’s beneath them to ask a nurse for advice.’ She had been leaning on the reception desk, but now she straightened, saying quickly, ‘Present company excepted, of course.’

Amber laughed. ‘It’s all right, I know what you meant.’ She put her forms to one side and said, ‘I wonder how it was that he was available at such short notice? Like you say, Nick was lucky to find anyone to fill in.’

‘Casey said that he was in between jobs just now. He’s just finished a stint working with the lifeboat rescue service, stationed just a few miles away from here along the coast, and he wanted a change. He said he was looking to specialise in emergency medicine, but by the time his contract had finished, all the posts had been taken. I think he was really glad to get this job.’ Mandy paused, glancing at her. ‘I’m surprised he didn’t tell you that when you were in the cafeteria together.’

‘Actually, we spent most of the time talking about how he covered for me this morning,’ Amber confessed. ‘I only just made it here on time, and I was praying that Nick hadn’t seen me. I didn’t want him to think that I was completely useless and that I wasn’t ready to plunge straight into work.’

‘What happened?’

‘Some workmen turned up at my house to start renovating my kitchen. I wasn’t expecting them until the end of the week, to be honest, but they had a slot and I didn’t want to turn them away. By the time they’d finished asking me what was what, it meant that I was late leaving home. Then I had to drop the car off for its MOT test, and of course the traffic was bad this morning. I knew I had to get a move on to get here before Nick started wondering where I was.’ She grimaced. ‘I think Casey must have guessed that I wasn’t quite on the ball and he kept Nick talking while I sorted myself out.’

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