Midwives On Call: Stealing The Surgeon's Heart

‘Have you managed to speak to Alyssa alone?’

‘No.’ Ciro shrugged, his shoulders moving just a fraction. ‘Sister…’

‘Harriet,’ she corrected automatically.

‘Harriet, I do not overreact.’ He stared unblinkingly at her. ‘I do not make problems when there are none. I have asked for the most senior nurse to come with me, as I am going to attempt again to examine Alyssa properly, and if the mother again refuses then I am going to have to get…’ Again he paused, again Harriet guessed he was trying to find the right word—only this time she attempted to help him.

‘Heavy?’ Harriet suggested, and from his slightly bemused expression clearly that wasn’t the word he’d been searching for!

‘If the mother doesn’t comply, then the polite requests and friendly small talk ends and I will call the mother into the interview room and tell her that unless the daughter is examined and treated properly tonight, not only will I be consulting with the paediatrician but also the Department of Community Services, because, although it may be unusual circumstances, Alyssa is at risk.’

‘You’ll get heavy!’ Harriet summed up for him with a smile.

‘Very!’ Briefly he smiled back as the alternative meaning of the word dawned on him, but it faded quickly, his voice slightly urgent when he spoke. ‘Harriet, this is not good.’

She believed him.

Despite the fact she hadn’t even observed him with a patient, had only known him for a few moments, Harriet knew, as nurses just did, that this was a voice of experience talking, knew to go along with his hunch in the knowledge it would be reciprocated; that one day when it was Harriet that was concerned, that when everything on paper told her that the patient was fine, she’d be able to turn to him and tell him that today or tonight or whenever the time came to follow a hunch, she was worried about a patient.

And he would listen.

‘Let’s go and get Alyssa examined and speak with Mrs Harrison, shall we?’

‘Are you OK, Harriet?’ He was still frowning. ‘You look a bit…flushed.’

She felt a bit flushed, only, unlike earlier, it had nothing to do with six feet four of Mediterranean hunk and everything to do with her stomach pain which, despite a hot-water bottle and some painkillers, was still making itself known, but she certainly wasn’t about to tell Ciro that.

‘I’m fine.’ Harriet shook her head dismissively, walking briskly towards the cubicles, ignoring the griping pain in her stomach and mentally preparing for the potentially unpleasant task ahead.

But Ciro clearly hadn’t quite finished. One hand caught her arm as she went to go, those observant eyes staring down at her, narrowing slightly as he took in the pale lips in her flushed face and the tiny grimace of pain as she swung around to face him.

‘You are unwell.’ His statement was delivered as fact, his eyes holding hers as Harriet’s mind raced for some witty response, desperate to shrug off his attention. Sympathy was the very last thing she wanted or needed right now if she was going to get through the night but, given that she had no choice but to get through the night, Harriet decided to swallow her pride and ask this relative stranger for a bit of help.

‘I’m feeling a bit nauseous,’ she admitted. ‘Would you mind writing a script for some Maxalon for me?’ She watched as his eyes narrowed slightly. ‘I don’t usually ask things like this, anyone will tell you that, if I could just have something to get rid of the nausea…’

‘Fine.’ He gave a short smile and Harriet gave a relieved one. ‘After I’ve examined you.’

‘Examined me?’ Horrified, her mouth dropped open. ‘I just asked you to write me up for two anti-emetics, Dr Delgato. Most doctors—’

‘Are you saying that doctors here are prepared to prescribe drugs without examining their patients?’ Ciro questioned, his frown deepening.

‘I’m not your patient, Dr Delgato,’ Harriet pointed out. ‘I’m your colleague.’

‘Well, in that case,’ Ciro answered in the same tight vein, ‘the answer is no.’

‘Then we’d better get on with our work,’ she responded tersely, reclaiming her arm from his grip and walking towards the cubicle more determinedly now. ‘If you can give me a couple of minutes alone with her before you come in, I’ll see if I can get Alyssa undressed so that you can examine her.’

‘You won’t get anywhere with the mother,’ Ciro warned.

‘Just watch me.’

Smiling, Harriet breezed into the cubicle, introducing herself to the patient who lay on the trolley. As Ciro had said, she was swathed in legwarmers and a thick cardigan. Her dark hair was drawn back in a small bun and gorgeous velvet-brown eyes, huge in her face, were blinking in confusion as Harriet produced a gown. Without pausing for breath, as if the entire conversation with Ciro hadn’t happened, as if she had no idea that the mother and patient were resisting treatment, Harriet explained in clear terms what was going to happen.

‘Mrs Harrison.’ Smile still in place, Harriet faced the well-groomed, heavily made-up woman. ‘We’re concerned that Alyssa’s heartbeat is rather irregular at times, so I’m just going to pop her into one of our gowns and then the doctor can examine her properly.’

‘No!’ Mrs Harrison’s voice was firm, her bracelets jangling as she went to grab at the gown, rouged lips furious, but Harriet’s smile remained intact. ‘I’ve already been through all this. I want to take my daughter home.’

‘Of course you do,’ Harriet replied sweetly, ‘but it really is imperative that Alyssa be examined thoroughly. Hopefully it’s nothing serious, but, as I’m sure you’ll understand, Mrs Harrison, we can’t just ignore an irregular heartbeat.’

‘As I’ve explained,’ Mrs Harrison snarled, ‘on several occasions, I’d rather my daughter was seen by our family doctor. I’ll take her there first thing tomorrow—’

‘This can’t wait till tomorrow.’ Harriet’s smile was still intact, but the slightly dizzy air to her tone had gone. Her voice was firm, holding the woman’s gaze as she spoke. ‘Your daughter has a cardiac arrhythmia.’ Still she stared directly at Mrs Harrison. ‘It has to be dealt with tonight. I’m going to get Alyssa into a gown and put her onto one of our monitors so we can keep a closer eye on her.’

And something in her unequivocal stance, something in her voice, must have told the woman that this was non-negotiable, and even though Harriet would never have forced Alyssa to undress, she demanded the mother’s co-operation, told her with her eyes that this had to be confronted. Finally, after the longest time, she felt an inward sigh of relief as Mrs Harrison gave a tiny reluctant nod and turned to her daughter.

‘Listen to the sister, Alyssa.’

‘Harriet,’ she offered, her smile softer now, her eyes kind as she approached the young girl. If Alyssa was, as Ciro suspected, suffering from anorexia nervosa then being undressed and exposed would be traumatic for her, and Harriet was determined to make the entire procedure as gentle and as unintrusive as possible, covering the young girl with a blanket as she helped her out of her clothes. Harriet had to keep her own emotions firmly in check as she briefly witnessed the stick-thin limbs. She talked in gentle soothing tones as she gently leant her patient forward to tie up the gown and even though there hadn’t been much room for doubt, any that might have lingered was quashed as she saw the length of Alyssa’s spinal column, vertebrae protruding, dry, flaky skin hanging off. Glancing up at Mrs Harrison, Harriet saw a flash of shock on the woman’s face but she didn’t comment.

Now wasn’t the time.

‘Well done,’ Harriet reassured the girl. ‘Now, these sticky things just go onto your chest, and it lets us keep an eye on your heartbeat.’ Placing the dots and leads on Alyssa’s frail chest, Harriet quickly covered her back up, before turning on the cardiac monitor. As Ciro made his way in he gave Harriet a brief appreciative nod when he saw that the family was now being more co-operative.

‘Alyssa, Mrs Harrison.’ Ciro smiled warmly. ‘I know you are both keen to go home, but first we need to ensure that Alyssa is well enough. Now, I know you’ve already been through this, but, given the doctor that first treated you has gone home now, can you tell me again what happened this evening when you cut your head?’

‘I was at rehearsal—we’ve got the first performance next Saturday.’ It was the first time Harriet had heard Alyssa speak, her voice, small and breathless, almost drowned out by the busy background noise of the emergency department.

‘She’s the lead,’ Mrs Harrison explained. ‘That’s why I want to get her home. She needs her sleep so she can practise tomorrow. It’s a very demanding role—’

‘Alyssa,’ Ciro broke in, ‘why did you fall?’

‘She landed awkwardly…’ Mrs Harrison started, but her voice trailed away as Ciro and Harriet both looked at Alyssa for the answer.

‘I was halfway through my routine and I just got a bit dizzy. It only lasted a second, but I was in the middle of a jump, so I fell awkwardly.’

‘How often do you get dizzy?’ Ciro asked, and Harriet could only admire his questioning, assuming, as was probably rightly so, that this was probably fairly normal for Alyssa.

‘A bit…’ She gave a tiny shrug.

‘OK.’ Ciro nodded. ‘Alyssa, I’m going to examine you, it’s nothing to worry about, and then I’m going to take some blood from you. Harriet has put you onto one of our heart monitors so that we can see what your heartbeat is doing and maybe find out why you’ve been getting dizzy.’

Infinitely reassuring, still he was commanding, his voice firm but somehow soothing. His hands were gentle as he first pulled down Alyssa’s lower eyelids, examining the conjunctiva, then her hands and nail beds. Lifting the blanket and checking her reflexes, his middle finger probed the swollen ankles that looked out of place on such thin legs.

‘You have some fluid retention. Does this happen often?’

‘Sometimes,’ Alyssa answered, ‘but Mum gives me—’

‘Just some vitamins,’ Mrs Harrison said quickly. ‘I get them at the chemist.’

‘OK.’ Ciro didn’t push for any further details, acted as if the information barely merited a comment, but Harriet knew, just knew, it had been noted, but that for now he was focussed on the important task of gaining Alyssa’s trust.

He listened to her chest, warming the stethoscope in his palms first, all the while keeping as much of Alyssa covered as possible. When he’d finished listening he probed her abdomen for a moment before replacing the blanket.

‘Thank you, Alyssa. I know that wasn’t pleasant for you, but it was necessary. I’m going to take some blood now. I’m going to insert a small cannula and leave it there, but from that I can take blood, and if we need to give you any fluids or medication we can do it all through there, so at least you’ll only get one needle. I’ll try not to hurt you.’

He didn’t. Slipping the needle in neatly, he collected several vials of blood before unclipping the tourniquet and flushing the bung to keep it patent with the heparin flush Harriet had pulled up. Only when the blood had been taken, when the IV was in and Alyssa attached to a monitor did he approach the most difficult part of the whole subject. ‘How much do you weigh, Alyssa?’

‘I’m not sure…’

‘Would you get the scales?’ Ciro asked Harriet.

‘Alyssa knows her weight,’ Harriet responded without looking up at him, keeping her eyes on Alyssa. It would be easy to go and get the scales, but Harriet also knew that the delay and interruption could ruin the relatively compliant mood that they had somehow managed to foster, and it would be far better to forge ahead while the going was good. So instead she broached her patient, knowing, somehow knowing, this was what Ciro wanted her to do. Effective interview skills in Emergency required as much teamwork and synchrony as a surgeon and scrub nurse required, and with some doctors it took for ever—if ever—to perfect, yet with Ciro they fell into it easily, Harriet handing him the metaphoric scalpel without him needing to ask for it. ‘How much do you weigh, Alyssa?’

‘Forty kilos.’ When still Harriet held her gaze, she answered again. ‘Thirty-eight and a half.’

Deliberately Harriet didn’t flinch and she was thankful that, when Ciro spoke, his voice was matter-of-fact.

‘We’ll need to check it before we give any medication,’ he said, more to Harriet, ‘but whatever way you look at it, this is very underweight.’

‘She’s a ballet dancer.’ Mrs Harrison’s voice was terse. ‘She has to watch her weight.’

‘Of course.’ Ciro nodded, smiling at the agitated woman. ‘But Alyssa is extremely underweight. I’m going to run some tests and then I’ll ask one of my colleagues to come down.’

‘And how long is that going to take?’

‘It might take a while,’ Ciro admitted, ‘but I will tell you that it is my belief that Alyssa needs to be admitted—’

‘No!’ Furiously Mrs Harrison shook her head. ‘This can all wait.’

‘I’m afraid not.’ Ciro shook his head. ‘Look, I understand—’

‘No, Doctor, clearly you don’t!’ Mrs Harrison angrily interrupted. ‘My daughter is dancing next week in a role that could see her getting into the most elite dancing school in Australia. She has to rehearse, she has to—’

‘Perhaps we could talk outside,’ Harriet suggested, anxious to move what could be a very emotional discussion well away from Alyssa’s bedside, but Mrs Harrison wasn’t going anywhere.

‘Perhaps we can’t!’ she smartly retorted, and Harriet knew that for now the conversation was over. ‘I’ll wait for those blood results, and then I’m taking my daughter home.’

‘Thank you for your help in there.’ Ciro caught up with Harriet at the nurses’ station as Harriet attempted to put to paper what had just taken place, knowing that a detailed record, though always required, was especially important in cases such as this, so that the staff that were involved later knew exactly what had been broached and what the response had been. ‘You were very good with Alyssa, the mother, too. It looked as if you actually knew what you were doing.’ He smiled as she frowned. ‘That came out wrong, forgive me. What I am trying to say is that you—’

‘I worked on an adolescent psychiatric unit when I did my training,’ Harriet explained, realising that no offence had been meant. ‘I really enjoyed it. For a while there I even thought of…’ Her voice trailed off, long-forgotten dreams briefly surfacing as she remembered the thrill of excitement at being accepted to study psychology and the thud of disappointment when her fledgling plans had been effectively doused. A part-time nursing wage, while she’d studied at uni, had been nowhere near enough to cover a very part-time actor, whose dreams had always somehow been more important than her own. But this was neither the time nor place for what could have been and, quashing memories, she concentrated instead on the matter in hand. ‘Mrs Harrison was shocked when she first saw Alyssa undressed,’ Harriet said. ‘I don’t think she knew, until then, just how thin her daughter was.’

‘Because she doesn’t want to know,’ Ciro responded. ‘At least, not until the concert is over and Alyssa has her scholarship. She wants her daughter to get into this dance school—that is her sole focus.’

‘I think you’re being a bit harsh.’ Harriet frowned, but Ciro stood unmoved.

‘I have worked with many athletes, and with their parents, too. Believe me, Mrs Harrison doesn’t want to hear anything that might compromise her daughter’s chances of performing next week, whatever the cost.’

His arrogant assumption annoyed her, and Harriet let it show, her forehead puckering into a frown, her mouth opening to speak, but Ciro got there first.

‘I don’t want them to leave the department.’

‘We can’t force them to stay—’ Harriet started, but Ciro halted her with a stern gaze, his voice clipped when he spoke.

‘I was not exaggerating earlier, Harriet. I will call Community Services if I have to. If Alyssa goes home, I can guarantee she will be back at the bar first thing tomorrow, rehearsing for her performance. And, from my clinical examination, it is my belief that that child is in danger of collapse and possibly sudden death if she exerts herself.

‘So, I repeat—I do not want her leaving this department!’

As Ciro called over the porter and handed him the bloods to take directly to Pathology, Harriet stood stock-still at the desk, pen poised over the notes she was writing, her eyes shuttered for a moment. It wasn’t Ciro’s ominous warning that caused her eyes to close in horror, but the use of the word ‘child’.

They were talking about a fifteen-year-old child, and she mustn’t lose sight of that fact. It was their duty to protect her, especially if Ciro’s educated hunch proved to be correct.

‘What was all that about?’ Charlotte nudged her, putting a massive pile of drug charts in front of Harriet that needed to be checked.

‘The patient in cubicle four,’ Harriet murmured, her mind ticking over. ‘Alyssa Harrison…’

‘The head injury that’s here with her mother?’ Charlotte checked. ‘I thought she was being discharged.’

‘Not any more. Ciro doesn’t want her to leave the department. I’m going to ask Security to keep an eye on them.’

‘But what if the mother wants to take her?’

‘Then a simple head injury will become incredibly complicated.’ Harriet gave a thin smile. ‘Let’s hope it doesn’t come to that. For now just keep an eye open and let me know straight away if they show signs of leaving.’ The emergency phone trilling loudly interrupted the conversation and had Charlotte practically dancing on the spot with anticipation. When the red phone rang, everything stopped! A direct line to Ambulance Control, it was used to warn the staff about any serious emergencies they could expect, and sometimes, if the situation merited it, an emergency squad of nurses and a doctor would be sent out.

Harriet answered the telephone calmly, listening patiently to Ambulance Control and shaking her head as Susan came over swiftly, with Ciro following closely behind, clearly wanting to find out what was coming in, or whether the squad needed to go out.

‘Just a plane about to land with one engine,’ Harriet said easily, and Susan gave a dismissive shrug, before wandering off. Even the easily excited Charlotte managed a rather bored rolling of her eyes and went off to answer a call bell.

Only Ciro remained, his expressive face clearly appalled at the news.

‘One engine!’

‘Yep,’ Harriet answered. ‘I’ll just let the nursing coordinator know.’

‘And then what?’

‘Sorry?’

‘Then what?’ Ciro barked, clearly frustrated by her obvious lack of urgency. ‘Am I to go out to the airport? Should we start moving patients out of the department?’

‘Ciro…’ Putting up her hand, Harriet stopped him. ‘It’s no big deal.’

‘Tell that to the poor souls flying thirty thousand feet in the air,’ he started, and somewhere deep inside, something flared in Harriet—a twitch of a smile on her lips, a small gurgle of laughter building within, a tiny flash of mischievousness at the realisation that she could prolong his agony, a glimpse of the old Harriet, the old, fun-loving Harriet, that seemed to have been left behind somehow. Ciro responded to it.

‘What?’ His lips were reluctantly twitching into a smile, too. ‘What is so funny? I am overreacting, no?’

‘Yes.’ Harried grinned. ‘You obviously haven’t worked in an emergency department that covers an international airport before.’

‘No.’

‘Those poor souls won’t even know there’s a potential problem. This type of thing happens all the time. Ambulance Control alerts us as a courtesy, to be ready in case…’

‘Then shouldn’t we be doing something, getting ready?’

‘Ciro, we are ready,’ Harriet answered. ‘The mobile emergency equipment was all checked at the beginning of the shift, we’ve got a major disaster procedure plan in place, ready to be implemented at any given moment. This is a fairly regular occurrence. Planes can and do land perfectly well with one engine. However, as a precaution, the airport emergency crews will all be ready to meet the plane and if, if, a disaster were to eventuate, we’d commence the major incident plan. But for now it’s way too soon to do anything.’ He didn’t look particularly convinced. ‘Ciro, if they had rung to say a plane was going to land with no engines, we’d be moving. This time next month you’ll barely turn a hair at the news. They’ll ring soon to say it’s landed safely.’

He gave a relieved nod and she should have left it there, should have ended it with a swift smile and got straight back to work, but she didn’t.

‘Unless, of course, the wheels get stuck in the undercarriage.’

‘Now you are teasing.’

‘Yes.’ Harriet smiled, but somewhere in mid-smile it wavered, somewhere in mid-conversation the witty responses ended and all she could do was stare. Stare back at those mocha eyes that held hers, stare at that full, sensual mouth. He smiled back at her and the terrible realisation hit that she was flirting.

Oh, not licking her lips and hand on hips flirting, but there was a dangerous undercurrent that was pulling her. A rip in the ocean that was slowly but surely dragging her in, this seemingly light conversation peppered with dangerous undertones. Surely, surely she shouldn’t be noticing the tiny golden flecks that lightened those velvet eyes, surely she should no more than vaguely register the heavy, masculine scent of him. But instead it permeated her.

Harriet could feel her own pulse flickering in her throat and from the tiny dart of his eyes Ciro registered it too, and for a slice of time the department faded into insignificance, for a second it was only the two of them, not two colleagues sharing a light-hearted joke, but instead a man and a woman partaking in that primitive, almost indefinable ritual. A ritual that somehow acknowledged mutual attraction, that managed, without words, to voice a thousand questions. Never had she been more grateful for the sharp trill of the emergency phone ringing, dragging her back to reality, a mental slap to her flushed cheeks, a chance to regroup, to pull back, a chance to stop something that must never, ever be started.

‘It landed.’ Her voice was high and slightly breathless as she replaced the receiver, taking great pains to calmly log the call in the book, anything other than look at him. ‘Safely.’

‘I told you it would!’ Blinking in confusion, she dragged her eyes to his, smiling despite herself when he gave a nonchalant shrug and somehow turned the previous few minutes on their head. ‘Didn’t I try and tell you that you were overreacting, Sister?’

One good thing about being busy was that the hours went by quickly. Ciro, clearly used to dealing with a full department, worked his way expertly through the patients. Harriet guessed that once he didn’t have to pause to look up every last phone number and find out where every blessed form was kept to order various tests, he’d be an absolute dream to work with—so long as you followed his rules!

‘Look at you, Harriet!’ Charlotte’s voice was almost a screech. ‘You’re in the newspaper! Why didn’t you say?’

Mortified, clutching a telephone receiver in one hand, with the other Harriet reached out to grab the paper, but Charlotte was having none of it. At twenty-one she was a huge fan of Drew’s and never missed an opportunity to talk about him.

‘I just saw one of the patients reading it! I told them that you worked here so they let me have the paper—Oh, Harriet, you look gorgeous!’

‘I look huge,’ Harriet corrected, refusing to even glance at the beastly photo of her on the red carpet at the acting awards ceremony that had been held the previous night.

‘Any results back on Alyssa?’ Ciro asked as he came over. ‘The medics are waiting to see her, but I want some more information before I speak with the mother again and tell her that we’re keeping her in.’

‘I’m still on hold.’ Harriet didn’t even look at him, couldn’t actually! She was concentrating too hard on breathing, tiny white spots dancing in front of her eyes, sweat beading on her forehead as great waves of nausea rolled over her. And Charlotte’s incessant voice wasn’t exactly helping matters.