‘Well, then, I’d better take a look,’ Guy said, taking the card from Madison. ‘Would you mind coming with me? Given that you know her, no doubt you’ll realise, sooner than I, if she’s up to her tricks.’
‘Doctor?’ Alanna was back from her coffee-break, blushing furiously as she looked up at Guy, and Madison was sure it had nothing to do with his seniority and everything to do with six feet three of tousled, rugged sex appeal. ‘Could you, please, write up a new IV order for cubicle eight? The saline’s just about through.’
‘Sure,’ Guy said easily, taking the card, apparently not noticing Alanna’s furious blush. But he was probably used to women being three shades of crimson darker when he was around. In his world, no doubt, it was entirely normal to have women acting like gauche teenagers. The jeans had gone, instead he was dressed today in theatre greens and a pair of sneakers. A stethoscope hung from his neck and a pen was in the V-neck of his top. He pulled out the pen and started writing up the further IV order. His ID badge was clipped to the top pocket and, despite the unflattering lines of the theatre greens, it was evident there was a toned body beneath, a deeply tanned toned body, Madison mentally added, seeing the sun-bleached hairs on his forearms as he filled in the orders and handed the card back to Alanna. ‘I’ll be in to check on him soon. Can you let the patient know that I haven’t forgotten him?’
‘Right.’ He smiled again at Madison. ‘Let’s go and say hi to Judith.’
‘Good morning, Mrs Baker.’ Supremely polite, he entered the cubicle. ‘I hear that you have some stomach pain.’
‘I have,’ Judith sobbed. ‘And no one believes me. For the last four days I’ve been trying to get someone—’
‘Forget about that now,’ Guy cut in, his voice crisp and commanding. ‘Can you tell me when the pain started?’
‘On Saturday,’ Judith replied. ‘I woke up with it.’
‘Any vomiting?’
‘Lots.’
‘OK.’ Guy nodded. ‘And have you had a fever?’ He looked down at the casualty card, which gave Judith’s low temperature reading.
‘I did, I really did, Doctor. I know it isn’t up now but I was shaking and sweating. I took it myself and it was over forty degrees.’
‘How did you get to…?’ He frowned as he picked up one of the medicine bottles, looking at the name of the chemist that had dispensed the drug.
‘Moe,’ Judith answered for him. ‘I asked a friend to drive me and finally we found a doctor’s surgery that had a doctor who would take a look at me, someone who didn’t know who I was. I’d tried to be seen by a few of the local doctors but I’m blacklisted.’
‘Why’s that?’ Guy asked, and Madison could only admire him. Even though she had explained the problem to Guy, he was giving Judith the opportunity to tell her own story. She was pleating the sheet beneath her fingers and Madison watched the tears of pain, frustration and utter humiliation rolling down Judith’s cheeks.
‘Because I make things up.’
‘What sort of things?’ Guy asked, as if it were the most natural question in the world.
‘Illnesses,’ Judith sobbed. ‘I lie so that I can get myself admitted to hospital.’ When Guy didn’t say anything and was clearly waiting for more information, finally Judith elaborated. ‘I’ve had hundreds of tests, loads of operations and none of them were needed.’
‘How did you do that?’ Guy asked. ‘Have you had any medical training?’
‘No.’ Judith shook her head angrily, and for a moment a flash of the old Judith returned, a flash of the manipulative, scheming woman who had graced so many hospital corridors. ‘But I can read and, much to the doctors’ indignation, I’m actually clever. They hate to think that someone without a medical degree might actually know more than them, hate to think that they’ve been fooled—’
‘I’d hate it, too,’ Guy admitted, halting her angry tirade. ‘I’d hate to think I’d put anyone, no matter how much they thought they needed it, through a medical procedure that wasn’t warranted—when clearly they needed a different kind of help.’ He stared directly at her and Madison noted that it was Judith who looked away first. ‘You’ve obviously pretended to have stomach pain before.’
‘But I haven’t done it for ages,’ Judith whispered through chattering teeth.
‘Why not?’
‘Because I didn’t want to live like that any more. I’ve been seeing a psychiatrist. She’s been wonderful, and we’ve been sorting the mess out.’
‘The mess?’ Guy asked.
‘The mess in my head.’ Judith tried to shout, but the pain forced her back on the pillow, sobbing in defeat as she lay there.
‘OK, can you show me where the pain is?’ Guy asked.
Madison lifted Judith’s gown, silently appalled at the numerous scars—a legacy of her disorder.
‘It’s all over,’ Judith gasped as Guy probed her stomach. Taking his stethoscope from around his neck, he listened for a full minute for bowel sounds.
‘Have you taken any medication, apart from these?’ Guy asked, gesturing to the various painkillers that had been found in her bag.
‘Nothing.’ Judith shook her head, but Guy just stared, clearly not convinced. ‘I took some laxatives. I thought if I could go to the toilet, that might help.’
‘OK, let me listen to your chest.’ Gently, with Madison’s help, he leant her forward and listened to her chest. For fifteen minutes he conducted a full and very thorough examination, before finally replacing the blanket and opening one of the silver trolleys in the cubicle to prepare to put in an IV.
‘You won’t be able to do it,’ Judith said, as Guy applied a tourniquet. ‘My veins are all scarred and collapsed because of all the times they’ve been used.’
‘All the unnecessary times,’ Guy corrected her, and Judith nodded pitifully.
‘Normally they call for an anaesthetist or I have to go to Theatre to have a PICC line put in.’
‘Just stay very still,’ Guy said quietly. ‘I think I’ve got one.’
He had!
Madison gave a blink of admiration. She knew only too well that Judith’s veins were almost impossible to gain access to. Years and years of abuse had rendered this simple procedure practically impossible, yet with one attempt Guy had succeeded.
‘Africa.’ He gave a small smile and looked up at Madison. ‘If you can get a needle into a premature, malnourished, collapsed baby, then you can get one into Judith.’
‘Thank you, Doctor.’
‘Don’t thank me yet.’ Guy shook his head. ‘Now, Judith, I’m not going to give you anything for pain—’ As she opened her mouth to protest Guy got there first. ‘It has nothing to do with whether or not I believe you, or punishing you or anything like that at all. The fact is, until we know what’s going on, until the surgeons have seen you…’
‘They won’t look at me,’ Judith said. ‘I can’t take this pain for much longer.’
‘I’m going to send you for an urgent CT scan of your abdomen and I’ll talk to the surgeons myself. In the meantime, we’ll put an NG tube down—that’s a small tube that goes from your nose into your stomach and drains…’ He gave a small shrug. ‘You know what an NG tube is, I’m sure. Now, that might give you some comfort but at the very least it will empty your stomach and stop the nausea. My preliminary diagnosis is an obstruction, probably caused by adhesions.’ His voice was very clear and very firm as he spoke to Judith, refusing for even a second to be pulled into one of her mind games. ‘After even one operation, there is a chance of adhesions. They’re like a spider web of glue in the stomach, and, given the amount of surgery you’ve had in the past, it’s inevitable that there will be a lot of scar tissue and adhesions.’
‘So I really am sick this time.’
‘I think that you are,’ Guy admitted. ‘But possibly, looking at your history, you’re having me on. I’m telling you, Judith, not as a threat, not trying to be unkind—given the amount of surgery you’ve had in the past, you are going to
have a lot of very real health problems in the future with just this type of thing, and you’re going to need serious medical help. So if you’re playing games today, stop it now, tell me now and at least we’ll both know where we stand, because if this is just a need to get admitted to hospital, if this is attention-seeking behaviour, it has to stop right here and now, before I go out on a limb for you.’
Madison watched as he gave Judith a chance to come clean, a chance to back down. Despite Judith’s poor track record, so emphatic were Guy’s words, so utterly direct and to the point, Madison felt that if Judith was lying, if she was playing one of her elaborate games, then Guy had said enough to convince her to stop it right there and then.
‘It isn’t.’
‘OK,’ Guy said. ‘I actually do believe you, Judith. But if I’m proved wrong, next time I’m not going to be so ready to be convinced.’
‘I know that, Doctor.’
‘OK.’ He gave a small nod. ‘I’ll get this blood to the lab and arrange some tests, and I’ll also talk to the surgeons. And I’m going to get Madison to apply a shield to the IV keypad and lock it.’
‘I’m not going to change the dosage,’ Judith said.
‘No doubt you have in the past, though. Judith, I’m going to be completely frank with you and that starts here. I am going to remove the IV trolley so that you can’t take anything, I’m going to lock up the IV pad so that you can’t attempt to alter it and I’m going to ensure that a nurse watches you when we obtain any specimens because even though you may be sick this time, old habits die hard. You’ve been doctor-shopping this week, possibly with good reason, but the simple fact is that you cannot be relied on to tell the truth or to protect yourself from harm, so I’m going to do my best to minimise any temptations. Now, I’m being frank with you and I expect the same in return, OK?’
‘OK.’
‘Now, you’re right, I don’t expect the surgeons to come rushing to see you—they’re up on the ward with a very sick patient at the moment and they’ve got another one that needs to go to Theatre soon—so I’ve decided to give you an anti-emetic and a small dose of morphine just to take the edge off. I won’t give you much, so it will no doubt have worn off by the time you’ve had your CT and then the surgeons can see you and assess you properly.’
‘Thank you.’
‘Do you believe her,’ Guy asked as Madison headed over to the drug cupboard, calling Alanna over as she did so to check the controlled drug with her.
‘Yes,’ Madison admitted. ‘But I’ve believed her on many occasions and been proved wrong. If anything, she’s not as convincing today as she has been in the past. She’s given so many Oscar-winning performances…’
‘Judith Baker!’ Alanna said, rolling her eyes. ‘The hospital is only two days old and already she’s trying it on. Mind you, I’m surprised she wasn’t waiting on the doorstep when we opened yesterday, hoping to convince someone she hadn’t seen before that she was really sick this time.’
‘It looks as if she could be genuinely ill this time,’ Madison said, as Guy picked up the phone to ring the lab, but Alanna just groaned.
‘Last year, at my old hospital, she was rushed to Theatre ahead of a five-year-old with appendicitis, and while she was being operated on, for what turned out to be nothing, the poor kid perforated. It was touch and go—all thanks to Judith.’
‘I know,’ Madison said wearily, pulling out the drugs and checking them with Alanna. ‘But she is still a patient and sadly Judith is her own worst enemy. I’ve warned her over and over that one day she’s desperately going to need help and no one’s going to believe her. I’ve a feeling this time is it.’
As predicted by Guy, the surgeons didn’t exactly drop everything when they were informed that Judith Baker was waiting to be seen. In an unfortunate turn of events, it was the very surgeon who had unwittingly put her ahead of the little boy with appendicitis the previous year who was the surgeon on take that morning. Checking Judith’s obs, Madison didn’t like the picture that was being painted, didn’t like what she was seeing.
‘Get Guy—now,’ Madison called to Alanna, snapping off the gurney brakes with her foot and guiding the trolley out of cubicle two and over to Resus. Thankfully he was in the corridor and already coming over, and from the expression on his face he had clearly been anticipating the sudden commotion.
‘Let’s get her straight over,’ he said, steering the trolley, deftly pulling an oxygen mask from the wall and placing it over Judith’s mouth, even though she was still complaining loudly about the pain she was in.
‘Her temperature and blood pressure have dropped,’ Madison explained, turning on monitors and attaching red dots to her chest, then connecting the leads to them to give a cardiac tracing of her heart. She noted that Judith’s heart rate was extremely rapid.
‘I just came off the phone from the CT department. She’s got a large collection in her abdomen, probably pus. She’s going into septic shock. Alanna, page the surgeons and tell them to get down here now. And while you’re on the phone, page the theatre sister and tell her to expect an urgent laparoscopy.’ His orders were rapid, all delivered as he opened packs, giving out instructions to the gathering staff yet somehow finding the time to reassure Judith.
‘Judith, I need to get some more fluid into you and I don’t hold out much hope of finding another vein quickly so I’m going to put in a central line. Do you know what that is?’
‘A line in my neck.’ Judith’s eyes were wide with fear, her grey face beading with sweat. Perhaps she realised that this time, it really was a genuine medical crisis she was experiencing.
Though Madison didn’t understand her, even if Judith had brought this on herself, that wasn’t the issue. Judith was her patient, desperately ill and terribly scared, and as the team swung into action, Madison took a moment to hold Judith’s hand amidst the controlled chaos and offer some emotional support as Guy laid her flat and started to swab her neck with an iodine solution.
‘You have a nasty pocket of infection in your stomach, so I’m going to get some fluids and antibiotics into you. The surgeons are going to take you to Theatre to drain the infection and find out where it’s coming from.’
‘I’m scared.’Judith’s admission stilled his busy hand for a second, the years of bravado of playing Russian roulette with her life finally catching up with her.
‘I know you are, Judith. But we’re going to sort this out as best we can.’
‘You believe me?’ Judith begged, her greying face flailing on the pillow, a dry tongue licking even drier lips. ‘I really didn’t do it this time. I was working so hard on getting better.’
He nodded, his gloved hand cupping her cheek. ‘You really don’t want to be here, do you?’
‘No!’
‘Hey.’ A smile dusted his lips. ‘Today you might just find out how good we really are.’
‘The nursing supervisor’s on the phone for you, Madison.’ Alanna dashed in and, seeing what Guy was doing, started to open a flask of IV solution to run through the central line. ‘She wants to speak with you.’
‘Tell her I’m busy,’ Madison answered. ‘I’ll call her back when I can.’
‘I’ve got this,’Alanna answered, and though she was trying to be helpful, and Madison knew that the situation was now completely under control, she wanted to stay. Wanted to be looking after her patient, not on the phone with the nursing supervisor, trying to juggle the bed status of the hospital and get patients up to the wards.
‘Alanna?’ Guy said, clearly clueless about the internal struggle taking place in Madison right now. ‘Could you take off Judith’s oxygen for a couple of moments? I want to get some blood gases from her on air.’
‘I’ll do it…’ Madison started, reaching for the oxygen mask, but her hands met Alanna’s at the same time. Jerking her eyes upwards, she saw Guy watching her. A tiny frown crinkled the edges of his eyes, an instinctive understanding connecting them just for a moment.
Sh
e wanted to be nursing—not organising.
Trying to concentrate on paperwork was hell on earth. Despite her closed door, the department buzzed on outside Madison’s office. The loudspeaker paging doctors, the swish of rubber heels running, babies crying, unattended IV machines bleeping. In an effort to help, Madison dragged her paperwork out to the nurses’ station where she could at least take a few essential phone calls and direct the traffic somewhat, but before she knew it, she was giving out medication and handing out bedpans, ringing X-Ray to find out about delays and generally getting into the thick of things.
‘You’ve got to deliver a welcome at orientation day.’ Annie, the ward clerk, breezed in, peeling sheets of paper off a pile and trying to hand them to Madison.
‘Orientation day?’ Madison frowned, barely looking up as she took a student nurse through the rudimentaries of running through the IV that the doctor in cubicle four was shouting for.
‘For the nursing bank,’ Annie patiently explained. ‘Shirley wants a senior staff member from each department to talk to the new bank staff to explain what each unit requires—what we want from the personnel in Emergency to make the department run more smoothly.’
‘I’d settle for just an appearance right now,’ Guy fumed, missing half of the conversation but making his feelings very much known as he punched in the switch-board number. ‘I’m doing this well out of Judith’s earshot—she’s scared enough already, and if you don’t like bad language, ladies, I suggest you leave now. I will not be hung up on or fobbed off again by some adolescent intern, telling me to check my patient’s records.’
‘You’re going to be late,’ Annie warned Madison, completely ignoring Guy, used to doctors blowing off a bit of steam. ‘You’re expected in five minutes.’
‘Is it the orientation day?’ Alanna asked as she breezed into the nurses’ station, handing Guy a printout of Judith’s latest observations as he again attempted to contact the surgeons.
Needed: Full-Time Father (Medical Romance) Page 5
