'Which is probably more related to her pain and her alcoholism. Keep her nil by mouth for now and increase her pethidine,' Jeremy said.
Linda pursed her lips. 'Surely we're just replacing one addiction with another. A few sips of water must be better than increasing her pethidine.'
Jeremy picked up the drug chart. 'Mrs Marshall is in pain, and that needs to be addressed. A PRN order of Valium might be wise also, given her withdrawal from alcohol.'
He turned from Linda's angry gaze and addressed the patient.
'Mrs Marshall, we're going to keep you nil by mouth for now. I know you want a drink but it really is safer not to at the moment. We'll increase your pain control and I've written up an order for some Valium which will help you to settle.'
Surprisingly, Mrs Marshall seemed a lot happier with his decision than Linda and leant back resignedly on her pillows.
'A psychiatric and social work referral would also be appropriate,' Jeremy said, handing her folder back to the charge nurse.
'She had all that last time she was in,' Linda said. 'That's why I didn't order the works this time around. She always swears she's going to give up this time, and then back she bounces.'
Jeremy nodded. 'Which, while mildly frustrating for us, must be absolute hell for Mrs Marshall and her family. See she gets the appropriate referrals.'
'Bravo, Jeremy,' Josh whispered, and Alice actually found she felt like cheering herself. Jeremy had certainly put the obnoxious Linda in her place.
'I'm not entirely happy with her.' Jeremy looked over at Alice. 'When we finish up here, can you do some blood gases on Mrs Marshall?'
'Sure.'
'I'll see you both later in pre-op clinic.' With a small nod he walked off, as Linda marched furiously behind him.
'I'll start writing up the notes,, then, while you do the gases,' Josh suggested. 'Then we can grab a coffee.'
'I doubt it,' Alice said with a sigh. 'I've got three IVs to resite and a pile of drug charts that need writing up, and there's a couple of bloods that need doing.'
'Alice, Alice, Alice.' Josh gave her a wide smile. 'You have so much to learn. Fi,' he called to the charge nurse, who came over with a smile, 'this young intern hasn't yet learnt how to ask for favours. Do you think we should teach her?'
Fi smiled warmly at Alice. 'You're not listening to Josh, are you? He'll get you into all sorts of trouble.' Fi had delicate oriental features and a kind smile but, despite her seemingly easygoing nature, Alice knew just from this morning's ward round that Fi ran the ward with impeccable efficiency.
'That's not fair, Fi.' Josh winked at Alice. 'Fi and I worked together when I was a surgical intern,' he explained. 'Now, Fi, tell Alice the truth—didn't I always come at night when you paged me? Didn't I listen to you and call the reg when you were worried? Didn't I always bring doughnuts in?'
Fi nodded. 'And in return I had to do half your bloods and IVs.'
'Cheap at half the price. Come on, Fi, don't say you've gone all hard on me? You're the only reason I came back to this ward.'
Fi laughed. 'All right, I'll help with your bloods, if I get the time. But I'm on nights next week,' she warned, 'and you'd better remember your side of the deal.'
As Josh made his way to do his notes, Fi turned her attention to Alice, who was filling up a kidney dish with blood-gas syringes and alcohol swabs.
'When you've done the blood gases, I'll show you around,' she offered. 'Let you know how Jeremy likes things.'
'Thanks ever so much.'
Fi looked at her thoughtfully for a moment. 'Listen to me for a moment, Alice. I know I always look busy but I've always got time if you need to run something by me. If there's something you're not sure about, you can always come to me.'
Alice nodded. It was a kind offer that a lot of charge nurses made when new interns started and one that was much appreciated. Heaven knew, it was a busy enough job and you needed all the support you could get. But there was something about Fi's offer that sounded ominous, as if she almost expected trouble.
'I'd better get those gases done.'
'I'll get you some ice.'
Although Mrs Marshall was on oxygen, Alice removed the mask before she took the blood gases, as the blood taken while the patient was breathing only air would enable them to get a truer picture of her condition. Although obviously unwell, the increased pain control had already kicked in and she actually seemed in the mood for a chat.
'I'm just going to take a small sample of blood from your wrist, Mrs Marshall, so just hold still while I inject some anaesthetic.'
'No one else has bothered with anaesthetic. How come?'
'Maybe you were too sick and they needed the blood urgently,' Alice suggested diplomatically.
'Maybe they were in too much of a hurry,' the patient said pointedly. 'When are you due?'
'In about three months' time,' Alice muttered reluctantly.
'Your first?'
Alice nodded. She really didn't want to discuss her private life with Mrs Marshall but, as she was increasingly finding out, her obvious condition seemed to be a licence for all and sundry to strike up a conversation about the most personal of subjects.
'Must be hard on your own.' She gestured to Alice's naked ring finger.
Alice concentrated on finding the pulsing artery. 'Hold still, please, Mrs Marshall.'
Thankfully she hit the jackpot first time and the bright red arterial blood spurted up the syringe.
'She got it first go and even gave me an anaesthetic first,' Mrs Marshall said loudly—to whom, Alice had no idea.
'Glad to hear it.'
Alice nearly jumped out of her skin as Jeremy made his way over. 'Let's pop your oxygen back on now.' He replaced the mask over the patient's face.
'I was just saying how hard it must be for the young doctor, being pregnant and on her own.'
Alice wished the ground would open up and swallow her, but she had no choice other than to stand there and press the cotton-wool swab for a full two minutes on the site where she had taken the arterial blood.
'Oh, I don't know,' Jeremy said lightly. 'Solitude has its virtues. I think you can stop pressing now,' he added to Alice.
Mortified, she followed him out of the room.
'Don't tell them so much next time,' Jeremy said, taking her to one side.
Alice, blushing furiously, looked down at her feet. Her tinted moisturiser had gone all blotchy. 'I'm sorry, I know it mustn't look very good—professionally, I mean—what with me being a single mother and all that.'
To her utter amazement Jeremy gave a small laugh. 'We're in the twenty-first century, Alice, for heaven's sake, not the nineteen-fifties. Nobody gives a damn these days about pregnant women being single.'
'Well, I do.' Alice said curtly, though the fact he wasn't bothered by her status was somehow strangely comforting.
'I know,' he said, and Alice looked up, surprised at his perception. 'I could tell Mrs Marshall's probing was making you uncomfortable. Next time tell them your fingers have got too fat to put your rings on, or tell them you don't want to talk about it. Tell them what you like. You're the doctor. It's you holding the consultation, not the other way around.'
'Thanks, I never thought of it like that.'
'You'd better get those blood gases over to ICU.'
Only then did Alice remember the kidney dish she was holding. 'I'll take them down to the lab myself. We're not allowed to use the ICU blood-gas machine for ward patients unless it's a real emergency,' she reminded him.
Jeremy screwed up his nose. 'Since, when?'
'Since for ever—well, at least in the nine months I've been here.'
But Jeremy didn't look convinced. 'I've never had a problem. Maybe it's because I'm consultant,' he said pompously.
Well, you wouldn't have a problem, would you? Alice thought to herself as they entered the intensive care unit. One glimpse of those impossibly blue eyes and a flash of that ready smile and everyone melted. Even Flynn, the gayest of p
orters, smoothed down his hair when Jeremy walked past. They were all so delighted to see him that Alice stood there awkwardly as they chatted away, greeting him like a long-lost friend. Finally Jeremy seemed to remember why they were there:
'I'd better get these bloods done, or we'll have to get a fresh sample.'
Far from the grumbling staff that reluctantly allowed her to do blood gases in only the most dire of emergencies, for Jeremy it seemed it was absolutely no trouble at all. They even offered to run the test for him.
'No, but thanks anyway. I just want to have a quick look at the printout and then hopefully dash off. I'll catch you all later.'
Alice could find neither rhyme nor reason for her indignation as she smeared a drop of blood onto the machine and punched in her request.
'Don't take it personally,' Jeremy said, glancing at her sideways as she glared at the machine. 'They probably let me use the machine because they've got a bit of a soft spot for me. I was a patient here for a while.'
Alice gave a cynical laugh as the printout appeared. The staff might well have a soft spot for Jeremy Foster, but it certainly wasn't all down to the fact he had been a patient here, or even that he was a consultant.
Ripping the result off, she handed it to him.
'Better than I thought. Good. But keep an eye on her, Alice. Given that I've upped her pethidine and prescribed her Valium, her respiration rate could go down. Tell the nurses to do strict one- to two-hourly obs and keep a close eye on her oxygen saturations.'
Alice nodded.
'I'll catch you later, then.'
As he left the tiny annexe, the baby suddenly let out a massive kick. Alice's hands instinctively moved to her stomach and she tenderly massaged it. 'Don't worry, I haven't forgotten you're in there,' she whispered, and watched out of the window as Jeremy made his way down the unit, every nurse in the place turning her head to catch a glimpse as he left. At least she didn't have to worry about Jeremy trying his well-rehearsed lines on her. Just as well really, Alice thought to herself as she made her way back to the ward. With those blue eyes and that sultry smile she doubted whether even she would be able to offer much resistance.
Pre-op clinics always ran overtime and today was no exception, given the fact it was the intern's first day and the consultant had only just returned from sick leave.
It was Alice's job to clerk the patients, which involved taking a full medical history. From there she would order any test she thought necessary prior to the patient's admission, such as ECGs and blood tests. Then the consultant would review the patient and agree or disagree with the intern's suggestions, invariably adding or removing a test. At this point, Jeremy explained, he would like her to be present.
'There's not much point otherwise. At least we can both explain our thought processes behind the pre-op work-ups. The down side is it means we won't be out of here much before six.' He gave her a sideways look. 'Or maybe even seven. Is that a problem?'
Alice shook her head. 'Sounds fine to me.'
And so they battled away. Alice took excellent histories. Somehow she managed to get the patients to open up— maybe because she gave a bit of herself back. But under her steady, unaccusing gaze the 'occasional smoker' would admit to a twenty a day habit and even the 'social drinker' admitted to a few cans mid-week. She took Jeremy's advice, though, and somehow by remembering that it was she that was holding the consultation she managed to avoid some of the more embarrassing questions that, until now, patients had assumed it was their right to ask. Not that she wasn't personable and friendly, but Marcus's rejection and her current circumstances were something Alice was having difficulty dealing with herself without the constant, however well meaning, advice from strangers.
Jeremy, on the other hand, seemed to be taking his own advice to the extreme. He was courteous, friendly even, yet he gave nothing away about himself. Every personal comment, every attempt by a patient to make small talk was immediately and skilfully rebuffed. So skilfully, in fact, that it took Alice the full afternoon to realise he never spoke about himself other than with reference to his work.
Jeremy didn't seem remotely bothered by her apparent slowness. In fact, by the time the last patient had been seen and the clock was edging towards seven, he seemed more than happy to prolong the evening with a chat.
'That's the last, Mr Foster.'
The young nurse popped her head around the door and Alice noticed her looking pointedly at her watch.
'Thanks, Emily, you did a great job today. I'm sorry we've made you so late. And, by the way, it's Jeremy.'
Instantly the bitter expression melted.
'No problem.' Emily paused. 'Jeremy. It's nice to have you back.'
That man could get away with murder, Alice thought. Why, even the most respected consultant wouldn't be left in doubt of the nurse's wrath if he let the clinic run more than two hours over, but for some reason Jeremy could get away with it. The nurses had been just as forgiving as the patients.
'I'd just like to run a couple of things by you before you go,' Jeremy said, interrupting her thoughts.
'OK.' Putting the pile of notes she had completed into the in-tray, Alice took a seat at his desk.
'You're sure?' Jeremy checked. 'You haven't got a babysitter you've got to get back to or anything?'
'I don't have to worry about that for a few months yet.'
'And if Mrs Marshall's observations were correct, I can assume you don't have a husband or partner wanting his dinner on the table?'
Alice swallowed nervously. She had known it would only be a matter of time before he asked. 'Another thing I don't have to worry about.'
'Good.'
Alice looked up sharply. 'Is it?'
Jeremy gave her a brief smile. 'For me it is. Look, Alice, you've heard the gossip. I'm a has-been, I'm coining back too soon, I'm half the surgeon I used to be, and all that.'
Alice flushed. 'I've heard nothing of the sort,' she lied.
'Bull.'
His expletive hit the mark. 'Well, maybe a few remarks,' she admitted. 'But you know what this place is like. Once you've been back for a couple of weeks you'll soon put them right. Anyway,' she added somewhat more forcefully, 'what on earth has any of this to do with my marital status?'
'Everything and nothing. You know how politically correct everything is these days, Alice. Apparently, I'm not supposed to notice the obvious fact that you're pregnant. And even if it's brought to my attention I'm not supposed to let it affect my judgement of you in any way. Even by having this conversation, effectively you could run off to the anti-discrimination council and have me up to my neck in hot water.'
Alice was totally confused. 'Why would I?'
'Because, as I said, your rather large bump supposedly shouldn't affect my judgement of you in the slightest.'
'And does it?' Alice asked boldly.
Jeremy stared at her for an age. Her heavy dark hair was too much for the loose scrunchy she was wearing and was slipping from its grasp, and dark grey eyes were staring up at him as if waiting for his judgement. For a second he lost his train of thought, but only for a second. His eyes flicked downwards again, and came to rest on the soft yet firm swell of her stomach.
'Yes,' he answered simply. 'Yes, it does.'
'But why? Just because I'm pregnant, it doesn't make me any less a doctor.'
Jeremy put his hands up. Tanned, manicured, long-fingered hands, Alice noticed...surgeon's hands. 'I never meant—'
But Alice interrupted him, jumping to her feet. Suddenly she felt threatened. Maybe he was about to say he didn't want her on his team, would never have agreed to it had he been in on the interview. All she knew was that it was imperative he let her stay. 'Being pregnant makes me a better doctor. I now know what it's like to lie on an examining couch and be prodded and poked. I know how it feels to be vulnerable, to be a number in the system.'
'Whoa.' Jeremy gestured for her to sit down.
Furious with herself for reacting so violently, Ali
ce meekly did as she was told. Not trusting herself to speak, she looked up at him.
Jeremy cleared his throat before speaking. 'Firstly, I have absolutely no doubt you're a fine doctor. Your references are exemplary, and from what I've seen today you merit every word that was written. Secondly, I'm sure you really are a better doctor for being on the receiving end of the health system. I know without a shadow of doubt that I am, or at least I hope I will be. Take Mrs Marshall today. Normally I'd have dropped her pethidine down even further, and I'm not proud of that fact. But, having been in pain myself, I now recognise it all the more.' He stopped talking and for a moment Alice thought he had forgotten she was even there.
'And thirdly,' she prompted. 'I assume there's more?'
Jeremy snapped back to attention, a wry smile touching the edge of his lips. 'I'm not an obstetrician, and with good reason.'
Alice's eyebrows shot up in a questioning look.
'Heaven knows, they make enough money.'
'Tell me about it,' Alice grumbled, thinking of the invoice from Brett Halliday sitting in her bedside drawer amongst the other pile of unpaid bills.
'What I'm trying to say,' Jeremy continued, 'albeit not very well, is that pregnant women terrify me.'
Alice started to laugh, then stifled her giggle as she realised he wasn't joking.
'You're not serious?'
Jeremy nodded. 'Deadly serious. I mean, see it from my angle. If I bawl you out, are you going to burst into tears or, worse, will I induce premature labour? If I keep you behind in a clinic or call you into Theatre at midnight, am I going to do irreparable damage to the baby?'
Alice really was laughing now. 'Jeremy, I'm not a doll. I'm not some precious Ming vase that's about to shatter, for heaven's sake. I'm pregnant, that's all. Women have been managing it throughout time, in fact.'
'I know, I know. Look, I'm probably not being fair, landing this lot on you. I know you haven't asked for special favours or anything. It's just that I'm going to be pretty full-on in the ensuing months, far more so than any of the other surgeons, and that means I'm going to be asking a lot from you. I just need to know that you're up to it and if you're not I need you to tell me.'
The Pregnant Intern Page 2
